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Al-Osaimi HM, Kanan M, Marghlani L, Al-Rowaili B, Albalawi R, Saad A, Alasmari S, Althobaiti K, Alhulaili Z, Alanzi A, Alqarni R, Alsofiyani R, Shrwani R. A systematic review on malaria and dengue vaccines for the effective management of these mosquito borne diseases: Improving public health. Hum Vaccin Immunother 2024; 20:2337985. [PMID: 38602074 PMCID: PMC11017952 DOI: 10.1080/21645515.2024.2337985] [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: 02/17/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Insect vector-borne diseases (VBDs) pose significant global health challenges, particularly in tropical and subtropical regions. The WHO has launched the "Global Vector Control Response (GVCR) 2017-2030" to address these diseases, emphasizing a comprehensive approach to vector control. This systematic review investigates the potential of malaria and dengue vaccines in controlling mosquito-borne VBDs, aiming to alleviate disease burdens and enhance public health. Following PRISMA 2020 guidelines, the review incorporated 39 new studies out of 934 identified records. It encompasses various studies assessing malaria and dengue vaccines, emphasizing the significance of vaccination as a preventive measure. The findings indicate variations in vaccine efficacy, duration of protection, and safety considerations for each disease, influencing public health strategies. The review underscores the urgent need for vaccines to combat the increasing burden of VBDs like malaria and dengue, advocating for ongoing research and investment in vaccine development.
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Affiliation(s)
- Hind M. Al-Osaimi
- Department of Pharmacy Services Administration, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Lujain Marghlani
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Badria Al-Rowaili
- Pharmaceutical Services Department, Northern Area Armed Forces Hospital, King Khalid Military, Hafr Al Batin, Kingdom of Saudi Arabia
| | - Reem Albalawi
- Department of Medicine, Tabuk University, Tabuk, Kingdom of Saudi Arabia
| | - Abrar Saad
- Pharmacy Department, Royal Commission Hospital, Yanbu, Kingdom of Saudi Arabia
| | - Saba Alasmari
- Department of Clinical Pharmacy, King Khalid University, Jeddah, Kingdom of Saudi Arabia
| | - Khaled Althobaiti
- Department of Medicine, Taif University, Ta’if, Kingdom of Saudi Arabia
| | - Zainab Alhulaili
- Department of Clinical Pharmacy, Dammam Medical Complex, Dammam, Kingdom of Saudi Arabia
| | - Abeer Alanzi
- Department of Medicine, King Abdulaziz Hospital, Makkah, Kingdom of Saudi Arabia
| | - Rawan Alqarni
- Department of Medicine and Surgery, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Razan Alsofiyani
- Department of Medicine, Taif University, Ta’if, Kingdom of Saudi Arabia
| | - Reem Shrwani
- Department of Clinical Pharmacy, Jazan University, Jazan, Kingdom of Saudi Arabia
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2
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Cheung YB, Ma X, Lam KF, Yung CF, Milligan P. Estimation of trajectory of protective efficacy in infectious disease prevention trials using recurrent event times. Stat Med 2024; 43:1759-1773. [PMID: 38396234 DOI: 10.1002/sim.10049] [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: 08/23/2023] [Revised: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
In studies of infectious disease prevention, the level of protective efficacy of medicinal products such as vaccines and prophylactic drugs tends to vary over time. Many products require administration of multiple doses at scheduled times, as opposed to one-off or continual intervention. Accurate information on the trajectory of the level of protective efficacy over time facilitates informed clinical recommendations and implementation strategies, for example, with respect to the timing of administration of the doses. Based on concepts from pharmacokinetic and pharmacodynamic modeling, we propose a non-linear function for modeling the trajectory after each dose. The cumulative effect of multiple doses of the products is captured by an additive series of the function. The model has the advantages of parsimony and interpretability, while remaining flexible in capturing features of the trajectories. We incorporate this series into the Andersen-Gill model for analysis of recurrent event time data and compare it with alternative parametric and non-parametric functions. We use data on clinical malaria disease episodes from a trial of four doses of an anti-malarial drug combination for chemoprevention to illustrate, and evaluate the performance of the methods using simulation. The proposed method out-performed the alternatives in the analysis of real data in terms of Akaike and Bayesian Information Criterion. It also accurately captured the features of the protective efficacy trajectory such as the area under curve in simulations. The proposed method has strong potential to enhance the evaluation of disease prevention measures and improve their implementation strategies.
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Affiliation(s)
- Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Xiangmei Ma
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - K F Lam
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Department of Statistics and Actuarial Science, University of Hong Kong, Hong Kong, China
| | - Chee Fu Yung
- Infectious Disease Service, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Academic Medicine Department, Duke-NUS Medical School, Singapore, Singapore
| | - Paul Milligan
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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3
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Dobbs KR, Atieli HE, Valim C, Beeson JG. Previous Malaria Exposures and Immune Dysregulation: Developing Strategies To Improve Malaria Vaccine Efficacy in Young Children. Am J Trop Med Hyg 2024; 110:627-630. [PMID: 38442424 PMCID: PMC10993830 DOI: 10.4269/ajtmh.23-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/06/2023] [Indexed: 03/07/2024] Open
Abstract
After several decades in development, two malaria vaccines based on the same antigen and with very similar constructs and adjuvants, RTS,S/AS01 (RTS,S) and R21/Matrix-M (R21), were recommended by the WHO for widespread vaccination of children. These vaccines are much-needed additions to malaria control programs that, when used in conjunction with other control measures, will help to accelerate reductions in malaria morbidity and mortality. Although R21 is not yet available, RTS,S is currently being integrated into routine vaccine schedules in some areas. However, the efficacy of RTS,S is partial, short-lived, and varies widely according to age and geographic location. It is not clear why RTS,S induces protection in some individuals and not others, what the immune mechanisms are that favor protective immunity with RTS,S, and how immune mechanisms are influenced by host and environmental factors. Several studies suggest that higher levels of previous malaria exposure negatively impact RTS,S clinical efficacy. In this article, we summarize data suggesting that previous malaria exposures negatively impact the efficacy of RTS,S and other malaria vaccine candidates. We highlight recent evidence suggesting that increasing malaria exposure impairs the generation of functional antibody responses to RTS,S. Finally, we discuss how investigation of clinical and immune factors associated with suboptimal responses to RTS,S can be used to develop strategies to optimize RTS,S, which will remain relevant to R21 and next-generation vaccines.
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Affiliation(s)
| | | | - Clarissa Valim
- Boston University School of Public Health, Boston, Massachusetts
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4
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Powell TJ, Tang J, Mitchell R, DeRome ME, Jacobs A, Palath N, Cardenas E, Yorke M, Boyd JG, Kaba SA, Nardin E. Immunogenicity, Efficacy, and Safety of a Novel Synthetic Microparticle Pre-Erythrocytic Malaria Vaccine in Multiple Host Species. Vaccines (Basel) 2023; 11:1789. [PMID: 38140193 PMCID: PMC10748200 DOI: 10.3390/vaccines11121789] [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: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
We previously reported a protective antibody response in mice immunized with synthetic microparticle vaccines made using layer-by-layer fabrication (LbL-MP) and containing the conserved T1BT* epitopes from the P. falciparum circumsporozoite protein. To further optimize the vaccine candidate, a benchtop tangential flow filtration method (LbL-by-TFF) was developed and utilized to produce vaccine candidates that differed in the status of base layer crosslinking, inclusion of a TLR2 ligand in the antigenic peptide, and substitution of serine or alanine for an unpaired cysteine residue in the T* epitope. Studies in mice revealed consistent superiority of the Pam3Cys-modified candidates and a modest benefit of base layer crosslinking, as evidenced by higher and more persistent antibody titers (up to 18 months post-immunization), a qualitative improvement of T-cell responses toward a Th1 phenotype, and greater protection from live parasite challenges compared to the unmodified prototype candidate. Immunogenicity was also tested in a non-human primate model, the rhesus macaque. Base layer-crosslinked LbL-MP loaded with T1BT* peptide with or without covalently linked Pam3Cys elicited T1B-specific antibody responses and T1BT*-specific T-cell responses dominated by IFNγ secretion with lower levels of IL-5 secretion. The Pam3Cys-modified construct was more potent, generating antibody responses that neutralized wild-type P. falciparum in an in vitro hepatocyte invasion assay. IgG purified from individual macaques immunized with Pam3Cys.T1BT* LbL-MP protected naïve mice from challenges with transgenic P. berghei sporozoites that expressed the full-length PfCS protein, with 50-88% of passively immunized mice parasite-free for ≥15 days. Substitution of serine for an unpaired cysteine in the T* region of the T1BT* subunit did not adversely impact immune potency in the mouse while simplifying the manufacture of the antigenic peptide. In a Good Laboratory Practices compliant rabbit toxicology study, the base layer-crosslinked, Pam3Cys-modified, serine-substituted candidate was shown to be safe and immunogenic, eliciting parasite-neutralizing antibody responses and establishing the dose/route/regimen for a clinical evaluation of this novel synthetic microparticle pre-erythrocytic malaria vaccine candidate.
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Affiliation(s)
- Thomas J. Powell
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - Jie Tang
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - Robert Mitchell
- Department of Microbiology, School of Medicine, New York University, New York, NY 10010, USA; (R.M.); (E.N.)
| | - Mary E. DeRome
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
- Multiple Myeloma Research Foundation, 383 Main Avenue, 5th Floor, Norwalk, CT 06851, USA
| | - Andrea Jacobs
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - Naveen Palath
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
- Pfizer, Inc., Andover, MA 01810, USA
| | - Edwin Cardenas
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - Michelle Yorke
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - James G. Boyd
- Artificial Cell Technologies, Inc., 5 Science Park, Suite 13, New Haven, CT 06511, USA; (J.T.); (M.E.D.); (A.J.); (N.P.); (E.C.); (M.Y.); (J.G.B.)
| | - Stephen A. Kaba
- Malaria Vaccine Branch, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA;
- GreenLight Biosciences, Inc., Lexington, MA 02421, USA
| | - Elizabeth Nardin
- Department of Microbiology, School of Medicine, New York University, New York, NY 10010, USA; (R.M.); (E.N.)
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Furtado R, Paul M, Zhang J, Sung J, Karell P, Kim RS, Caillat-Zucman S, Liang L, Felgner P, Bauleni A, Gama S, Buchwald A, Taylor T, Seydel K, Laufer M, Delahaye F, Daily JP, Lauvau G. Cytolytic circumsporozoite-specific memory CD4 + T cell clones are expanded during Plasmodium falciparum infection. Nat Commun 2023; 14:7726. [PMID: 38001069 PMCID: PMC10673885 DOI: 10.1038/s41467-023-43376-y] [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: 08/02/2021] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Clinical immunity against Plasmodium falciparum infection develops in residents of malaria endemic regions, manifesting in reduced clinical symptoms during infection and in protection against severe disease but the mechanisms are not fully understood. Here, we compare the cellular and humoral immune response of clinically immune (0-1 episode over 18 months) and susceptible (at least 3 episodes) during a mild episode of Pf malaria infection in a malaria endemic region of Malawi, by analysing peripheral blood samples using high dimensional mass cytometry (CyTOF), spectral flow cytometry and single-cell transcriptomic analyses. In the clinically immune, we find increased proportions of circulating follicular helper T cells and classical monocytes, while the humoral immune response shows characteristic age-related differences in the protected. Presence of memory CD4+ T cell clones with a strong cytolytic ZEB2+ T helper 1 effector signature, sharing identical T cell receptor clonotypes and recognizing the Pf-derived circumsporozoite protein (CSP) antigen are found in the blood of the Pf-infected participants gaining protection. Moreover, in clinically protected participants, ZEB2+ memory CD4+ T cells express lower level of inhibitory and chemotactic receptors. We thus propose that clonally expanded ZEB2+ CSP-specific cytolytic memory CD4+ Th1 cells may contribute to clinical immunity against the sporozoite and liver-stage Pf malaria.
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Affiliation(s)
- Raquel Furtado
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
- RF: BioNTech US, 40 Erie Street, Cambridge, MA, 02139, USA
| | - Mahinder Paul
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Jinghang Zhang
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Joowhan Sung
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Paul Karell
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Sophie Caillat-Zucman
- Université de Paris, AP-HP, Hôpital Saint-Louis, Laboratoire d'Immunologie et Histocompatiblité, INSERM UMR976, 75010, Paris, France
| | - Li Liang
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Philip Felgner
- Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Andy Bauleni
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Syze Gama
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andrea Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Terrie Taylor
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, MI, 48824, USA
| | - Karl Seydel
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, MI, 48824, USA
| | - Miriam Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Fabien Delahaye
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, 10461, USA
- FD: Precision Oncology, Sanofi, Vitry sur Seine, France
| | - Johanna P Daily
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
| | - Grégoire Lauvau
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
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6
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Abstract
Malaria is a mosquito-borne disease caused by protozoan parasites of the genus Plasmodium. Despite significant declines in malaria-attributable morbidity and mortality over the last two decades, it remains a major public health burden in many countries. This underscores the critical need for improved strategies to prevent, treat and control malaria if we are to ultimately progress towards the eradication of this disease. Ideally, this will include the development and deployment of a highly effective malaria vaccine that is able to induce long-lasting protective immunity. There are many malaria vaccine candidates in development, with more than a dozen of these in clinical development. RTS,S/AS01 (also known as Mosquirix) is the most advanced malaria vaccine and was shown to have modest efficacy against clinical malaria in phase III trials in 5- to 17-month-old infants. Following pilot implementation trials, the World Health Organisation has recommended it for use in Africa in young children who are most at risk of infection with P. falciparum, the deadliest of the human malaria parasites. It is well recognised that more effective malaria vaccines are needed. In this review, we discuss malaria vaccine candidates that have progressed into clinical evaluation and highlight the most advanced candidates: Sanaria's irradiated sporozoite vaccine (PfSPZ Vaccine), the chemoattenuated sporozoite vaccine (PfSPZ-CVac), RTS,S/AS01 and the novel malaria vaccine candidate, R21, which displayed promising, high-level efficacy in a recent small phase IIb trial in Africa.
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Affiliation(s)
- Danielle I Stanisic
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
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Bell GJ, Gyaase S, Goel V, Adu B, Mensah B, Essone P, Dosoo D, Osei M, Niare K, Wiru K, Brandt K, Emch M, Ghansah A, Asante KP, Mvalo T, Agnandji ST, Juliano JJ, Bailey JA. Background malaria incidence and parasitemia during the three-dose RTS,S/AS01 vaccination series do not reduce magnitude of antibody response nor efficacy against the first case of malaria. BMC Infect Dis 2023; 23:716. [PMID: 37872492 PMCID: PMC10594884 DOI: 10.1186/s12879-023-08699-7] [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: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND RTS,S/AS01 has been recommended by WHO for widespread implementation in medium to high malaria transmission settings. Previous analyses have noted lower vaccine efficacies in higher transmission settings, possibly due to the more rapid development of naturally acquired immunity in the control group. METHODS To investigate a reduced immune response to vaccination as a potential mechanism behind lower efficacy in high transmission areas, we examine initial vaccine antibody (anti-CSP IgG) response and vaccine efficacy against the first case of malaria (to exclude the effect of naturally acquired immunity) using data from three study areas (Kintampo, Ghana; Lilongwe, Malawi; Lambaréné, Gabon) from the 2009-2014 phase III trial (NCT00866619). Our key exposures are parasitemia during the vaccination series and background malaria incidence. We calculate vaccine efficacy (one minus hazard ratio) using a cox-proportional hazards model and allowing for the time-varying effect of RTS,S/AS01. RESULTS We find that antibody responses to the primary three-dose vaccination series were higher in Ghana than in Malawi and Gabon, but that neither antibody levels nor vaccine efficacy against the first case of malaria varied by background incidence or parasitemia during the primary vaccination series. CONCLUSIONS We find that vaccine efficacy is unrelated to infections during vaccination. Contributing to a conflicting literature, our results suggest that vaccine efficacy is also unrelated to infections before vaccination, meaning that control-group immunity is likely a major reason for lower efficacy in high transmission settings, not reduced immune responses to RTS,S/AS01. This may be reassuring for implementation in high transmission settings, though further studies are needed.
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Affiliation(s)
- Griffin J Bell
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
| | | | - Varun Goel
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Benedicta Mensah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Paulin Essone
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - David Dosoo
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Musah Osei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Karamoko Niare
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912, USA
| | - Kenneth Wiru
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Katerina Brandt
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Tisungane Mvalo
- University of North Carolina Project, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Jonathan J Juliano
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, 02912, USA
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8
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Nyandele JP, Kibondo UA, Issa F, Van Geertruyden JP, Warimwe G, Jongo S, Abdulla S, Olotu A. Pre-vaccination monocyte-to-lymphocyte ratio as a biomarker for the efficacy of malaria candidate vaccines: A subgroup analysis of pooled clinical trial data. PLoS One 2023; 18:e0291244. [PMID: 37708143 PMCID: PMC10501550 DOI: 10.1371/journal.pone.0291244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/24/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Pre-vaccination monocyte-to-lymphocyte ratio was previously suggested as a marker for malaria vaccine effectiveness. We investigated the potential of this cell ratio as a marker for malaria vaccine efficacy and effectiveness. Effectiveness was investigated by using clinical malaria endpoint, and efficacy was investigated by using surrogate endpoints of Plasmodium falciparum prepatent period, parasite density, and multiplication rates in a controlled human malaria infection trial (CHMI). METHODS We evaluated the correlation between monocyte-to-lymphocyte ratio and RTS,S vaccine effectiveness using Cox regression modeling with clinical malaria as the primary endpoint. Of the 1704 participants in the RTS,S field trial, data on monocyte-to-lymphocyte ratio was available for 842 participants, of whom our analyses were restricted. We further used Spearman Correlations and Cox regression modeling to evaluate the correlation between monocyte-to-lymphocyte ratio and Whole Sporozoite malaria vaccine efficacy using the surrogate endpoints. Of the 97 participants in the controlled human malaria infection vaccine trials, hematology and parasitology information were available for 82 participants, of whom our analyses were restricted. RESULTS The unadjusted efficacy of RTS,S malaria vaccine was 54% (95% CI: 37%-66%, p <0.001). No correlation was observed between monocyte-to-lymphocyte ratio and RTS,S vaccine efficacy (Hazard Rate (HR):0.90, 95%CI:0.45-1.80; p = 0.77). The unadjusted efficacy of Whole Sporozoite malaria vaccine in the appended dataset was 17.6% (95%CI:10%-28.5%, p<0.001). No association between monocyte-to-lymphocyte ratio and the Whole Sporozoite malaria vaccine was found against either the prepatent period (HR = 1.16; 95%CI:0.51-2.62, p = 0.72), parasite density (rho = 0.004, p = 0.97) or multiplication rates (rho = 0.031, p = 0.80). CONCLUSION Monocyte-to-lymphocyte ratio alone may not be an adequate marker for malaria vaccine efficacy. Further investigations on immune correlates and underlying mechanisms of immune protection against malaria could provide a clearer explanation of the differences between those protected in comparison with those not protected against malaria by vaccination.
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Affiliation(s)
- Jane Paula Nyandele
- Global Health Institute, University of Antwerp, Antwerp, Belgium
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
| | - Ummi Abdul Kibondo
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
| | - Fatuma Issa
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
| | | | | | - Said Jongo
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
| | - Salim Abdulla
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
| | - Ally Olotu
- Ifakara Health Institute, Bagamoyo Clinical Trial Unit, Bagamoyo, Tanzania
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9
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Bucheli OTM, Eyer K. Insights into the relationship between persistent antibody secretion and metabolic programming - A question for single-cell analysis. Immunol Lett 2023; 260:35-43. [PMID: 37315849 DOI: 10.1016/j.imlet.2023.06.006] [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: 11/02/2022] [Revised: 04/28/2023] [Accepted: 06/10/2023] [Indexed: 06/16/2023]
Abstract
Vaccination aims to generate a protective and persisting antibody response. Indeed, humoral vaccine-mediated protection depends on the quality and quantity of the produced antigen-specific antibodies for its initial magnitude and the persistence of the plasma cells for its duration. Therefore, understanding the mechanisms behind the generation, selection and maintenance of long-lived plasma cells secreting protective antibodies is of fundamental importance for understanding long-term immunity, vaccine responses, therapeutical approaches for autoimmune disease and multiple myeloma. Recent studies have observed correlations between the generation, function and lifespan of plasma cells and their metabolism, with metabolism being both a main driver and primary consequence of changes in cellular behavior. This review introduces how metabolic programs influence and drive immune cell functions in general and plasma cell differentiation and longevity more specifically, summarizing the current knowledge on metabolic pathways and their influences on cellular fate. In addition, available technologies to profile metabolism and their limitations are discussed, leading to the unique and open technological challenges for further advancement of this research field.
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Affiliation(s)
- Olivia T M Bucheli
- Laboratory for Functional Immune Repertoire Analysis, Institute of Pharmaceutical Sciences, D-CHAB, ETH Zürich, 8093 Zürich, Switzerland
| | - Klaus Eyer
- Laboratory for Functional Immune Repertoire Analysis, Institute of Pharmaceutical Sciences, D-CHAB, ETH Zürich, 8093 Zürich, Switzerland.
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10
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González-Sanz M, Berzosa P, Norman FF. Updates on Malaria Epidemiology and Prevention Strategies. Curr Infect Dis Rep 2023; 25:1-9. [PMID: 37361492 PMCID: PMC10248987 DOI: 10.1007/s11908-023-00805-9] [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] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The objective of this review was to provide an update on recent malaria epidemiology, both globally and in non-endemic areas, to identify the current distribution and repercussions of genetically diverse Plasmodium species and summarize recently implemented intervention and prevention tools. Recent Findings Notable changes in malaria epidemiology have occurred in recent years, with an increase in the number of total cases and deaths globally during 2020-2021, in part attributed to the COVID-19 pandemic. The emergence of artemisinin-resistant species in new areas and the expanding distribution of parasites harbouring deletions of the pfhrp2/3 genes have been concerning. New strategies to curb the burden of this infection, such as vaccination, have been implemented in certain endemic areas and their performance is currently being evaluated. Summary Inadequate control of malaria in endemic regions may have an effect on imported malaria and measures to prevent re-establishment of transmission in malaria-free areas are essential. Enhanced surveillance and investigation of Plasmodium spp. genetic variations will contribute to the successful diagnosis and treatment of malaria in future. Novel strategies for an integrated One Health approach to malaria control should also be strengthened.
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Affiliation(s)
- Marta González-Sanz
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Berzosa
- Malaria and Neglected Tropical Diseases Laboratory, National Centre for Tropical Medicine, Carlos III Health Institute, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Francesca F. Norman
- Infectious Diseases Department, National Referral Unit for Tropical Diseases, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
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11
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Bell GJ, Gyaase S, Goel V, Adu B, Mensah B, Essone P, Dosoo D, Osei M, Niare K, Wiru K, Brandt K, Emch M, Ghansah A, Asante KP, Mvalo T, Agnandji ST, Juliano JJ, Bailey JA. Malaria Transmission Intensity and Parasitemia during the Three-Dose RTS,S/AS01 Vaccination Series do not Reduce Magnitude of Antibody Response nor Efficacy Against the First Case of Malaria. RESEARCH SQUARE 2023:rs.3.rs-2960373. [PMID: 37292711 PMCID: PMC10246269 DOI: 10.21203/rs.3.rs-2960373/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background RTS,S/AS01 has been recommended by WHO for widespread implementation in medium to high malaria transmission settings. Previous analyses have noted lower vaccine efficacies in higher transmission settings, possibly due to the more rapid development of naturally acquired immunity in the control group. Methods To investigate a reduced immune response to vaccination as a potential mechanism behind lower efficacy in high transmission areas, we examine initial vaccine antibody (anti-CSP IgG) response and vaccine efficacy against the first case of malaria to exclude the delayed malaria effect using data from three study areas (Kintampo, Ghana; Lilongwe, Malawi; Lambaréné, Gabon) from the 2009-2014 phase III trial (NCT00866619). Our key exposures are parasitemia during the vaccination series and malaria transmission intensity. We calculate vaccine efficacy (one minus hazard ratio) using a cox-proportional hazards model and allowing for the time-varying effect of RTS,S/AS01. Results We find that antibody responses to the primary three-dose vaccination series were higher in Ghana than in Malawi and Gabon, but that neither antibody levels nor vaccine efficacy against the first case of malaria varied by transmission intensity or parasitemia during the primary vaccination series. Conclusions We find that vaccine efficacy is unrelated to infections during vaccination. Contributing to a conflicting literature, our results suggest that vaccine efficacy is also unrelated to infections before vaccination, meaning that delayed malaria is likely the main reason for lower efficacy in high transmission settings, not reduced immune responses. This may be reassuring for implementation in high transmission settings, though further studies are needed.
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Ezema CA, Okagu IU, Ezeorba TPC. Escaping the enemy's bullets: an update on how malaria parasites evade host immune response. Parasitol Res 2023:10.1007/s00436-023-07868-6. [PMID: 37219610 DOI: 10.1007/s00436-023-07868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
Malaria continues to cause untold hardship to inhabitants of malaria-endemic regions, causing significant morbidity and mortality that severely impact global health and the economy. Considering the complex life cycle of malaria parasites (MPs) and malaria biology, continued research efforts are ongoing to improve our understanding of the pathogenesis of the diseases. Female Anopheles mosquito injects MPs into its hosts during a blood meal, and MPs invade the host skin and the hepatocytes without causing any serious symptoms. Symptomatic infections occur only during the erythrocytic stage. In most cases, the host's innate immunity (for malaria-naïve individuals) and adaptive immunity (for pre-exposed individuals) mount severe attacks and destroy most MPs. It is increasingly understood that MPs have developed several mechanisms to escape from the host's immune destruction. This review presents recent knowledge on how the host's immune system destroys invading MPs as well as MPs survival or host immune evasion mechanisms. On the invasion of host cells, MPs release molecules that bind to cell surface receptors to reprogram the host in a way to lose the capacity to destroy them. MPs also hide from the host immune cells by inducing the clustering of both infected and uninfected erythrocytes (rosettes), as well as inducing endothelial activation. We hope this review will inspire more research to provide a complete understanding of malaria biology and promote interventions to eradicate the notorious disease.
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Affiliation(s)
- Chinonso Anthony Ezema
- Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
- Division of Soft Matter, Hokkaido University, Sapporo, 060-0810, Japan
| | - Innocent Uzochukwu Okagu
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
| | - Timothy Prince Chidike Ezeorba
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria.
- Department of Genetics and Biotechnology, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria.
- Department of Molecular Biotechnology, School of Biosciences, University of Birmingham Edgbaston, Birmingham, B15 2TT, UK.
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13
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Siddiqui AJ, Bhardwaj J, Saxena J, Jahan S, Snoussi M, Bardakci F, Badraoui R, Adnan M. A Critical Review on Human Malaria and Schistosomiasis Vaccines: Current State, Recent Advancements, and Developments. Vaccines (Basel) 2023; 11:vaccines11040792. [PMID: 37112704 PMCID: PMC10146311 DOI: 10.3390/vaccines11040792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Malaria and schistosomiasis are two major parasitic diseases that remain leading causes of morbidity and mortality worldwide. Co-infections of these two parasites are common in the tropics, where both diseases are endemic. The clinical consequences of schistosomiasis and malaria are determined by a variety of host, parasitic, and environmental variables. Chronic schistosomiasis causes malnutrition and cognitive impairments in children, while malaria can cause fatal acute infections. There are effective drugs available to treat malaria and schistosomiasis. However, the occurrence of allelic polymorphisms and the rapid selection of parasites with genetic mutations can confer reduced susceptibility and lead to the emergence of drug resistance. Moreover, the successful elimination and complete management of these parasites are difficult due to the lack of effective vaccines against Plasmodium and Schistosoma infections. Therefore, it is important to highlight all current vaccine candidates undergoing clinical trials, such as pre-erythrocytic and erythrocytic stage malaria, as well as a next-generation RTS,S-like vaccine, the R21/Matrix-M vaccine, that conferred 77% protection against clinical malaria in a Phase 2b trial. Moreover, this review also discusses the progress and development of schistosomiasis vaccines. Furthermore, significant information is provided through this review on the effectiveness and progress of schistosomiasis vaccines currently under clinical trials, such as Sh28GST, Sm-14, and Sm-p80. Overall, this review provides insights into recent progress in malarial and schistosomiasis vaccines and their developmental approaches.
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Affiliation(s)
- Arif Jamal Siddiqui
- Department of Biology, College of Science, University of Ha’il, Ha’il P.O. Box 2440, Saudi Arabia
| | - Jyoti Bhardwaj
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Juhi Saxena
- Department of Biotechnology, University Institute of Biotechnology, Chandigarh University, Gharuan, NH-95, Ludhiana—Chandigarh State Hwy, Mohali 140413, India
| | - Sadaf Jahan
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mejdi Snoussi
- Department of Biology, College of Science, University of Ha’il, Ha’il P.O. Box 2440, Saudi Arabia
- Laboratory of Genetics, Biodiversity and Valorization of Bio-Resources (LR11ES41), Higher Institute of Biotechnology of Monastir, University of Monastir, Avenue TaharHaddas BP74, Monastir 5000, Tunisia
| | - Fevzi Bardakci
- Department of Biology, College of Science, University of Ha’il, Ha’il P.O. Box 2440, Saudi Arabia
| | - Riadh Badraoui
- Department of Biology, College of Science, University of Ha’il, Ha’il P.O. Box 2440, Saudi Arabia
- Section of Histology-Cytology, Medicine Faculty of Tunis, University of Tunis El Manar, Tunis 1017, Tunisia
| | - Mohd Adnan
- Department of Biology, College of Science, University of Ha’il, Ha’il P.O. Box 2440, Saudi Arabia
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Dieng CC, Ford CT, Lerch A, Doniou D, Vegesna K, Janies D, Cui L, Amoah L, Afrane Y, Lo E. Genetic variations of Plasmodium falciparum circumsporozoite protein and the impact on interactions with human immunoproteins and malaria vaccine efficacy. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 110:105418. [PMID: 36841398 DOI: 10.1016/j.meegid.2023.105418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
In October 2021, the world's first malaria vaccine RTS,S was endorsed by WHO for broad use in children, despite its low efficacy. This study examined polyclonal infections and the associations of parasite genetic variations with binding affinity to human leukocyte antigen (HLA). Multiplicity of infection was determined by amplicon deep sequencing of PfMSP1. Genetic variations in PfCSP were examined across 88 samples from Ghana and analyzed together with 1655 PfCSP sequences from other African and non-African isolates. Binding interactions of PfCSP peptide variants and HLA were predicted using NetChop and HADDOCK. High polyclonality was detected among infections, with each infection harboring multiple non-3D7 PfCSP variants. Twenty-seven PfCSP haplotypes were detected in the Ghanaian samples, and they broadly represented PfCSP diversity across Africa. The number of genetic differences between 3D7 and non-3D7 PfCSP variants does not influence binding to HLA. However, CSP peptide length after proteolytic degradation significantly affects its molecular weight and binding affinity to HLA. Despite the high diversity of HLA, the majority of the HLAI and II alleles interacted/bound with all Ghana CSP peptides. Multiple non-3D7 strains among P. falciparum infections could impact the effectiveness of RTS,S. Longer peptides of the Th2R/Th3R CSP regions should be considered in future versions of RTS,S.
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Affiliation(s)
- Cheikh Cambel Dieng
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Colby T Ford
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA; School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Anita Lerch
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | - Dickson Doniou
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kovidh Vegesna
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Daniel Janies
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Linda Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; West Africa Center for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Yaw Afrane
- Department of Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA; School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA.
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Quansah E, Chen Y, Yang S, Wang J, Sun D, Zhao Y, Chen M, Yu L, Zhang C. CRISPR-Cas13 in malaria parasite: Diagnosis and prospective gene function identification. Front Microbiol 2023; 14:1076947. [PMID: 36760507 PMCID: PMC9905151 DOI: 10.3389/fmicb.2023.1076947] [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: 10/24/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Malaria caused by Plasmodium is still a serious public health problem. Genomic editing is essential to understand parasite biology, elucidate mechanical pathways, uncover gene functions, identify novel therapeutic targets, and develop clinical diagnostic tools. Recent advances have seen the development of genomic diagnostic technologies and the emergence of genetic manipulation toolbox comprising a host of several systems for editing the genome of Plasmodium at the DNA, RNA, and protein level. Genomic manipulation at the RNA level is critical as it allows for the functional characterization of several transcripts. Of notice, some developed artificial RNA genome editing tools hinge on the endogenous RNA interference system of Plasmodium. However, Plasmodium lacks a robust RNAi machinery, hampering the progress of these editing tools. CRISPR-Cas13, which belongs to the VI type of the CRISPR system, can specifically bind and cut RNA under the guidance of crRNA, with no or minimal permanent genetic scar on genes. This review summarizes CRISPR-Cas13 system from its discovery, classification, principle of action, and diagnostic platforms. Further, it discusses the application prospects of Cas13-based systems in Plasmodium and highlights its advantages and drawbacks.
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Affiliation(s)
- Elvis Quansah
- Anhui Provincial Laboratory of Microbiology and Parasitology, Anhui Key Laboratory of Zoonoses, Department of Microbiology and Parasitology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Yihuan Chen
- The Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Shijie Yang
- The Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Junyan Wang
- The Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Danhong Sun
- The Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yangxi Zhao
- The First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Ming Chen
- The Second Clinical Medical College, Anhui Medical University, Hefei, China
| | - Li Yu
- Anhui Provincial Laboratory of Microbiology and Parasitology, Anhui Key Laboratory of Zoonoses, Department of Microbiology and Parasitology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China,*Correspondence: Li Yu, ✉
| | - Chao Zhang
- Anhui Provincial Laboratory of Microbiology and Parasitology, Anhui Key Laboratory of Zoonoses, Department of Microbiology and Parasitology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China,Chao Zhang, ✉
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16
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Weiland AS. Recent Advances in Imported Malaria Pathogenesis, Diagnosis, and Management. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2023; 11:49-57. [PMID: 37213266 PMCID: PMC10091340 DOI: 10.1007/s40138-023-00264-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/23/2023]
Abstract
Purpose of Review Malaria is an important human parasitic disease affecting the population of tropical, subtropical regions as well as travelers to these areas.The purpose of this article is to provide clinicians practicing in non-endemic areas with a comprehensive overview of the recent data on microbiologic and pathophysiologic features of five Plasmodium parasites, clinical presentation of uncomplicated and severe cases, modern diagnostic methods, and treatment of malaria. Recent Findings Employment of robust surveillance programs, rapid diagnostic tests, highly active artemisinin-based therapy, and the first malaria vaccine have led to decline in malaria incidence; however, emerging drug resistance, disruptions due to the COVID-19 pandemic, and other socio-economic factors have stalled the progress. Summary Clinicians practicing in non-endemic areas such as the United States should consider a diagnosis of malaria in returning travelers presenting with fever, utilize rapid diagnostic tests if available at their practice locations in addition to microscopy, and timely initiate guideline-directed management as delays in treatment can lead to poor clinical outcomes.
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Affiliation(s)
- Anastasia S. Weiland
- Department of Medicine, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH USA
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17
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Parums DV. Editorial: Current Status of Two Adjuvanted Malaria Vaccines and the World Health Organization (WHO) Strategy to Eradicate Malaria by 2030. Med Sci Monit 2023; 29:e939357. [PMID: 36587274 PMCID: PMC9814194 DOI: 10.12659/msm.939357] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
There is hope that 2023 could bring regulatory approval, licensing, and implementation programs for safe and effective adjuvanted vaccines to prevent malaria. Clinical trials involving the two leading adjuvanted malaria vaccines directed to the Plasmodium falciparum circumsporozoite protein (PfCSP) are ongoing. These vaccines are RTS,S/ASO1 (Mosquirix®) and R21/Matrix-M™ (R21/MM). This year, the World Health Organization (WHO) updated its strategy to eradicate malaria by 2030. The hope is that major advances in global health security from effective malarial vaccines could reduce morbidity and save the lives of millions of people living in malaria-endemic countries to achieve the goals recommended by the WHO. This Editorial aims to give an update on recent findings from key clinical trials on the safety and efficacy of RTS,S/ASO1 and R21/MM malaria vaccines and to provide an insight into the importance of key ongoing clinical trials that will report in early 2023.
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Affiliation(s)
- Dinah V. Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, USA
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18
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Bell GJ, Goel V, Essone P, Dosoo D, Adu B, Mensah BA, Gyaase S, Wiru K, Mougeni F, Osei M, Minsoko P, Sinai C, Niaré K, Juliano JJ, Hudgens M, Ghansah A, Kamthunzi P, Mvalo T, Agnandji ST, Bailey JA, Asante KP, Emch M. Malaria Transmission Intensity Likely Modifies RTS, S/AS01 Efficacy Due to a Rebound Effect in Ghana, Malawi, and Gabon. J Infect Dis 2022; 226:1646-1656. [PMID: 35899811 PMCID: PMC10205900 DOI: 10.1093/infdis/jiac322] [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: 05/20/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND RTS,S/AS01 is the first malaria vaccine to be approved and recommended for widespread implementation by the World Health Organization (WHO). Trials reported lower vaccine efficacies in higher-incidence sites, potentially due to a "rebound" in malaria cases in vaccinated children. When naturally acquired protection in the control group rises and vaccine protection in the vaccinated wanes concurrently, malaria incidence can become greater in the vaccinated than in the control group, resulting in negative vaccine efficacies. METHODS Using data from the 2009-2014 phase III trial (NCT00866619) in Lilongwe, Malawi; Kintampo, Ghana; and Lambaréné, Gabon, we evaluate this hypothesis by estimating malaria incidence in each vaccine group over time and in varying transmission settings. After estimating transmission intensities using ecological variables, we fit models with 3-way interactions between vaccination, time, and transmission intensity. RESULTS Over time, incidence decreased in the control group and increased in the vaccine group. Three-dose efficacy in the lowest-transmission-intensity group (0.25 cases per person-year [CPPY]) decreased from 88.2% to 15.0% over 4.5 years, compared with 81.6% to -27.7% in the highest-transmission-intensity group (3 CPPY). CONCLUSIONS These findings suggest that interventions, including the fourth RTS,S dose, that protect vaccinated individuals during the potential rebound period should be implemented for high-transmission settings.
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Affiliation(s)
- Griffin J Bell
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Varun Goel
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paulin Essone
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - David Dosoo
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Bright Adu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | | | - Kenneth Wiru
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Fabrice Mougeni
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Musah Osei
- Kintampo Health Research Centre, Kintampo, Ghana
| | - Pamela Minsoko
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Cyrus Sinai
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karamoko Niaré
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, USA
| | - Jonathan J Juliano
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | | | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, USA
| | | | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
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19
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Inklaar MR, Barillas-Mury C, Jore MM. Deceiving and escaping complement - the evasive journey of the malaria parasite. Trends Parasitol 2022; 38:962-974. [PMID: 36089499 PMCID: PMC9588674 DOI: 10.1016/j.pt.2022.08.013] [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: 05/13/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 01/13/2023]
Abstract
During its life cycle, Plasmodium, the malaria parasite, is exposed to the human and mosquito complement systems. Early experiments demonstrated that activation of complement can pose a serious threat to parasites, but recent studies revealed complement-evasion mechanisms important for parasite survival. Blood-stage parasites and gametes recruit regulators to neutralize human complement activation, while ookinetes inhibit mosquito complement by disrupting epithelial nitration in response to midgut invasion. Here we provide an in-depth overview of the evasion mechanisms currently known and speculate on the existence of others not yet identified. Finally, we discuss how these mechanisms could provide novel targets for urgently needed malaria vaccines and therapeutics.
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Affiliation(s)
| | - Carolina Barillas-Mury
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA.
| | - Matthijs M Jore
- Department of Medical Microbiology, Radboudumc, The Netherlands.
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20
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Abstract
RTS,S/AS01 (Mosquirix®) is a vaccine against malaria caused by Plasmodium falciparum. In a phase 3 trial, RTS,S/AS01 showed vaccine efficacy against clinical malaria, severe malaria and malaria hospitalization, with an acceptable safety and tolerability profile, in children aged 6 weeks to 17 months; the vaccine efficacy was greater in children than in infants and waned over time. In another phase 3 trial, RTS,S/AS01 was noninferior to seasonal malaria chemoprevention in children. WHO recommends a 4-dose schedule of RTS,S/AS01 for the prevention of P. falciparum malaria in children from 5 months of age living in regions with moderate to high malaria transmission, with an optional 5-dose schedule for areas with highly seasonal malaria transmission. First results from large pilot implementation in Africa show that RTS,S/AS01 has a favourable safety profile, increases equity in access to malaria prevention, is highly cost effective, can be delivered through routine national immunization programmes and substantially reduces severe malaria burden. Malaria is a life-threatening disease caused by Plasmodium parasites, which are spread to humans through bites of infected mosquitoes. RTS,S/AS01 (Mosquirix®) is a vaccine against malaria caused by P. falciparum. In phase 3 trials, RTS,S/AS01 showed vaccine efficacy against P. falciparum malaria and was at least as effective as seasonal malaria chemoprevention in children, with an acceptable safety and tolerability profile. Results of the first 2 years of a large scale pilot implementation of RTS,S/AS01 in Africa allowed WHO to recommend the vaccine for the prevention of P. falciparum malaria in children from 5 months of age living in regions with moderate to high malaria transmission, with an optional use for seasonal malaria.
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21
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Murphy SC, Vaughan AM, Kublin JG, Fishbauger M, Seilie AM, Cruz KP, Mankowski T, Firat M, Magee S, Betz W, Kain H, Camargo N, Haile MT, Armstrong J, Fritzen E, Hertoghs N, Kumar S, Sather DN, Pinder LF, Deye GA, Galbiati S, Geber C, Butts J, Jackson LA, Kappe SH. A genetically engineered Plasmodium falciparum parasite vaccine provides protection from controlled human malaria infection. Sci Transl Med 2022; 14:eabn9709. [PMID: 36001680 PMCID: PMC10423335 DOI: 10.1126/scitranslmed.abn9709] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Genetically engineered live Plasmodium falciparum sporozoites constitute a potential platform for creating consistently attenuated, genetically defined, whole-parasite vaccines against malaria through targeted gene deletions. Such genetically attenuated parasites (GAPs) do not require attenuation by irradiation or concomitant drug treatment. We previously developed a P. falciparum (Pf) GAP with deletions in P52, P36, and SAP1 genes (PfGAP3KO) and demonstrated its safety and immunogenicity in humans. Here, we further assessed safety, tolerability, and immunogenicity of the PfGAP3KO vaccine and tested its efficacy against controlled human malaria infection (CHMI) in malaria-naïve subjects. The vaccine was delivered by three (n = 6) or five (n = 8) immunizations with ~200 PfGAP3KO-infected mosquito bites per immunization. PfGAP3KO was safe and well tolerated with no breakthrough P. falciparum blood stage infections. Vaccine-related adverse events were predominately localized urticaria related to the numerous mosquito bites administered per vaccination. CHMI via bites with mosquitoes carrying fully infectious Pf NF54 parasites was carried out 1 month after the last immunization. Half of the study participants who received either three or five PfGAP3KO immunizations remained P. falciparum blood stage negative, as shown by a lack of detection of Plasmodium 18S rRNA in the blood for 28 days after CHMI. Six protected study participants received a second CHMI 6 months later, and one remained completely protected. Thus, the PfGAP3KO vaccine was safe and immunogenic and was capable of inducing protection against sporozoite infection. These results warrant further evaluation of PfGAP3KO vaccine efficacy in dose-range finding trials with an injectable formulation.
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Affiliation(s)
- Sean C. Murphy
- Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington; Seattle, WA 98109
- Department of Microbiology, University of Washington; Seattle, WA 98109
| | - Ashley M. Vaughan
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
- Department of Pediatrics, University of Washington; Seattle, WA 98105
| | - James G. Kublin
- Department of Global Health, University of Washington; Seattle, WA 98195
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA 98109
| | - Matthew Fishbauger
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Annette M. Seilie
- Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington; Seattle, WA 98109
| | - Kurtis P. Cruz
- Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington; Seattle, WA 98109
| | - Tracie Mankowski
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Melike Firat
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Sara Magee
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Will Betz
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Heather Kain
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Nelly Camargo
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Meseret T. Haile
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Janna Armstrong
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Emma Fritzen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Nina Hertoghs
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Sudhir Kumar
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - D. Noah Sather
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
| | - Leeya F. Pinder
- Department of Obstetrics and Gynecology, University of Washington; Seattle, WA 98195
| | - Gregory A. Deye
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda, MD, United States
| | | | - Casey Geber
- The Emmes Company; Rockville, MD, United States
| | | | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute; Seattle, WA
| | - Stefan H.I. Kappe
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute; 307 Westlake Avenue North, Suite 500, Seattle, WA 98109
- Department of Global Health, University of Washington; Seattle, WA 98195
- Department of Pediatrics, University of Washington; Seattle, WA 98105
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22
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An Optimal Control Model to Understand the Potential Impact of the New Vaccine and Transmission-Blocking Drugs for Malaria: A Case Study in Papua and West Papua, Indonesia. Vaccines (Basel) 2022; 10:vaccines10081174. [PMID: 35893823 PMCID: PMC9331692 DOI: 10.3390/vaccines10081174] [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: 05/30/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Malaria is one of the major causes of a high death rate due to infectious diseases every year. Despite attempts to eradicate the disease, results have not been very successful. New vaccines and other treatments are being constantly developed to seek optimal ways to prevent malaria outbreaks. In this article, we formulate and analyze an optimal control model of malaria incorporating the new pre-erythrocytic vaccine and transmission-blocking treatment. Sufficient conditions to guarantee local stability of the malaria-free equilibrium were derived based on the controlled reproduction number condition. Using the non-linear least square fitting method, we fitted the incidence data from the province of Papua and West Papua in Indonesia to estimate the model parameter values. The optimal control characterization and optimality conditions were derived by applying the Pontryagin Maximum Principle, and numerical simulations were also presented. Simulation results show that both the pre-erythrocytic vaccine and transmission-blocking treatment significantly reduce the spread of malaria. Accordingly, a high doses of pre-erythrocytic vaccine is needed if the number of infected individuals is relatively small, while transmission blocking is required if the number of infected individuals is relatively large. These results suggest that a large-scale implementation of both strategies is vital as the world continues with the effort to eradicate malaria, especially in endemic regions across the globe.
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23
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Hasegawa RB, Small DS. Estimating Malaria Vaccine Efficacy in the Absence of a Gold Standard Case Definition: Mendelian Factorial Design. J Am Stat Assoc 2022. [DOI: 10.1080/01621459.2020.1863222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Raiden B. Hasegawa
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Dylan S. Small
- Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia, PA
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24
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Bhattacharya D. Instructing durable humoral immunity for COVID-19 and other vaccinable diseases. Immunity 2022; 55:945-964. [PMID: 35637104 PMCID: PMC9085459 DOI: 10.1016/j.immuni.2022.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
Many aspects of SARS-CoV-2 have fully conformed with the principles established by decades of viral immunology research, ultimately leading to the crowning achievement of highly effective COVID-19 vaccines. Nonetheless, the pandemic has also exposed areas where our fundamental knowledge is thinner. Some key unknowns are the duration of humoral immunity post-primary infection or vaccination and how long booster shots confer protection. As a corollary, if protection does not last as long as desired, what are some ways it can be improved? Here, I discuss lessons from other infections and vaccines that point to several key features that influence durable antibody production and the perseverance of immunity. These include (1) the specific innate sensors that are initially triggered, (2) the kinetics of antigen delivery and persistence, (3) the starting B cell receptor (BCR) avidity and antigen valency, and (4) the memory B cell subsets that are recalled by boosters. I further highlight the fundamental B cell-intrinsic and B cell-extrinsic pathways that, if understood better, would provide a rational framework for vaccines to reliably provide durable immunity.
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Affiliation(s)
- Deepta Bhattacharya
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
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25
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Jagannathan P, Kakuru A. Malaria in 2022: Increasing challenges, cautious optimism. Nat Commun 2022; 13:2678. [PMID: 35562368 PMCID: PMC9106727 DOI: 10.1038/s41467-022-30133-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/12/2022] [Indexed: 01/29/2023] Open
Affiliation(s)
- Prasanna Jagannathan
- grid.168010.e0000000419368956Department of Medicine, Stanford University, Stanford, CA United States ,grid.168010.e0000000419368956Department of Microbiology and Immunology, Stanford University, Stanford, CA United States
| | - Abel Kakuru
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration, Kampala, Uganda
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26
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White M, Chitnis CE. Potential role of vaccines in elimination of Plasmodium vivax. Parasitol Int 2022; 90:102592. [PMID: 35489701 DOI: 10.1016/j.parint.2022.102592] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
The unique biology of Plasmodium vivax, with its ability to form latent hypnozoites in the liver stage and the early appearance of gametocytes during blood stage infection, makes it difficult to target for elimination with standard malaria control tools. Here, we use modelling studies to demonstrate that vaccines that target different stages of P. vivax could greatly assist efforts to eliminate P. vivax. Combination of vaccines that target different P. vivax life cycle stages may be required to achieve high efficacy. Our simulations demonstrate that repeated rounds of mass vaccination with multi-stage vaccines can help achieve pre-elimination levels of P. vivax in both low and high transmission settings. We review the status of global efforts to develop vaccines for P. vivax malaria. We describe the status of the leading P. vivax vaccine candidates and share some thoughts on the prospects for availability of an effective vaccine for P. vivax malaria.
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Affiliation(s)
- Michael White
- Infectious Disease Epidemiology and Analytics G5 Unit, Department of Global Health, Institut Pasteur, Université de Paris, Paris, France
| | - Chetan E Chitnis
- Malaria Parasite Biology and Vaccines Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Université de Paris, Paris, France.
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27
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Wang LT, Hurlburt NK, Schön A, Flynn BJ, Flores-Garcia Y, Pereira LS, Kiyuka PK, Dillon M, Bonilla B, Zavala F, Idris AH, Francica JR, Pancera M, Seder RA. The light chain of the L9 antibody is critical for binding circumsporozoite protein minor repeats and preventing malaria. Cell Rep 2022; 38:110367. [PMID: 35172158 PMCID: PMC8896312 DOI: 10.1016/j.celrep.2022.110367] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/17/2021] [Accepted: 01/20/2022] [Indexed: 01/23/2023] Open
Abstract
L9 is a potent human monoclonal antibody (mAb) that preferentially binds two adjacent NVDP minor repeats and cross-reacts with NANP major repeats of the Plasmodium falciparum circumsporozoite protein (PfCSP) on malaria-infective sporozoites. Understanding this mAb's ontogeny and mechanisms of binding PfCSP will facilitate vaccine development. Here, we isolate mAbs clonally related to L9 and show that this B cell lineage has baseline NVDP affinity and evolves to acquire NANP reactivity. Pairing the L9 kappa light chain (L9κ) with clonally related heavy chains results in chimeric mAbs that cross-link two NVDPs, cross-react with NANP, and more potently neutralize sporozoites in vivo compared with their original light chain. Structural analyses reveal that the chimeric mAbs bound minor repeats in a type-1 β-turn seen in other repeat-specific antibodies. These data highlight the importance of L9κ in binding NVDP on PfCSP to neutralize sporozoites and suggest that PfCSP-based immunogens might be improved by presenting ≥2 NVDPs.
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Affiliation(s)
- Lawrence T Wang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicholas K Hurlburt
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Arne Schön
- Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Barbara J Flynn
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Yevel Flores-Garcia
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lais S Pereira
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Patience K Kiyuka
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marlon Dillon
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brian Bonilla
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fidel Zavala
- Department of Molecular Microbiology and Immunology, Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Azza H Idris
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Joseph R Francica
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Marie Pancera
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
| | - Robert A Seder
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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28
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Addy JW, Bediako Y, Ndungu FM, Valetta JJ, Reid AJ, Mwacharo J, Ngoi JM, Wambua J, Otieno E, Musyoki J, Said K, Berriman M, Marsh K, Bejon P, Recker M, Langhorne J. 10-year longitudinal study of malaria in children: Insights into acquisition and maintenance of naturally acquired immunity. Wellcome Open Res 2022; 6:79. [PMID: 35141425 PMCID: PMC8822141 DOI: 10.12688/wellcomeopenres.16562.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/26/2023] Open
Abstract
Background: Studies of long-term malaria cohorts have provided essential insights into how Plasmodium falciparum interacts with humans, and influences the development of antimalarial immunity. Immunity to malaria is acquired gradually after multiple infections, some of which present with clinical symptoms. However, there is considerable variation in the number of clinical episodes experienced by children of the same age within the same cohort. Understanding this variation in clinical symptoms and how it relates to the development of naturally acquired immunity is crucial in identifying how and when some children stop experiencing further malaria episodes. Where variability in clinical episodes may result from different rates of acquisition of immunity, or from variable exposure to the parasite. Methods: Using data from a longitudinal cohort of children residing in an area of moderate P. falciparum transmission in Kilifi district, Kenya, we fitted cumulative episode curves as monotonic-increasing splines, to 56 children under surveillance for malaria from the age of 5 to 15. Results: There was large variability in the accumulation of numbers of clinical malaria episodes experienced by the children, despite being of similar age and living in the same general location. One group of children from a particular sub-region of the cohort stopped accumulating clinical malaria episodes earlier than other children in the study. Despite lack of further clinical episodes of malaria, these children had higher asymptomatic parasite densities and higher antibody titres to a panel of P. falciparum blood-stage antigens. Conclusions: This suggests development of clinical immunity rather than lack of exposure to the parasite, and supports the view that this immunity to malaria disease is maintained by a greater exposure to P. falciparum, and thus higher parasite burdens. Our study illustrates the complexity of anti-malaria immunity and underscores the need for analyses which can sufficiently reflect the heterogeneity within endemic populations.
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Affiliation(s)
- John W.G. Addy
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
| | - Yaw Bediako
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | | | - John Joseph Valetta
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - Adam J. Reid
- Parasite Genomics, Wellcome Sanger Institute, Hixton, UK
| | | | | | - Joshua Wambua
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edward Otieno
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Khadija Said
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Philip Bejon
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mario Recker
- Centre for Ecology and Conservation, University of Exeter, Penryn Campus, Penryn, UK
| | - Jean Langhorne
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
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29
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Wei L, Zhao T, Zhang J, Mao Q, Gong G, Sun Y, Chen Y, Wang M, Tan D, Gong Z, Li B, Niu J, Li S, Gong H, Zou L, Zhou W, Jia Z, Tang Y, Fei L, Hu Y, Shang X, Han J, Zhang B, Wu Y. Efficacy and safety of a nanoparticle therapeutic vaccine in patients with chronic hepatitis B: A randomized clinical trial. Hepatology 2022; 75:182-195. [PMID: 34396571 DOI: 10.1002/hep.32109] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/28/2021] [Accepted: 07/31/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM HBV DNA can be reduced using antiviral drugs in patients with chronic hepatitis B (CHB); however, the rate of HBeAg seroconversion remains low. A clinical trial was conducted to assess the efficacy and safety of a de novo designed liposome-based nanoparticle lipopeptide vaccine, εPA-44, for CHB. APPROACH AND RESULTS A two-stage phase 2 trial, which included a 76-week, randomized, double-blind, placebo-controlled trial (stage 1) and a 68-week open-label extension (stage 2), was conducted in 15 centers across China (Clinicaltrials.gov No. NCT00869778). In stage 1, 360 human leukocyte antigen A2 (HLA-A2)-positive and HBeAg-positive patients were randomly and equally distributed to receive six subcutaneous injections of 600 µg or 900 µg εPA-44 or placebo at week 0, 4, 8, 12, 20, and 28. In stage 2, 183 patients received extended 900 µg εPA-44, and 26 patients were observed for relapse without further treatment. The primary endpoint was the percentage of patients with HBeAg seroconversion at week 76. At week 76, patients receiving 900 µg εPA-44 achieved significantly higher HBeAg seroconversion rate (38.8%) versus placebo (20.2%) (95% CI, 6.9-29.6%; p = 0.002). With a combined endpoint of HBeAg seroconversion, alanine aminotransferase normalization and HBV DNA < 2,000 IU/mL, both 900 µg (18.1%) and 600 µg (14.3%), resulted in significantly higher rate versus placebo (5.0%) (p = 0.002 and p = 0.02, respectively) at week 76. In stage 2, none (0 of 20) of 900 µg εPA-44-treated patients experienced serologic relapse. The safety profile of εPA-44 was comparable to that of placebo. CONCLUSIONS Among HLA-A2-positive patients with progressive CHB, a finite duration of 900 µg εPA-44 monotherapy resulted in significantly higher HBeAg seroconversion rate than placebo and sustained off-treatment effect. A phase 3 trial is ongoing (ChiCTR2100043708).
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Affiliation(s)
- Lai Wei
- Peking University People's Hospital, Peking University Hepatology institute, Beijing, China
| | - Tingting Zhao
- Chongqing International Institute for Immunology, Chongqing, China
| | - Ji Zhang
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Qing Mao
- Infectious Diseases Institute of PLA, Southwest Hospital, Army Medical University, Chongqing, China
| | - Guozhong Gong
- Infectious Diseases Department, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yongtao Sun
- Infectious Diseases Department, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yongping Chen
- Infectious Diseases Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Maorong Wang
- Infectious Diseases Department, The 81th Hospital of PLA, Nanjing, China
| | - Deming Tan
- Infectious Diseases Department, Xiangya Hospital of Central South University, Changsha, China
| | - Zuojiong Gong
- Infectious Diseases Department, Renmin Hospital of Wuhan University, Wuhan, China
| | - Baosen Li
- Infectious Diseases Department, 302 Military Hospital, Beijing, China
| | - Junqi Niu
- Infectious Diseases Department, The First Hospital of Jilin University, Changchun, China
| | - Shuchen Li
- Infectious Diseases Department, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huanyu Gong
- Infectious Diseases Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Liyun Zou
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Wei Zhou
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Zhengcai Jia
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Yan Tang
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Lei Fei
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Yang Hu
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Xiaoyun Shang
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Junfeng Han
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
| | - Bei Zhang
- Department of Immunology, Medical College of Qingdao University, Qingdao, China
| | - Yuzhang Wu
- Institute of Immunology, PLA, Army Medical University, Chongqing, China
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30
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Mwamlima TG, Mwakasungula SM, Mkindi CG, Tambwe MM, Mswata SS, Mbwambo SG, Mboya MF, Draper SJ, Silk SE, Mpina MG, Vianney JM, Olotu AI. Understanding the role of serological and clinical data on assessing the dynamic of malaria transmission: a case study of Bagamoyo district, Tanzania. Pan Afr Med J 2022; 43:60. [PMID: 36578806 PMCID: PMC9755714 DOI: 10.11604/pamj.2022.43.60.35779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo. Methods 252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14. Results this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year. Conclusion total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.
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Affiliation(s)
- Tunu Guntram Mwamlima
- Ifakara Health Institute, Bagamoyo, Tanzania
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Corresponding author: Tunu Guntram Mwamlima, Ifakara Health Institute, Bagamoyo, Tanzania.
| | | | | | | | | | | | | | - Simon John Draper
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom
| | | | | | - John-Mary Vianney
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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31
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Addy JW, Bediako Y, Ndungu FM, Valetta JJ, Reid AJ, Mwacharo J, Ngoi JM, Wambua J, Otieno E, Musyoki J, Said K, Berriman M, Marsh K, Bejon P, Recker M, Langhorne J. 10-year longitudinal study of malaria in children: Insights into acquisition and maintenance of naturally acquired immunity. Wellcome Open Res 2021; 6:79. [PMID: 35141425 PMCID: PMC8822141 DOI: 10.12688/wellcomeopenres.16562.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Studies of long-term malaria cohorts have provided essential insights into how Plasmodium falciparum interacts with humans, and influences the development of antimalarial immunity. Immunity to malaria is acquired gradually after multiple infections, some of which present with clinical symptoms. However, there is considerable variation in the number of clinical episodes experienced by children of the same age within the same cohort. Understanding this variation in clinical symptoms and how it relates to the development of naturally acquired immunity is crucial in identifying how and when some children stop experiencing further malaria episodes. Where variability in clinical episodes may result from different rates of acquisition of immunity, or from variable exposure to the parasite. Methods: Using data from a longitudinal cohort of children residing in an area of moderate P. falciparum transmission in Kilifi district, Kenya, we fitted cumulative episode curves as monotonic-increasing splines, to 56 children under surveillance for malaria from the age of 5 to 15. Results: There was large variability in the accumulation of numbers of clinical malaria episodes experienced by the children, despite being of similar age and living in the same general location. One group of children from a particular sub-region of the cohort stopped accumulating clinical malaria episodes earlier than other children in the study. Despite lack of further clinical episodes of malaria, these children had higher asymptomatic parasite densities and higher antibody titres to a panel of P. falciparum blood-stage antigens. Conclusions: This suggests development of clinical immunity rather than lack of exposure to the parasite, and supports the view that this immunity to malaria disease is maintained by a greater exposure to P. falciparum, and thus higher parasite burdens. Our study illustrates the complexity of anti-malaria immunity and underscores the need for analyses which can sufficiently reflect the heterogeneity within endemic populations.
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Affiliation(s)
- John W.G. Addy
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
| | - Yaw Bediako
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | | | - John Joseph Valetta
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - Adam J. Reid
- Parasite Genomics, Wellcome Sanger Institute, Hixton, UK
| | | | | | - Joshua Wambua
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edward Otieno
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Khadija Said
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Philip Bejon
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mario Recker
- Centre for Ecology and Conservation, University of Exeter, Penryn Campus, Penryn, UK
| | - Jean Langhorne
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
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32
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Mugo RM, Mwai K, Mwacharo J, Shee FM, Musyoki JN, Wambua J, Otieno E, Bejon P, Ndungu FM. Seven-year kinetics of RTS, S/AS01-induced anti-CSP antibodies in young Kenyan children. Malar J 2021; 20:452. [PMID: 34856981 PMCID: PMC8641151 DOI: 10.1186/s12936-021-03961-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/20/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND RTS,S/AS01, the leading malaria vaccine has been recommended by the WHO for widespread immunization of children at risk. RTS,S/AS01-induced anti-CSP IgG antibodies are associated with the vaccine efficacy. Here, the long-term kinetics of RTS,S/AS01-induced antibodies was investigated. METHODS 150 participants were randomly selected from the 447 children who participated in the RTS,S/AS01 phase IIb clinical trial in 2007 from Kilifi-Kenya. Cumulatively, the retrospective follow-up period was 93 months with annual plasma samples collection. The levels of anti-CSP IgM, total IgG, IgG1, IgG2, IgG3, and IgG4 antibodies were then determined using an enzyme-linked immunosorbent assay. RESULTS RTS,S/AS01 induced high levels of anti-CSP IgG antibodies which exhibited a rapid waning over 6.5 months post-vaccination, followed by a slower decay over the subsequent years. RTS,S/AS01-induced anti-CSP IgG antibodies remained elevated above the control group levels throughout the 7 years follow-up period. The anti-CSP IgG antibodies were mostly IgG1, IgG3, IgG2, and to a lesser extent IgG4. IgG2 predominated in later timepoints. RTS,S/AS01 also induced high levels of anti-CSP IgM antibodies which increased above the control group levels by month 3. The controls exhibited increasing levels of the anti-CSP IgM antibodies which caught up with the RTS,S/AS01 vaccinees levels by month 21. In contrast, there were no measurable anti-CSP IgG antibodies among the controls. CONCLUSION RTS,S/AS01-induced anti-CSP IgG antibodies kinetics are consistent with long-lived but waning vaccine efficacy. Natural exposure induces anti-CSP IgM antibodies in children, which increases with age, but does not induce substantial levels of anti-CSP IgG antibodies.
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Affiliation(s)
- Robert M Mugo
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya.
- Institute of Immunology, Center for Infection Medicine, Freie Universtät Berlin, 14163, Berlin, Germany.
- Department of Biological Sciences, Pwani University, P.O. Box 195-80108, Kilifi, Kenya.
| | - Kennedy Mwai
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
| | - Jedidah Mwacharo
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
| | - Faiz M Shee
- Department of Biological Sciences, Pwani University, P.O. Box 195-80108, Kilifi, Kenya
| | - Jennifer N Musyoki
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
| | - Juliana Wambua
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
| | - Edward Otieno
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Francis M Ndungu
- KEMRI-Wellcome Trust Collaborative Programme, P.O. Box 230, Kilifi, 80108, Kenya.
- Institute of Immunology, Center for Infection Medicine, Freie Universtät Berlin, 14163, Berlin, Germany.
- Department of Biological Sciences, Pwani University, P.O. Box 195-80108, Kilifi, Kenya.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Division of Infectious Diseases, Department of Medicine Solna and Centre for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
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Virnik K, Zhou W, Medvedev A, Walsh G, Perry-Anderson J, Majam V, Felber BK, Kumar S, Berkower I. Live attenuated rubella vectors expressing Plasmodium falciparum circumsporozoite protein (Pf-CSP) provide a novel malaria vaccine platform in the rhesus macaque. Biochem Biophys Res Commun 2021; 577:58-63. [PMID: 34507066 PMCID: PMC10167915 DOI: 10.1016/j.bbrc.2021.08.052] [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: 07/25/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
There is an urgent need for a malaria vaccine that can prevent severe disease in young children and adults. Despite earlier work showing an immunological mechanism for preventing infection and reducing disease severity, there is currently no reliable vaccine that can provide durable protection. In part, this may reflect a limited number of ways that the host can respond to the NANP repeat sequences of circumsporozoite protein (CSP) in the parasite. In addition, it may reflect antigenic escape by the parasite from protective antibodies. To be successful, a vaccine must protect against repeated exposure to infected mosquitoes in endemic areas. We have created a series of live viral vectors based on the rubella vaccine strain that express multiple tandem repeats of NANP, and we demonstrate immunogenicity in a rhesus macaque model. We tested the vectors in a sequential immunization strategy. In the first step, the animals were primed with CSP-DNA vaccine and boosted with rubella/CSP vectors. In the second step, we gave rubella/CSP vectors again, followed by recombinant CSP protein. Following the second step, antibody titers were comparable to adult exposure to malaria in an endemic area. The antibodies were specific for native CSP protein on sporozoites, and they persisted for at least 1½ years in two out of three macaques. Given the safety profile of rubella vaccine in children, these vectors could be most useful in protecting young children, who are at greatest risk of severe malarial disease.
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Affiliation(s)
- Konstantin Virnik
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Wenshuo Zhou
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Alexei Medvedev
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Gabrielle Walsh
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Jasper Perry-Anderson
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Victoria Majam
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, CBER, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Barbara K Felber
- Human Retrovirus Pathogenesis Section, Vaccine Branch, Center for Cancer Research, National Cancer Institute at Frederick, Frederick, MD, 21702, USA
| | - Sanjai Kumar
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, CBER, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA
| | - Ira Berkower
- Lab of Immunoregulation, Division of Viral Products, Office of Vaccines Research and Review, Center for Biologics, FDA, 10903 New Hampshire Ave., Silver Spring, MD, 20993, USA.
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Parums DV. Editorial: The First Monoclonal Antibody Vaccine to Prevent Malaria Heralds a New Era of Malaria Vaccines to the Plasmodium falciparum Circumsporozoite Protein (PfCSP). Med Sci Monit 2021; 27:e934676. [PMID: 34511592 PMCID: PMC8447852 DOI: 10.12659/msm.934676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Malaria affects more than 3 billion people in 95 countries, with an estimated mortality rate of 400,000 per year. The female Anopheles spp mosquito most commonly transmits malaria, and the main burden of disease is due to Plasmodium falciparum. The most abundant antigen on the sporozoite surface is the Plasmodium falciparum circumsporozoite protein (PfCSP). PfCSP is required for parasite development and attachment to host hepatocytes. The first potential protein vaccine, RTS,S/ASO1, consists of a recombinant fusion antigen based on PfCSP. Initial findings from a phase 3 trial of RTS,S/ASO1 were promising but resulted in recommendations for further evaluation in large-scale trials. R21, a circumsporozoite protein-based vaccine, combined with an adjuvant, Matrix-M (MM), was recently evaluated in a phase 2 investigational study in children between 5–17 months of age in Burkina Faso. The R21/MM candidate vaccine resulted in high titers of malaria-specific antibodies. On August 26, 2021, the findings from a phase 1 trial on a new monoclonal antibody to PfCSP, CIS43LS, showed that a single dose of the CIS43LS monoclonal antibody resulted in protection against malaria. These new findings have implications for the seasonal control of malaria in endemic regions and a possible future role in public health strategies to eliminate malaria. This Editorial aims to provide the background to developing and evaluating the new malaria vaccines that target PfCSP, including the first monoclonal antibody vaccine to malaria.
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Affiliation(s)
- Dinah V Parums
- Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA
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35
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Agudelo Higuita NI, White BP, Franco-Paredes C, McGhee MA. An update on prevention of malaria in travelers. Ther Adv Infect Dis 2021; 8:20499361211040690. [PMID: 34484736 PMCID: PMC8408895 DOI: 10.1177/20499361211040690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Malaria, a parasitic disease caused by protozoa belonging to the genus Plasmodium, continues to represent a formidable public health challenge. Despite being a preventable disease, cases reported among travelers have continued to increase in recent decades. Protection of travelers against malaria, a potentially life-threatening disease, is of paramount importance, and it is therefore necessary for healthcare professionals to be up to date with the most recent recommendations. The present review provides an update of the existent measures for malaria prevention among travelers.
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Affiliation(s)
| | - Bryan Pinckney White
- Infectious Diseases Clinical Pharmacist, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Carlos Franco-Paredes
- Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Miranda Ann McGhee
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Science Center, 800 Stanton L. Young Blvd., Suite 7300, Oklahoma City, OK 73104, USA
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36
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Addy JW, Bediako Y, Ndungu FM, Valetta JJ, Reid AJ, Mwacharo J, Ngoi JM, Wambua J, Otieno E, Musyoki J, Said K, Berriman M, Marsh K, Bejon P, Recker M, Langhorne J. 10-year longitudinal study of malaria in children: Insights into acquisition and maintenance of naturally acquired immunity. Wellcome Open Res 2021; 6:79. [PMID: 35141425 PMCID: PMC8822141 DOI: 10.12688/wellcomeopenres.16562.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Studies of long-term malaria cohorts have provided essential insights into how Plasmodium falciparum interacts with humans, and influences the development of antimalarial immunity. Immunity to malaria is acquired gradually after multiple infections, some of which present with clinical symptoms. However, there is considerable variation in the number of clinical episodes experienced by children of the same age within the same cohort. Understanding this variation in clinical symptoms and how it relates to the development of naturally acquired immunity is crucial in identifying how and when some children stop experiencing further malaria episodes. Where variability in clinical episodes may result from different rates of acquisition of immunity, or from variable exposure to the parasite. Methods: Using data from a longitudinal cohort of children residing in an area of moderate P. falciparum transmission in Kilifi district, Kenya, we fitted cumulative episode curves as monotonic-increasing splines, to 56 children under surveillance for malaria from the age of 5 to 15. Results: There was large variability in the accumulation of numbers of clinical malaria episodes experienced by the children, despite being of similar age and living in the same general location. One group of children from a particular sub-region of the cohort stopped accumulating clinical malaria episodes earlier than other children in the study. Despite lack of further clinical episodes of malaria, these children had higher asymptomatic parasite densities and higher antibody titres to a panel of P. falciparum blood-stage antigens. Conclusions: This suggests development of clinical immunity rather than lack of exposure to the parasite, and supports the view that this immunity to malaria disease is maintained by a greater exposure to P. falciparum, and thus higher parasite burdens. Our study illustrates the complexity of anti-malaria immunity and underscores the need for analyses which can sufficiently reflect the heterogeneity within endemic populations.
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Affiliation(s)
- John W.G. Addy
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
| | - Yaw Bediako
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | | | - John Joseph Valetta
- School of Mathematics and Statistics, University of St Andrews, St Andrews, UK
| | - Adam J. Reid
- Parasite Genomics, Wellcome Sanger Institute, Hixton, UK
| | | | | | - Joshua Wambua
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edward Otieno
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Khadija Said
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Philip Bejon
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mario Recker
- Centre for Ecology and Conservation, University of Exeter, Penryn Campus, Penryn, UK
| | - Jean Langhorne
- Malaria Immunology Laboratory, Francis Crick Institute, London, UK
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37
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Eacret JS, Parzych EM, Gonzales DM, Burns JM. Inclusion of an Optimized Plasmodium falciparum Merozoite Surface Protein 2-Based Antigen in a Trivalent, Multistage Malaria Vaccine. THE JOURNAL OF IMMUNOLOGY 2021; 206:1817-1831. [PMID: 33789984 DOI: 10.4049/jimmunol.2000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
Plasmodium falciparum merozoite surface protein (PfMSP)2 is a target of parasite-neutralizing Abs. Inclusion of recombinant PfMSP2 (rPfMSP2) as a component of a multivalent malaria vaccine is of interest, but presents challenges. Previously, we used the highly immunogenic PfMSP8 as a carrier to enhance production and/or immunogenicity of malaria vaccine targets. In this study, we exploited the benefits of rPfMSP8 as a carrier to optimize a rPfMSP2-based subunit vaccine. rPfMSP2 and chimeric rPfMSP2/8 vaccines produced in Escherichia coli were evaluated in comparative immunogenicity studies in inbred (CB6F1/J) and outbred (CD1) mice, varying the dose and adjuvant. Immunization of mice with both rPfMSP2-based vaccines elicited high-titer anti-PfMSP2 Abs that recognized the major allelic variants of PfMSP2. Vaccine-induced T cells recognized epitopes present in both PfMSP2 and the PfMSP8 carrier. Competition assays revealed differences in Ab specificities induced by the two rPfMSP2-based vaccines, with evidence of epitope masking by rPfMSP2-associated fibrils. In contrast to aluminum hydroxide (Alum) as adjuvant, formulation of rPfMSP2 vaccines with glucopyranosyl lipid adjuvant-stable emulsion, a synthetic TLR4 agonist, elicited Th1-associated cytokines, shifting production of Abs to cytophilic IgG subclasses. The rPfMSP2/8 + glucopyranosyl lipid adjuvant-stable emulsion formulation induced significantly higher Ab titers with superior durability and capacity to opsonize P. falciparum merozoites for phagocytosis. Immunization with a trivalent vaccine including PfMSP2/8, PfMSP1/8, and the P. falciparum 25 kDa sexual stage antigen fused to PfMSP8 (Pfs25/8) induced high levels of Abs specific for epitopes in each targeted domain, with no evidence of antigenic competition. These results are highly encouraging for the addition of rPfMSP2/8 as a component of an efficacious, multivalent, multistage malaria vaccine.
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Affiliation(s)
- Jacqueline S Eacret
- Center for Molecular Parasitology, Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129
| | - Elizabeth M Parzych
- Center for Molecular Parasitology, Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129
| | - Donna M Gonzales
- Center for Molecular Parasitology, Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129
| | - James M Burns
- Center for Molecular Parasitology, Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA 19129
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38
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Pholcharee T, Oyen D, Flores-Garcia Y, Gonzalez-Paez G, Han Z, Williams KL, Volkmuth W, Emerling D, Locke E, Richter King C, Zavala F, Wilson IA. Structural and biophysical correlation of anti-NANP antibodies with in vivo protection against P. falciparum. Nat Commun 2021; 12:1063. [PMID: 33594061 PMCID: PMC7887213 DOI: 10.1038/s41467-021-21221-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/13/2021] [Indexed: 01/07/2023] Open
Abstract
The most advanced P. falciparum circumsporozoite protein-based malaria vaccine, RTS,S/AS01 (RTS,S), confers partial protection but with antibody titers that wane relatively rapidly, highlighting the need to elicit more potent and durable antibody responses. Here, we elucidate crystal structures, binding affinities and kinetics, and in vivo protection of eight anti-NANP antibodies derived from an RTS,S phase 2a trial and encoded by three different heavy-chain germline genes. The structures reinforce the importance of homotypic Fab-Fab interactions in protective antibodies and the overwhelmingly dominant preference for a germline-encoded aromatic residue for recognition of the NANP motif. In this study, antibody apparent affinity correlates best with protection in an in vivo mouse model, with the more potent antibodies also recognizing epitopes with repeating secondary structural motifs of type I β- and Asn pseudo 310 turns; such insights can be incorporated into design of more effective immunogens and antibodies for passive immunization.
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Affiliation(s)
- Tossapol Pholcharee
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - David Oyen
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
- Pfizer Inc, San Diego, CA, USA
| | - Yevel Flores-Garcia
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gonzalo Gonzalez-Paez
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Zhen Han
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
- Wondfo USA Co., Ltd, San Diego, CA, USA
| | | | | | | | - Emily Locke
- PATH's Malaria Vaccine Initiative, Washington, DC, USA
| | | | - Fidel Zavala
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ian A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA.
- The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA, USA.
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39
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Kisalu NK, Pereira LD, Ernste K, Flores-Garcia Y, Idris AH, Asokan M, Dillon M, MacDonald S, Shi W, Chen X, Pegu A, Schön A, Zavala F, Balazs AB, Francica JR, Seder RA. Enhancing durability of CIS43 monoclonal antibody by Fc mutation or AAV delivery for malaria prevention. JCI Insight 2021; 6:143958. [PMID: 33332286 PMCID: PMC7934869 DOI: 10.1172/jci.insight.143958] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023] Open
Abstract
CIS43 is a potent neutralizing human mAb that targets a highly conserved "junctional" epitope in the Plasmodium falciparum (Pf) circumsporozoite protein (PfCSP). Enhancing the durability of CIS43 in vivo will be important for clinical translation. Here, 2 approaches were used to improve the durability of CIS43 in vivo while maintaining potent neutralization. First, the Fc domain was modified with the LS mutations (CIS43LS) to increase CIS43 binding affinity for the neonatal Fc receptor (FcRn). CIS43LS and CIS43 showed comparable in vivo protective efficacy. CIS43LS had 9- to 13-fold increased binding affinity for human (6.2 nM versus 54.2 nM) and rhesus (25.1 nM versus 325.8 nM) FcRn at endosomal pH 6.0 compared with CIS43. Importantly, the half-life of CIS43LS in rhesus macaques increased from 22 days to 39 days compared with CIS43. The second approach for sustaining antibody levels of CIS43 in vivo is through adeno-associated virus (AAV) expression. Mice administered once with AAV-expressing CIS43 had sustained antibody levels of approximately 300 μg/mL and mediated protection against sequential malaria challenges up to 36 weeks. Based on these data, CIS43LS has advanced to phase I clinical trials, and AAV delivery provides a potential next-generation approach for malaria prevention.
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MESH Headings
- Amino Acid Substitution
- Animals
- Antibodies, Anti-Idiotypic/biosynthesis
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/genetics
- Antibodies, Protozoan/administration & dosage
- Antibodies, Protozoan/blood
- Antibodies, Protozoan/genetics
- Dependovirus/genetics
- Female
- Humans
- Immunoglobulin Fc Fragments/administration & dosage
- Immunoglobulin Fc Fragments/genetics
- Macaca mulatta
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/prevention & control
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mutagenesis, Site-Directed
- Plasmodium falciparum/immunology
- Protozoan Proteins/immunology
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Affiliation(s)
- Neville K. Kisalu
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Lais D. Pereira
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Keenan Ernste
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Yevel Flores-Garcia
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Azza H. Idris
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Mangaiarkarasi Asokan
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Marlon Dillon
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Scott MacDonald
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Wei Shi
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Xuejun Chen
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Amarendra Pegu
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Arne Schön
- Department of Biology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fidel Zavala
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alejandro B. Balazs
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Joseph R. Francica
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Robert A. Seder
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
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40
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Chatterjee D, Cockburn IA. The challenges of a circumsporozoite protein-based malaria vaccine. Expert Rev Vaccines 2021; 20:113-125. [PMID: 33554669 DOI: 10.1080/14760584.2021.1874924] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION A safe and effective vaccine will likely be necessary for the control or eradication of malaria which kills 400,000 annually. Our most advanced vaccine candidate to date is RTS,S which is based on the Plasmodium falciparum circumsporozoite protein (PfCSP) of the malaria parasite. However, protection by RTS,S is incomplete and short-lived. AREAS COVERED Here we summarize results from recent clinical trials of RTS,S and critically evaluate recent studies that aim to understand the correlates of protective immunity and why vaccine-induced protection is short-lived. In particular, recent systems serology studies have highlighted a key role for the necessity of inducing functional antibodies. In-depth analyses of immune responses to CSP in both mouse models and vaccinated humans have also highlighted difficulties in generating the maintaining high-quality antibody responses. Finally, in recent years biophysical and structural studies of antibody binding to PfCSP have led to a better understanding of how highly potent antibodies can block infection, which can inform vaccine design. EXPERT OPINION We highlight how both structure-guided vaccine design and a better understanding of the immune response to PfCSP can inform a second generation of PfCSP-based vaccines stimulating a broader range of protective targets within PfCSP.
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Affiliation(s)
- Deepyan Chatterjee
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, the Australian National University, Canberra, Australia
| | - Ian Andrew Cockburn
- Department of Immunology and Infectious Disease, John Curtin School of Medical Research, the Australian National University, Canberra, Australia
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41
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Hassan Shah SM, Mukarram Shah SM, Khan S, Ullah F, Ali Shah SW, Ghias M, Shahid M, Smyth HDC, Hussain Z, Sohail M, Elhissi A, Isreb M. Efficient design to fabricate smart Lumefantrine nanocrystals using DENA® particle engineering technology: Characterisation, in vitro and in vivo antimalarial evaluation and assessment of acute and sub-acute toxicity. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2020.102228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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42
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Gyaase S, Asante KP, Adeniji E, Boahen O, Cairns M, Owusu-Agyei S. Potential effect modification of RTS,S/AS01 malaria vaccine efficacy by household socio-economic status. BMC Public Health 2021; 21:240. [PMID: 33509156 PMCID: PMC7845116 DOI: 10.1186/s12889-021-10294-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/20/2021] [Indexed: 01/17/2023] Open
Abstract
Background In the phase III RTS,S /AS01 trial, significant heterogeneity in efficacy of the vaccine across study sites was seen. Question on whether variations in socio - economic status (SES) of participant contributed to the heterogeinity of the vaccine efficacy (VE) remains unknown. Methods Data from the Phase III RTS,S /AS01 trial in children aged 5–17 months in Kintampo were re-analysed. SES of each child was derived from the Kintampo Health and Demographic Surveillance System, using principal component analysis of household assets. Extended Cox regression was used to estimate the interaction between RTS,S/AS01 VE and household SES. Results Protective efficacy of the RTS,S/AS0 vaccine significantly varied by participant’s household SES, thus increase in household SES was associated with an increase in protective efficacy (P-value = 0.0041). Effect modification persisted after adjusting for age at first vaccination, gender, distance from community to the health facility, child’s haemoglobin level, household size, place of residence and mothers’ educational level. Conclusion Household SES may be a proxy for malaria transmission intensity. The study showed a significant modification of the RTS,S/AS01 malaria vaccine efficacy by the different levels of child’s household socio - economic status. Trial registration Efficacy of GSK Biologicals’ candidate malaria vaccine (25049) against malaria disease in infants and children in Africa. NCT00866619 prospectively registered on 20 March 2009.
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Affiliation(s)
- Stephaney Gyaase
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.,Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Elisha Adeniji
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Owusu Boahen
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana
| | - Matthew Cairns
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana. .,Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. .,Institute of Health Research, University of Health and Allied Sciences, Ho, Volta, Ghana.
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A chemokine-fusion vaccine targeting immature dendritic cells elicits elevated antibody responses to malaria sporozoites in infant macaques. Sci Rep 2021; 11:1220. [PMID: 33441615 PMCID: PMC7807052 DOI: 10.1038/s41598-020-79427-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
Infants and young children are the groups at greatest risk for severe disease resulting from Plasmodium falciparum infection. We previously demonstrated in mice that a protein vaccine composed of the chemokine macrophage inflammatory protein 3α genetically fused to the minimally truncated circumsporozoite protein of P. falciparum (MCSP) elicits high concentrations of specific antibody and significant reduction of liver sporozoite load in a mouse model system. In the current study, a squalene based adjuvant (AddaVax, InvivoGen, San Diego, Ca) equivalent to the clinically approved MF59 (Seqiris, Maidenhead, UK) elicited greater antibody responses in mice than the previously employed adjuvant polyinosinic:polycytidylic acid, ((poly(I:C), InvivoGen, San Diego, Ca) and the clinically approved Aluminum hydroxide gel (Alum, Invivogen, San Diego, Ca) adjuvant. Use of the AddaVax adjuvant also expanded the range of IgG subtypes elicited by mouse vaccination. Sera passively transferred into mice from MCSP/AddaVax immunized 1 and 6 month old macaques significantly reduced liver sporozoite load upon sporozoite challenge. Protective antibody concentrations attained by passive transfer in the mice were equivalent to those observed in infant macaques 18 weeks after the final immunization. The efficacy of this vaccine in a relevant non-human primate model indicates its potential usefulness for the analogous high risk human population.
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Bell GJ, Agnandji ST, Asante KP, Ghansah A, Kamthunzi P, Emch M, Bailey JA. Impacts of Ecology, Parasite Antigenic Variation, and Human Genetics on RTS,S/AS01e Malaria Vaccine Efficacy. CURR EPIDEMIOL REP 2021; 8:79-88. [PMID: 34367877 PMCID: PMC8324449 DOI: 10.1007/s40471-021-00271-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Global malaria elimination has little chance of success without an effective vaccine. The first malaria vaccine, RTS,S/AS01e, demonstrated moderate efficacy against clinical malaria in phase III trials and is undergoing large-scale effectiveness trials in Africa. Importantly, the vaccine did not perform equally well between phase III study sites. Though reasons for the moderate efficacy and this variation are unclear, various mechanisms have been suggested. This review summarizes the recent literature on such mechanisms, with a focus on those involving landscape ecology, parasite antigenic variation, and human host genetic differences. RECENT FINDINGS Transmission intensity may have a role pre- and post-vaccination in modulating immune responses to the vaccine. Furthermore, malaria incidence may "rebound" in vaccinated populations living in high transmission intensity settings. There is growing evidence that both genetic variation in the parasite circumsporozoite protein and variation of human host genetic factors affect RTS,S vaccine efficacy. These genetic factors may be interacting in complex ways to produce variation in the natural and vaccine-induced immune responses that protect against malaria. SUMMARY Due to the modest efficacy of RTS,S/AS01e, the combinations of factors (ecological, parasite, human host) impacting its effectiveness must be clearly understood, as this information will be critical for implementation policy and future vaccine designs.
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Affiliation(s)
- Griffin J. Bell
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon ,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Michael Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA ,Department of Geography, University of North Carolina, Chapel Hill 220 E Cameron Ave, Chapel Hill, NC 27599 USA
| | - Jeffrey A. Bailey
- Department of Pathology and Laboratory Medicine, Brown University, 55 Claverick St, Rm 314B, Providence, RI 02912 USA
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Hamre KES, Ondigo BN, Hodges JS, Dutta S, Theisen M, Ayodo G, John CC. Antibody Correlates of Protection from Clinical Plasmodium falciparum Malaria in an Area of Low and Unstable Malaria Transmission. Am J Trop Med Hyg 2020; 103:2174-2182. [PMID: 33124533 DOI: 10.4269/ajtmh.18-0805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Immune correlates of protection against clinical malaria are difficult to ascertain in low-transmission areas because of the limited number of malaria cases. We collected blood samples from 5,753 individuals in a Kenyan highland area, ascertained malaria incidence in this population over the next 6 years, and then compared antibody responses to 11 Plasmodium falciparum vaccine candidate antigens in individuals who did versus did not develop clinical malaria in a nested case-control study (154 cases and 462 controls). Individuals were matched by age and village. Antigens tested included circumsporozoite protein (CSP), liver-stage antigen (LSA)-1, apical membrane antigen-1 FVO and 3D7 strains, erythrocyte-binding antigen-175, erythrocyte-binding protein-2, merozoite surface protein (MSP)-1 FVO and 3D7 strains, MSP-3, and glutamate-rich protein (GLURP) N-terminal non-repetitive (R0) and C-terminal repetitive (R2) regions. After adjustment for potential confounding factors, the presence of antibodies to LSA-1, GLURP-R2, or GLURP-R0 was associated with decreased odds of developing clinical malaria (odds ratio [OR], [95% CI] 0.56 [0.36-0.89], 0.56 [0.36-0.87], and 0.77 [0.43-1.02], respectively). Levels of antibodies to LSA-1, GLURP-R2, and CSP were associated with decreased odds of developing clinical malaria (OR [95% CI]; 0.61 [0.41-0.89], 0.60 [0.43-0.84], and 0.49 [0.24-0.99], for every 10-fold increase in antibody levels, respectively). The presence of antibodies to CSP, GLURP-R0, GLURP-R2, and LSA-1 combined best-predicted protection from clinical malaria. Antibodies to CSP, GLURP-R0, GLURP-R2, and LSA-1 are associated with protection against clinical malaria in a low-transmission setting. Vaccines containing these antigens should be evaluated in low malaria transmission areas.
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Affiliation(s)
- Karen E S Hamre
- CDC Foundation, Atlanta, Georgia.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Bartholomew N Ondigo
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya
| | - James S Hodges
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Sheetij Dutta
- Walter Reed Army Institute for Research, Silver Spring, Maryland
| | | | - George Ayodo
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya.,Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Chandy C John
- Division of Global Pediatrics, University of Minnesota, Minneapolis, Minnesota.,Department of Biochemistry and Molecular Biology, Egerton University, Nakuru, Kenya.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Pediatrics, Indiana University, Indianapolis, Indiana
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46
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VOGT-GEISSE KATIA, NGONGHALA CALISTUSN, FENG ZHILAN. THE IMPACT OF VACCINATION ON MALARIA PREVALENCE: A VACCINE-AGE-STRUCTURED MODELING APPROACH. J BIOL SYST 2020. [DOI: 10.1142/s0218339020400094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A deterministic model for the effects on disease prevalence of the most advanced pre-erythrocytic vaccine against malaria is proposed and studied. The model includes two vaccinated classes that correspond to initially vaccinated and booster dose vaccinated individuals. These two classes are structured by time-since-initial-vaccination (vaccine-age). This structure is a novelty for vector–host models; it allows us to explore the effects of parameters that describe timed and delayed delivery of a booster dose, and immunity waning on disease prevalence. Incorporating two vaccinated classes can predict more accurately threshold vaccination coverages for disease eradication under multi-dose vaccination programs. We derive a vaccine-age-structured control reproduction number [Formula: see text] and establish conditions for the existence and stability of equilibria to the system. The model is bistable when [Formula: see text]. In particular, it exhibits a backward (sub-critical) bifurcation, indicating that [Formula: see text] is no longer the threshold value for disease eradication. Thus, to achieve eradication we must identify and implement control measures that will reduce [Formula: see text] to a value smaller than unity. Therefore, it is crucial to be cautious when using [Formula: see text] to guide public health policy, although it remains a key quantity for decision making. Our results show that if the booster vaccine dose is administered with delay, individuals may not acquire its full protective effect, and that incorporating waning efficacy into the system improves the accuracy of the model outcomes. This study suggests that it is critical to follow vaccination schedules closely, and anticipate the consequences of delays in those schedules.
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Affiliation(s)
- KATIA VOGT-GEISSE
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Peñalolén, Santiago, 7941169, Chile
| | - CALISTUS N. NGONGHALA
- Department of Mathematics, University of Florida, 1400 Stadium Rd, Gainesville, FL 32611, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - ZHILAN FENG
- Department of Mathematics, Purdue University, 150 N. University Street, West Lafayette, IN 47907-2067, USA
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47
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Phares TW, Kotraiah V, Karunarathne DS, Huang J, Browne CD, Buontempo P, Mansour M, Noe AR, Wykes MN, Pannucci J, Tsuji M, Gutierrez GM. A Peptide-Based PD1 Antagonist Enhances T-Cell Priming and Efficacy of a Prophylactic Malaria Vaccine and Promotes Survival in a Lethal Malaria Model. Front Immunol 2020; 11:1377. [PMID: 32733457 PMCID: PMC7363839 DOI: 10.3389/fimmu.2020.01377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/29/2020] [Indexed: 12/14/2022] Open
Abstract
The blockade of programmed cell death-1 (PD1) and its ligand PDL1 has been proven to be a successful immunotherapy against several cancers. Similar to cancer, PD1 contributes to the establishment of several chronic infectious diseases, including malaria. While monoclonal antibodies (mAbs) targeting checkpoint receptors are revolutionary in cancer treatment, the immune-related adverse events (irAEs) may prevent their utilization in prophylactic and therapeutic treatments of infectious diseases. The irAEs are, in part, due to the prolonged half-life of mAbs resulting in prolonged activation of the immune system. As an alternative modality to mAbs, peptides represent a viable option because they possess a shorter pharmacokinetic half-life and offer more formulation and delivery options. Here, we report on a 22-amino acid immunomodulatory peptide, LD01, derived from a Bacillus bacteria. When combined prophylactically with an adenovirus-based or irradiated sporozoite-based malaria vaccine, LD01 significantly enhanced antigen-specific CD8+ T cell expansion. Therapeutically, LD01 treatment of mice infected with a lethal malaria strain resulted in survival that was associated with lower numbers of FOXP3+Tbet+CD4+ regulatory T cells. Taken together, our results demonstrate that LD01 is a potent immunomodulator that acts upon the adaptive immune system to stimulate T cell responses both prophylactically and therapeutically.
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Affiliation(s)
- Timothy W Phares
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
| | - Vinayaka Kotraiah
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
| | | | - Jing Huang
- The Aaron Diamond AIDS Research Center, New York, NY, United States
| | | | - Peter Buontempo
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
| | - Marc Mansour
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
| | - Amy R Noe
- Leidos Life Sciences, Leidos Inc., Frederick, MD, United States
| | | | - James Pannucci
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
| | - Moriya Tsuji
- The Aaron Diamond AIDS Research Center, New York, NY, United States
| | - Gabriel M Gutierrez
- Explorations in Global Health (ExGloH), Leidos Inc., Frederick, MD, United States
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48
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Hickey B, Teneza-Mora N, Lumsden J, Reyes S, Sedegah M, Garver L, Hollingdale MR, Banania JG, Ganeshan H, Dowler M, Reyes A, Tamminga C, Singer A, Simmons A, Belmonte M, Belmonte A, Huang J, Inoue S, Velasco R, Abot S, Vasquez CS, Guzman I, Wong M, Twomey P, Wojnarski M, Moon J, Alcorta Y, Maiolatesi S, Spring M, Davidson S, Chaudhury S, Villasante E, Richie TL, Epstein JE. IMRAS-A clinical trial of mosquito-bite immunization with live, radiation-attenuated P. falciparum sporozoites: Impact of immunization parameters on protective efficacy and generation of a repository of immunologic reagents. PLoS One 2020; 15:e0233840. [PMID: 32555601 PMCID: PMC7299375 DOI: 10.1371/journal.pone.0233840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/12/2020] [Indexed: 12/31/2022] Open
Abstract
Background Immunization with radiation-attenuated sporozoites (RAS) by mosquito bite provides >90% sterile protection against Plasmodium falciparum (Pf) malaria in humans. RAS invade hepatocytes but do not replicate. CD8+ T cells recognizing parasite-derived peptides on the surface of infected hepatocytes are likely the primary protective mechanism. We conducted a randomized clinical trial of RAS immunization to assess safety, to achieve 50% vaccine efficacy (VE) against controlled human malaria infection (CHMI), and to generate reagents from protected and non-protected subjects for future identification of protective immune mechanisms and antigens. Methods Two cohorts (Cohort 1 and Cohort 2) of healthy, malaria-naïve, non-pregnant adults age 18–50 received five monthly immunizations with infected (true-immunized, n = 21) or non-infected (mock-immunized, n = 5) mosquito bites and underwent homologous CHMI at 3 weeks. Immunization parameters were selected for 50% protection based on prior clinical data. Leukapheresis was done to collect plasma and peripheral blood mononuclear cells. Results Adverse event rates were similar in true- and mock-immunized subjects. Two true- and two mock-immunized subjects developed large local reactions likely caused by mosquito salivary gland antigens. In Cohort 1, 11 subjects received 810–1235 infected bites; 6/11 (55%) were protected against CHMI vs. 0/3 mock-immunized and 0/6 infectivity controls (VE 55%). In Cohort 2, 10 subjects received 839–1131 infected bites with a higher first dose and a reduced fifth dose; 9/10 (90%) were protected vs. 0/2 mock-immunized and 0/6 controls (VE 90%). Three/3 (100%) protected subjects administered three booster immunizations were protected against repeat CHMI vs. 0/6 controls (VE 100%). Cohort 2 uniquely showed a significant rise in IFN-γ responses after the third and fifth immunizations and higher antibody responses to CSP. Conclusions PfRAS were generally safe and well tolerated. Cohort 2 had a higher first dose, reduced final dose, higher antibody responses to CSP and significant rise of IFN-γ responses after the third and fifth immunizations. Whether any of these factors contributed to increased protection in Cohort 2 requires further investigation. A cryobank of sera and cells from protected and non-protected individuals was generated for future immunological studies and antigen discovery. Trial registration ClinicalTrials.gov NCT01994525.
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Affiliation(s)
- Bradley Hickey
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Nimfa Teneza-Mora
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Joanne Lumsden
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Sharina Reyes
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Martha Sedegah
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Lindsey Garver
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Michael R. Hollingdale
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
- * E-mail:
| | - Jo Glenna Banania
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Harini Ganeshan
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Megan Dowler
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Anatalio Reyes
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Cindy Tamminga
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Alexandra Singer
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Alicia Simmons
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Maria Belmonte
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Arnel Belmonte
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Jun Huang
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Sandra Inoue
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Rachel Velasco
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Steve Abot
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Carlos S. Vasquez
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Ivelese Guzman
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Mimi Wong
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Patrick Twomey
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Mariusz Wojnarski
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - James Moon
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Yolanda Alcorta
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Santina Maiolatesi
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Michele Spring
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Silas Davidson
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
| | - Sidhartha Chaudhury
- Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Biotechnology HPC Software Applications Institute, Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Development Command, Frederick, MD, United States of America
| | - Eileen Villasante
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Thomas L. Richie
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Judith E. Epstein
- Malaria Department, Naval Medical Research Center, Silver Spring, MD, United States of America
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49
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Marques RF, Gimenez AM, Aliprandini E, Novais JT, Cury DP, Watanabe IS, Dominguez MR, Silveira ELV, Amino R, Soares IS. Protective Malaria Vaccine in Mice Based on the Plasmodium vivax Circumsporozoite Protein Fused with the Mumps Nucleocapsid Protein. Vaccines (Basel) 2020; 8:vaccines8020190. [PMID: 32325874 PMCID: PMC7348950 DOI: 10.3390/vaccines8020190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/22/2022] Open
Abstract
Plasmodium vivax is the most common species of human malaria parasite found outside Africa, with high endemicity in Asia, Central and South America, and Oceania. Although Plasmodium falciparum causes the majority of deaths, P. vivax can lead to severe malaria and result in significant morbidity and mortality. The development of a protective vaccine will be a major step toward malaria elimination. Recently, a formulation containing the three allelic variants of the P. vivax circumsporozoite protein (PvCSP—All epitopes) showed partial protection in mice after a challenge with the hybrid Plasmodium berghei (Pb) sporozoite, in which the PbCSP central repeats were replaced by the VK210 PvCSP repeats (Pb/Pv sporozoite). In the present study, the chimeric PvCSP allelic variants (VK210, VK247, and P. vivax-like) were fused with the mumps virus nucleocapsid protein in the absence (NLP-CSPR) or presence of the conserved C-terminal (CT) domain of PvCSP (NLP-CSPCT). To elicit stronger humoral and cellular responses, Pichia pastoris yeast was used to assemble them as nucleocapsid-like particles (NLPs). Mice were immunized with each recombinant protein adjuvanted with Poly (I:C) and presented a high frequency of antigen-specific antibody-secreting cells (ASCs) on days 5 and 30, respectively, in the spleen and bone marrow. Moreover, high IgG titers against all PvCSP variants were detected in the sera. Later, these immunized mice with NLP-CSPCT were challenged with Pb/Pv sporozoites. Sterile protection was observed in 30% of the challenged mice. Therefore, this vaccine formulation use has the potential to be a good candidate for the development of a universal vaccine against P. vivax malaria.
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Affiliation(s)
- Rodolfo F. Marques
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
| | - Alba Marina Gimenez
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
- Center of Cellular and Molecular Therapy, Federal University of São Paulo, São Paulo 04044-010 SP, Brazil
| | - Eduardo Aliprandini
- Unit of Malaria Infection & Immunity, Institut Pasteur, 75015 Paris, France; (E.A.); (R.A.)
| | - Janaina T. Novais
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
| | - Diego P. Cury
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (D.P.C.); (I.-S.W.)
| | - Ii-Sei Watanabe
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (D.P.C.); (I.-S.W.)
| | - Mariana R. Dominguez
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
| | - Eduardo L. V. Silveira
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
| | - Rogerio Amino
- Unit of Malaria Infection & Immunity, Institut Pasteur, 75015 Paris, France; (E.A.); (R.A.)
| | - Irene S. Soares
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05508-000 SP, Brazil; (R.F.M.); (A.M.G.); (J.T.N.); (M.R.D.); (E.L.V.S.)
- Correspondence:
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Dinga JN, Perimbie SN, Gamua SD, Chuma FNG, Njimoh DL, Djikeng A, Pelle R, Titanji VPK. Analysis of the Role of TpUB05 Antigen from Theileria parva in Immune Responses to Malaria in Humans Compared to Its Homologue in Plasmodium falciparum the UB05 Antigen. Pathogens 2020; 9:pathogens9040271. [PMID: 32276308 PMCID: PMC7238281 DOI: 10.3390/pathogens9040271] [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: 01/27/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/19/2022] Open
Abstract
Despite the amount of resources deployed and the technological advancements in molecular biology, vaccinology, immunology, genetics, and biotechnology, there are still no effective vaccines against malaria. Immunity to malaria is usually seen to be species- and/or strain-specific. However, there is a growing body of evidence suggesting the possibility of the existence of cross-strain, cross-species, and cross-genus immune responses in apicomplexans. The principle of gene conservation indicates that homologues play a similar role in closely related organisms. The homologue of UB05 in Theileria parva is TpUB05 (XP_763711.1), which has been tested and shown to be associated with protective immunity in East Coast fever. In a bid to identify potent markers of protective immunity to aid malaria vaccine development, TpUB05 was tested in malaria caused by Plasmodium falciparum. It was observed that TpUB05 was better at detecting antigen-specific antibodies in plasma compared to UB05 when tested by ELISA. The total IgG raised against TpUB05 was able to block parasitic growth in vitro more effectively than that raised against UB05. However, there was no significant difference between the two study antigens in recalling peripheral blood mononuclear cell (PBMC) memory through IFN-γ production. This study suggests, for the first time, that TpUB05 from T. parva cross-reacts with UB05 from P. falciparum and is a marker of protective immunity in malaria. Hence, TpUB05 should be considered for possible development as a potential subunit vaccine candidate against malaria.
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Affiliation(s)
- Jerome Nyhalah Dinga
- Biotechnology Unit, Faculty of Science, University of Buea, P O. Box 63 Buea, Cameroon
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P. O. Box 63 Buea, Cameroon
- Correspondence: ; Tel.: +237-233322134
| | - Stephanie Numenyi Perimbie
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P. O. Box 63 Buea, Cameroon
| | - Stanley Dobgima Gamua
- Biotechnology Unit, Faculty of Science, University of Buea, P O. Box 63 Buea, Cameroon
| | - Francis N. G. Chuma
- Biosciences Eastern and Central Africa—International Livestock Research Institute (BecA-ILRI) Hub, P. O. Box 30709 Nairobi, Kenya
| | - Dieudonné Lemuh Njimoh
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P. O. Box 63 Buea, Cameroon
| | - Appolinaire Djikeng
- Biosciences Eastern and Central Africa—International Livestock Research Institute (BecA-ILRI) Hub, P. O. Box 30709 Nairobi, Kenya
- Centre for Tropical Livestock Genetics and Health, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, Easter Bush Campus, EH25 9RG Edinburgh, UK
| | - Roger Pelle
- Biosciences Eastern and Central Africa—International Livestock Research Institute (BecA-ILRI) Hub, P. O. Box 30709 Nairobi, Kenya
| | - Vincent P. K. Titanji
- Biotechnology Unit, Faculty of Science, University of Buea, P O. Box 63 Buea, Cameroon
- Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, P. O. Box 63 Buea, Cameroon
- Faculty of Science, Engineering and Technology, Cameroon Christian University Institute, P.O. Box 5 Bali, Cameroon
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