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Anabire NG, Quintana MDP, Ofori MF, Hviid L. The Rapid and Spontaneous Postpartum Clearance of Plasmodium falciparum Is Related to Expulsion of the Placenta. J Infect Dis 2023; 228:196-201. [PMID: 36740589 PMCID: PMC10345473 DOI: 10.1093/infdis/jiad031] [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: 10/21/2022] [Revised: 12/29/2022] [Accepted: 02/02/2023] [Indexed: 02/07/2023] Open
Abstract
Parasitemia among pregnant women with protective immunity to Plasmodium falciparum malaria is often dominated by VAR2CSA-positive infected erythrocytes (IEs). VAR2CSA mediates sequestration of IEs in the placenta. We hypothesized that the previously observed spontaneous postpartum clearance of parasitemia in such women is related to the expulsion of the placenta, which removes the sequestration focus of VAR2CSA-positive IEs. We assessed parasitemias and gene transcription before and shortly after delivery in 17 Ghanaian women. The precipitous decline in parasitemia postpartum was accompanied by selective reduction in transcription of the gene encoding VAR2CSA. Our findings provide a mechanistic explanation for the earlier observation.
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Affiliation(s)
- Nsoh G Anabire
- Department of Immunology, Noguchi Memorial Institute for Medical Research,
University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, Department of
Biochemistry, Cell, and Molecular Biology, University of Ghana,
Accra, Ghana
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
| | - Maria del Pilar Quintana
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research,
University of Ghana, Accra, Ghana
| | - Lars Hviid
- Centre for Medical Parasitology, Department of Immunology and Microbiology,
Faculty of Health and Medical Sciences, University of Copenhagen,
Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet,
Copenhagen, Denmark
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2
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Naheda A, Aqeel S, Khan K, Khan W, Khan T. Immunohistopathological changes in the placenta of malaria-infected women in unstable transmission setting of Aligarh. Placenta 2022; 127:52-61. [PMID: 35970103 DOI: 10.1016/j.placenta.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/16/2022] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Pregnant women are more susceptible to malaria due to a combination of physiological and immunological changes. The infection may even affect the growth and survival of the foetus, which mainly occur when parasite enters the placenta. The sequestration of infected erythrocytes may trigger the host response, leading to placental inflammation and altered development, affecting the structure and nutrient transport of placenta. These factors collectively impair placental functions and affect foetal growth. METHODS Pregnant women with peripheral parasitaemia for P. falciparum and P. vivax (20 each) were included in the present study, along with 15 age-matched uninfected healthy pregnant women. Placentae were analysed for the presence of local parasitaemia along with pathological lesions caused due to the parasite. Immunohistochemical staining for CD20, CD45 and CD68 cells was performed for examining the specific leucocytes in the intervillous space of the placenta. RESULTS Of the 20 individuals with P. falciparum, only seven placentae showed parasitaemia, whereas individuals with P. vivax showed no placental infection. The pathological changes observed in the P. falciparum-infected placenta include syncytial knotting, excess fibrinoid deposition, syncytiotrophoblast necrosis, syncytial rupture, thickening of trophoblast basement membrane and increased collagen deposition. Immunohistochemical staining showed a significant increase in B cells (CD20), leucocytes (CD45) and monocytes and macrophages (CD68) in the P. falciparum-infected placenta (p < 0.0001). DISCUSSION The result implies that P. falciparum is responsible for pathological alterations in placenta, affecting the nutrient transport across placenta and foetal growth. The immune cells also migrate to the placenta and accumulate in the intervillous space to show humoral and cell-mediated immunity against the parasite.
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Affiliation(s)
- Ansari Naheda
- Section of Parasitology, Department of Zoology, Aligarh Muslim University, Aligarh, 202002, India.
| | - Sana Aqeel
- Section of Parasitology, Department of Zoology, Aligarh Muslim University, Aligarh, 202002, India
| | - Khadija Khan
- Section of Parasitology, Department of Zoology, Aligarh Muslim University, Aligarh, 202002, India
| | - Wajihullah Khan
- Section of Parasitology, Department of Zoology, Aligarh Muslim University, Aligarh, 202002, India.
| | - Tamkin Khan
- Department of Obstetrics & Gynaecology, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, Aligarh, 202002, India
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3
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Niikura M, Fukutomi T, Mineo S, Mitobe J, Kobayashi F. Malaria in the postpartum period causes damage to the mammary gland. PLoS One 2021; 16:e0258491. [PMID: 34644348 PMCID: PMC8513860 DOI: 10.1371/journal.pone.0258491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Mastitis is an inflammation of the mammary gland in the breast and is typically due to bacterial infection. In malaria-endemic areas, mastitis with accompanying fever can be challenging to differentiate from malaria. At the same time, it is unclear whether malaria infection is directly involved in the development of mastitis. In the present study, whether mastitis develops during infection with malaria parasites was investigated using a rodent malaria model with Plasmodium berghei (P. berghei; Pb) ANKA. The course of parasitemia in postpartum mice infected with Pb ANKA was similar to the course in infected virgin mice. However, infected postpartum mice died earlier than did infected virgin mice. In addition, the weight of pups from mice infected with Pb ANKA was significantly reduced compared with pups from uninfected mice. The macroscopic and histological analyses showed apparent changes, such as destruction of the alveolus wall and extensive presence of leukocytes, in mammary gland tissue in mice infected during the postpartum period. The findings suggest that women during the postpartum period are more vulnerable to complications when infected with malaria parasites, particularly women who do not acquire protective immunity against malaria parasites. Based on the proteomic analysis, IFN-γ signaling pathway-related proteins in mammary gland tissue of the infected postpartum mice were increased. Our results indicate that inflammation induced by IFN-γ, a proinflammatory cytokine, may contribute to negative histological changes in mammary gland tissue of postpartum mice infected with Pb ANKA. In IFN-γ receptor 1-deficient (IFNGR1-KO) mice, the histological changes in mammary gland tissue of the infected postpartum wild-type mice were improved to almost normal mammary gland structure. Furthermore, weight loss in pups delivered by infected IFNGR1-KO postpartum mice was not observed. Taken together, these findings indicate that inflammation induced by IFN-γ is associated with development of mastitis in postpartum mice infected with Pb ANKA. The present study results may increase our understanding of how disease aggravation occurs during postpartum malaria.
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Affiliation(s)
- Mamoru Niikura
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Toshiyuki Fukutomi
- Department of Pharmacology and Toxicology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shoichiro Mineo
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Jiro Mitobe
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Fumie Kobayashi
- Department of Environmental Science, School of Life and Environmental Science, Azabu University, Kanagawa, Japan
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4
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Megli CJ, Coyne CB. Infections at the maternal-fetal interface: an overview of pathogenesis and defence. Nat Rev Microbiol 2021; 20:67-82. [PMID: 34433930 PMCID: PMC8386341 DOI: 10.1038/s41579-021-00610-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 02/08/2023]
Abstract
Infections are a major threat to human reproductive health, and infections in pregnancy can cause prematurity or stillbirth, or can be vertically transmitted to the fetus leading to congenital infection and severe disease. The acronym ‘TORCH’ (Toxoplasma gondii, other, rubella virus, cytomegalovirus, herpes simplex virus) refers to pathogens directly associated with the development of congenital disease and includes diverse bacteria, viruses and parasites. The placenta restricts vertical transmission during pregnancy and has evolved robust mechanisms of microbial defence. However, microorganisms that cause congenital disease have likely evolved diverse mechanisms to bypass these defences. In this Review, we discuss how TORCH pathogens access the intra-amniotic space and overcome the placental defences that protect against microbial vertical transmission. Infections during pregnancy can be associated with devastating outcomes for the pregnant mother and developing fetus. In this Review, Megli and Coyne discuss placental defences and provide an overview of how various viral, bacterial and parasitic pathogens traverse the maternal–fetal interface and cause disease.
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Affiliation(s)
- Christina J Megli
- Division of Maternal-Fetal Medicine, Division of Reproductive Infectious Disease, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and the Magee Womens Research Institute, Pittsburgh, PA, USA.
| | - Carolyn B Coyne
- Department of Molecular Genetics and Microbiology and the Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.
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5
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Gill J, Chakraborti S, Bharti P, Sharma A. Structural insights into global mutations in the ligand-binding domain of VAR2CSA and its implications on placental malaria vaccine. Int J Infect Dis 2021; 112:35-39. [PMID: 34450283 DOI: 10.1016/j.ijid.2021.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022] Open
Abstract
Placental malaria is a public health burden particularly in Africa as it causes severe symptoms and results in stillbirths or maternal deaths. Plasmodium falciparum protein VAR2CSA drives placental malaria (PM) in pregnant women by adhering to chondroitin sulfate A (CSA) on the placenta. VAR2CSA is a primary vaccine candidate for PM with two vaccines based on it already under clinical trials. The first cryo-EM three-dimensional structure of Pf CSA-VAR2CSA complex revealed crucial interacting residues considered to be highly conserved across P. falciparum strains. In the current study, we have conducted a global sequence analysis of 1,114 VAR2CSA field isolate sequences from more than nine countries across three continents revealing numerous mutations in CSA-binding residues. Further, structural mapping has revealed significant polymorphisms on the ligand binding surfaces. The variants from this limited set of 1,114 sequences highlight the concerns that are vital in current considerations for development of vaccines based on VAR2CSA for placental malaria.
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Affiliation(s)
- Jasmita Gill
- ICMR-National Institute of Malaria Research, New Delhi, India.
| | | | - Praveen Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India; Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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6
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Mwin PK, Kuffuor A, Nuhu K, Okine R, Kubio C, Wurapa F, Osei FA, Afari E. Predictors of placental malaria in Upper West Regional Hospital-Ghana. BMC Pregnancy Childbirth 2021; 21:403. [PMID: 34039288 PMCID: PMC8157656 DOI: 10.1186/s12884-021-03861-y] [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: 06/12/2020] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Placental malaria (PM) poses life-threatening complications to pregnant women as they are at increased risk of maternal and perinatal morbidity and mortality associated with malaria. This study examined the factors associated with placental malaria in the Upper West Regional Hospital (UWR). Methods A cross-sectional hospital-based study was carried out among pregnant women delivering at Upper West Regional Hospital. A cross-sectional screening survey was conducted from January 2019 to April 2019. Three hundred eligible mothers were consecutively recruited. A record review of their maternal and child history was assessed using a checklist. Placental blood samples were taken for microscopy to determine placental malaria parasitemia. Logistic regression analysis was done to determine the factors associated with placental malaria at 95 % confidence level. Results The proportion of mothers with placental malaria was 7 % (21/300), (95 % CI, 4.3–10.5 %). Plasmodium falciparum was the only species identified in those with PM. Majority of the women 66.7 % (14/21) with placental malaria had parasite density in the range 501 to 5,000 parasites/µL. Obstetric and health service factors that were significantly associated with placental malaria were gravidity and antenatal care (ANC) attendance. Primigravida (aOR = 3.48, 95 %CI = 1.01–12.01) and having less than 4 ANC attendance (aOR = 9.78, 95 %CI = 2.89–33.11) were found to be significantly associated with placental malaria. Conclusions The proportion of women with PM was relatively low. Primigravid mothers reporting less than 4 ANC visits had the highest risk of placental malaria. Expectant mothers should be encouraged to attend at least 4 ANC visits prior to delivery.
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Affiliation(s)
- Pascal Kingsley Mwin
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
| | - Afreh Kuffuor
- Ghana Health Service, Upper West Regional Health Directorate, Karaga, Ghana
| | - Kaamel Nuhu
- State University of New York - Cortland, Cortland, USA
| | - Rafiq Okine
- World Health Organization (WHO), Country Office for Ghana, Accra, Ghana
| | - Chrysantus Kubio
- Ghana Health Service, Karaga District Health Directorate, Karaga, Ghana
| | - Frederick Wurapa
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
| | - Francis Adjei Osei
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana. .,KNUST School of Public Health, Kumasi, Ghana.
| | - Edwin Afari
- Field Epidemiology and Laboratory Training Program, School of Public Health, University of Ghana, Legon, USA
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7
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Toledo AG, Pihl J, Spliid CB, Persson A, Nilsson J, Pereira MA, Gustavsson T, Choudhary S, Oo HZ, Black PC, Daugaard M, Esko JD, Larson G, Salanti A, Clausen TM. An affinity chromatography and glycoproteomics workflow to profile the chondroitin sulfate proteoglycans that interact with malarial VAR2CSA in the placenta and in cancer. Glycobiology 2020; 30:989-1002. [PMID: 32337544 DOI: 10.1093/glycob/cwaa039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Chondroitin sulfate (CS) is the placental receptor for the VAR2CSA malaria protein, expressed at the surface of infected erythrocytes during Plasmodium falciparum infection. Infected cells adhere to syncytiotrophoblasts or get trapped within the intervillous space by binding to a determinant in a 4-O-sulfated CS chains. However, the exact structure of these glycan sequences remains unclear. VAR2CSA-reactive CS is also expressed by tumor cells, making it an attractive target for cancer diagnosis and therapeutics. The identities of the proteoglycans carrying these modifications in placental and cancer tissues remain poorly characterized. This information is clinically relevant since presentation of the glycan chains may be mediated by novel core proteins or by a limited subset of established proteoglycans. To address this question, VAR2CSA-binding proteoglycans were affinity-purified from the human placenta, tumor tissues and cancer cells and analyzed through a specialized glycoproteomics workflow. We show that VAR2CSA-reactive CS chains associate with a heterogenous group of proteoglycans, including novel core proteins. Additionally, this work demonstrates how affinity purification in combination with glycoproteomics analysis can facilitate the characterization of CSPGs with distinct CS epitopes. A similar workflow can be applied to investigate the interaction of CSPGs with other CS binding lectins as well.
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Affiliation(s)
- Alejandro Gómez Toledo
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA 92093, USA.,Glycobiology Research and Training Center, University of California, San Diego, La Jolla, CA 92093, USA
| | - Jessica Pihl
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Charlotte B Spliid
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA 92093, USA.,Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Andrea Persson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of SE405 30 Gothenburg, Sweden
| | - Jonas Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of SE405 30 Gothenburg, Sweden
| | - Marina Ayres Pereira
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Tobias Gustavsson
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Swati Choudhary
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Htoo Zarni Oo
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H3Z6, Canada
| | - Peter C Black
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H3Z6, Canada
| | - Mads Daugaard
- Vancouver Prostate Center, Department of Urologic Sciences, University of British Columbia, Vancouver, BC V6H3Z6, Canada
| | - Jeffrey D Esko
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA 92093, USA.,Glycobiology Research and Training Center, University of California, San Diego, La Jolla, CA 92093, USA
| | - Göran Larson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of SE405 30 Gothenburg, Sweden
| | - Ali Salanti
- Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
| | - Thomas Mandel Clausen
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA 92093, USA.,Centre for Medical Parasitology at Department for Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and Department of Infectious Disease, Copenhagen University Hospital, 2200 Copenhagen, Denmark
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8
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Lima FA, Barateiro A, Dombrowski JG, de Souza RM, Costa DDS, Murillo O, Epiphanio S, Gonçalves LA, Marinho CRF. Plasmodium falciparum infection dysregulates placental autophagy. PLoS One 2019; 14:e0226117. [PMID: 31805150 PMCID: PMC6894763 DOI: 10.1371/journal.pone.0226117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022] Open
Abstract
Plasmodium (P.) falciparum malaria during pregnancy has been frequently associated with severe consequences such as maternal anemia, abortion, premature birth, and reduced birth weight. Placental damage promotes disruption of the local homeostasis; though, the mechanisms underlying these events are still to be elucidated. Autophagy is a fundamental homeostatic mechanism in the natural course of pregnancy by which cells self-recycle in order to survive in stressful environments. Placentas from non-infected and P. falciparum-infected women during pregnancy were selected from a previous prospective cohort study conducted in the Brazilian Amazon (Acre, Brazil). Newborns from infected women experienced reduced birth weight (P = 0.0098) and placental immunopathology markers such as monocyte infiltrate (P < 0.0001) and IL-10 production (P = 0.0122). The placentas were evaluated for autophagy-related molecules. As a result, we observed reduced mRNA levels of ULK1 (P = 0.0255), BECN1 (P = 0.0019), and MAP1LC3B (P = 0.0086) genes in placentas from P. falciparum-infected, which was more striking in those diagnosed with placental malaria. Despite the protein levels of these genes followed the same pattern, the observed reduction was not statistically significant in placentas from P. falciparum-infected women. Nevertheless, our data suggest that chronic placental immunopathology due to P. falciparum infection leads to autophagy dysregulation, which might impair local homeostasis during malaria in pregnancy that may result in poor pregnancy outcomes.
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Affiliation(s)
- Flávia Afonso Lima
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - André Barateiro
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | - Douglas de Sousa Costa
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Oscar Murillo
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Sabrina Epiphanio
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Lígia Antunes Gonçalves
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Salinas ND, Tang WK, Tolia NH. Blood-Stage Malaria Parasite Antigens: Structure, Function, and Vaccine Potential. J Mol Biol 2019; 431:4259-4280. [PMID: 31103771 DOI: 10.1016/j.jmb.2019.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/22/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Plasmodium parasites are the causative agent of malaria, a disease that kills approximately 450,000 individuals annually, with the majority of deaths occurring in children under the age of 5 years and the development of a malaria vaccine is a global health priority. Plasmodium parasites undergo a complex life cycle requiring numerous diverse protein families. The blood stage of parasite development results in the clinical manifestation of disease. A vaccine that disrupts the blood stage is highly desired and will aid in the control of malaria. The blood stage comprises multiple steps: invasion of, asexual growth within, and egress from red blood cells. This review focuses on blood-stage antigens with emphasis on antigen structure, antigen function, neutralizing antibodies, and vaccine potential.
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Affiliation(s)
- Nichole D Salinas
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD,, 20892, USA
| | - Wai Kwan Tang
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD,, 20892, USA
| | - Niraj H Tolia
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD,, 20892, USA.
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10
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Tan J, Piccoli L, Lanzavecchia A. The Antibody Response to Plasmodium falciparum: Cues for Vaccine Design and the Discovery of Receptor-Based Antibodies. Annu Rev Immunol 2018; 37:225-246. [PMID: 30566366 DOI: 10.1146/annurev-immunol-042617-053301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Plasmodium falciparum remains a serious public health problem and a continuous challenge for the immune system due to the complexity and diversity of the pathogen. Recent advances from several laboratories in the characterization of the antibody response to the parasite have led to the identification of critical targets for protection and revealed a new mechanism of diversification based on the insertion of host receptors into immunoglobulin genes, leading to the production of receptor-based antibodies. These advances have opened new possibilities for vaccine design and passive antibody therapies to provide sterilizing immunity and control blood-stage parasites.
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Affiliation(s)
- Joshua Tan
- Institute for Research in Biomedicine, Università della Svizzera italiana, 6500 Bellinzona, Switzerland; .,Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, United Kingdom.,Current affiliation: National Institute of Allergy and Infectious Diseases, Rockville, Maryland 20852, USA
| | - Luca Piccoli
- Institute for Research in Biomedicine, Università della Svizzera italiana, 6500 Bellinzona, Switzerland;
| | - Antonio Lanzavecchia
- Institute for Research in Biomedicine, Università della Svizzera italiana, 6500 Bellinzona, Switzerland; .,VIR Biotechnology, San Francisco, California 94158, USA
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11
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Nordor AV, Bellet D, Siwo GH. Cancer-malaria: hidden connections. Open Biol 2018; 8:rsob.180127. [PMID: 30381365 PMCID: PMC6223206 DOI: 10.1098/rsob.180127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
Cancer and malaria exemplify two maladies historically assigned to separated research spaces. Cancer, on the one hand, ranks among the top priorities in the research agenda of developed countries. Its rise is mostly explained by the ageing of these populations and linked to environment and lifestyle. Malaria, on the other hand, represents a major health burden for developing countries in the Southern Hemisphere. These two diseases also belong to separate fields of medicine: non-communicable diseases for cancer and communicable diseases for malaria.
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Affiliation(s)
- Akpéli V Nordor
- Institut Curie, PSL Research University, Département de Recherche Translationnelle, 75005 Paris, France
| | - Dominique Bellet
- Institut Curie, PSL Research University, Hôpital René Huguenin, Laboratoire d'Oncobiologie, Pôle Pathologie-Génétique-Immunologie-Hémobiologie, 92210 Saint-Cloud, France
| | - Geoffrey H Siwo
- IBM Research Africa, Johannesburg, South Africa .,Center for Research Computing, Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN 46656, USA
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12
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Niikura M, Inoue S, Mineo S, Asahi H, Kobayashi F. IFNGR1 signaling is associated with adverse pregnancy outcomes during infection with malaria parasites. PLoS One 2017; 12:e0185392. [PMID: 29117241 PMCID: PMC5678718 DOI: 10.1371/journal.pone.0185392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/12/2017] [Indexed: 11/19/2022] Open
Abstract
Complicated/severe cases of placental pathology due to Plasmodium falciparum and P. vivax, especially adverse pregnancy outcomes during P. vivax infection, have been increasing in recent years. However, the pathogenesis of placental pathology during severe malaria is poorly understood, while responses against IFN-γ are thought to be associated with adverse pregnancy outcomes. In the present study, we explored the role of IFN-γ receptor 1 (IFNGR1) signaling in placental pathology during severe malaria using luciferase-expressing rodent malaria parasites, P. berghei NK65 (PbNK65L). We detected luciferase activities in the lung, spleen, adipose tissue, and placenta in pregnant mice, suggesting that infected erythrocytes could accumulate in various organs during infection. Importantly, we found that fetal mortality in IFNGR1-deficient mice infected with PbNK65L parasites was much less than in infected wild type (WT) mice. Placental pathology was also improved in IFNGR1-deficient mice. In contrast, bioluminescence imaging showed that parasite accumulation in the placentas of IFNGR1-deficient pregnant mice was comparable to that in WT mice infected with PbNK65L. These findings suggest that IFNGR1 signaling plays a pivotal role in placental pathology and subsequent adverse pregnancy outcomes during severe malaria. Our findings may increase our understanding of how disease aggravation occurs during malaria during pregnancy.
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Affiliation(s)
- Mamoru Niikura
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Shin–Ichi Inoue
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Shoichiro Mineo
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hiroko Asahi
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
| | - Fumie Kobayashi
- Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan
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Pehrson C, Salanti A, Theander TG, Nielsen MA. Pre-clinical and clinical development of the first placental malaria vaccine. Expert Rev Vaccines 2017; 16:613-624. [PMID: 28434376 DOI: 10.1080/14760584.2017.1322512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Malaria during pregnancy is a massive health problem in endemic areas. Placental malaria infections caused by Plasmodium falciparum are responsible for up to one million babies being born with a low birth weight every year. Significant efforts have been invested into preventing the condition. Areas covered: Pub Med was searched using the broad terms 'malaria parasite placenta' to identify studies of interactions between parasite and host, 'prevention of placental malaria' to identify current strategies to prevent placental malaria, and 'placental malaria vaccine' to identify pre-clinical vaccine development. However, all papers from these searches were not systematically included. Expert commentary: The first phase I clinical trials of vaccines are well underway. Trials testing efficacy are more complicated to carry out as only women that are exposed to parasites during pregnancy will contribute to endpoint measurements, further it may require extensive follow-up to establish protection. Future second generation vaccines may overcome the inherent challenges in making an effective placental malaria vaccine.
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Affiliation(s)
- Caroline Pehrson
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Ali Salanti
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Thor G Theander
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Morten A Nielsen
- a Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark.,b Department of Infectious Diseases , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
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14
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Pehrson C, Mathiesen L, Heno KK, Salanti A, Resende M, Dzikowski R, Damm P, Hansson SR, King CL, Schneider H, Wang CW, Lavstsen T, Theander TG, Knudsen LE, Nielsen MA. Adhesion of Plasmodium falciparum infected erythrocytes in ex vivo perfused placental tissue: a novel model of placental malaria. Malar J 2016; 15:292. [PMID: 27230523 PMCID: PMC4881162 DOI: 10.1186/s12936-016-1342-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Placental malaria occurs when Plasmodium falciparum infected erythrocytes sequester in the placenta. Placental parasite isolates bind to chondroitin sulphate A (CSA) by expression of VAR2CSA on the surface of infected erythrocytes, but may sequester by other VAR2CSA mediated mechanisms, such as binding to immunoglobulins. Furthermore, other parasite antigens have been associated with placental malaria. These findings have important implications for placental malaria vaccine design. The objective of this study was to adapt and describe a biologically relevant model of parasite adhesion in intact placental tissue. Results The ex vivo placental perfusion model was modified to study adhesion of infected erythrocytes binding to CSA, endothelial protein C receptor (EPCR) or a transgenic parasite where P. falciparum erythrocyte membrane protein 1 expression had been shut down. Infected erythrocytes expressing VAR2CSA accumulated in perfused placental tissue whereas the EPCR binding and the transgenic parasite did not. Soluble CSA and antibodies specific against VAR2CSA inhibited binding of infected erythrocytes. Conclusion The ex vivo model provides a novel way of studying receptor-ligand interactions and antibody mediated inhibition of binding in placental malaria. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1342-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Caroline Pehrson
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Line Mathiesen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Kristine K Heno
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ali Salanti
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Mafalda Resende
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ron Dzikowski
- Department of Microbiology and Molecular Genetics, The Institute for Medical Research Israel-Canada, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University and Veterans Affairs Medical Center, Cleveland, USA
| | - Henning Schneider
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian W Wang
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thomas Lavstsen
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thor G Theander
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Lisbeth E Knudsen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Morten A Nielsen
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen and at Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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15
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Doritchamou JYA, Herrera R, Aebig JA, Morrison R, Nguyen V, Reiter K, Shimp RL, MacDonald NJ, Narum DL, Fried M, Duffy PE. VAR2CSA Domain-Specific Analysis of Naturally Acquired Functional Antibodies to Plasmodium falciparum Placental Malaria. J Infect Dis 2016; 214:577-86. [PMID: 27190180 DOI: 10.1093/infdis/jiw197] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/05/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Placental malaria is caused by Plasmodium falciparum-infected erythrocytes (IEs) that surface-express VAR2CSA and bind chondroitin sulfate A. The inflammatory response to placenta-sequestered parasites is associated with poor pregnancy outcomes, and protection may be mediated in part by VAR2CSA antibodies that block placental IE adhesion. METHODS In this study, we used a new approach to assess VAR2CSA domains for functional epitopes recognized by naturally acquired antibodies. Antigen-specific immunoglobulin (Ig) G targeting Duffy binding-like (DBL) domains from different alleles were sequentially purified from plasma pooled from multigravid women and then characterized using enzyme-linked immunosorbent assay, flow cytometry, and antiadhesion assays. RESULTS Different DBL domain-specific IgGs could react to homologous as well as heterologous antigens and parasites, suggesting that conserved epitopes are shared between allelic variants. Homologous blocking of IE binding was observed with ID1-DBL2-ID2a-, DBL4-, and DBL5-specific IgG (range, 42%-75%), whereas partial cross-inhibition activity was observed with purified IgG specific to ID1-DBL2-ID2a and DBL4 antigens. Plasma retained broadly neutralizing activity after complete depletion of these VAR2CSA specificities. CONCLUSIONS Broadly neutralizing antibodies of multigravidae are not depleted on VAR2CSA recombinant antigens, and hence development of VAR2CSA vaccines based on a single construct and variant might induce antibodies with limited broadly neutralizing activity.
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Affiliation(s)
- Justin Yai Alamou Doritchamou
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Raul Herrera
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Joan A Aebig
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Robert Morrison
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland MOMS Project, Seattle Biomedical Research Institute, Washington
| | - Vu Nguyen
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Karine Reiter
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Richard L Shimp
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Nicholas J MacDonald
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - David L Narum
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Michal Fried
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
| | - Patrick E Duffy
- Laboratory of Malaria Immunology & Vaccinology, National Institute of Allergy and Infectious Disease, National Institute of Health, Rockville, Maryland
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Ndam NT, Denoeud-Ndam L, Doritchamou J, Viwami F, Salanti A, Nielsen MA, Fievet N, Massougbodji A, Luty AJF, Deloron P. Protective Antibodies against Placental Malaria and Poor Outcomes during Pregnancy, Benin. Emerg Infect Dis 2016; 21:813-23. [PMID: 25898123 PMCID: PMC4412227 DOI: 10.3201/eid2105.141626] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Immunity requires a vaccine that inhibits binding of infected erythrocytes to chondroitin sulfate. Placental malaria is caused by Plasmodium falciparum–infected erythrocytes that bind to placental tissue. Binding is mediated by VAR2CSA, a parasite antigen coded by the var gene, which interacts with chondroitin sulfate A (CSA). Consequences include maternal anemia and fetal growth retardation. Antibody-mediated immunity to placental malaria is acquired during successive pregnancies, but the target of VAR2CSA-specific protective antibodies is unclear. We assessed VAR2CSA-specific antibodies in pregnant women and analyzed their relationships with protection against placental infection, preterm birth, and low birthweight. Antibody responses to the N-terminal region of VAR2CSA during early pregnancy were associated with reduced risks for infections and low birthweight. Among women infected during pregnancy, an increase in CSA binding inhibition was associated with reduced risks for placental infection, preterm birth, and low birthweight. These data suggest that antibodies against VAR2CSA N-terminal region mediate immunity to placental malaria and associated outcomes. Our results validate current vaccine development efforts with VAR2CSA N-terminal constructs.
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MESH Headings
- Adult
- Antibodies, Protozoan/blood
- Antibodies, Protozoan/immunology
- Antibody Specificity/immunology
- Antigens, Protozoan/immunology
- Benin/epidemiology
- Erythrocytes/immunology
- Erythrocytes/parasitology
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Infant
- Infant, Newborn
- Malaria/epidemiology
- Malaria/immunology
- Malaria/parasitology
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Patient Outcome Assessment
- Placenta/parasitology
- Plasmodium falciparum/immunology
- Pregnancy
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/immunology
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Outcome
- Protein Binding
- Risk Factors
- Young Adult
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17
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Syncytiotrophoblast Functions and Fetal Growth Restriction during Placental Malaria: Updates and Implication for Future Interventions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:451735. [PMID: 26587536 PMCID: PMC4637467 DOI: 10.1155/2015/451735] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/08/2015] [Accepted: 10/04/2015] [Indexed: 01/06/2023]
Abstract
Syncytiotrophoblast lines the intervillous space of the placenta and plays important roles in fetus growth throughout gestation. However, perturbations at the maternal-fetal interface during placental malaria may possibly alter the physiological functions of syncytiotrophoblast and therefore growth and development of the embryo in utero. An understanding of the influence of placental malaria on syncytiotrophoblast function is paramount in developing novel interventions for the control of placental pathology associated with placental malaria. In this review, we discuss how malaria changes syncytiotrophoblast function as evidenced from human, animal, and in vitro studies and, further, how dysregulation of syncytiotrophoblast function may impact fetal growth in utero. We also formulate a hypothesis, stemming from epidemiological observations, that nutrition may override pathogenesis of placental malaria-associated-fetal growth restriction. We therefore recommend studies on nutrition-based-interventional approaches for high placental malaria-risk women in endemic areas. More investigations on the role of nutrition on placental malaria pathogenesis are needed.
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Teo A, Hasang W, Randall LM, Feng G, Bell L, Unger H, Langer C, Beeson JG, Siba PM, Mueller I, Molyneux ME, Brown GV, Rogerson SJ. Decreasing malaria prevalence and its potential consequences for immunity in pregnant women. J Infect Dis 2014; 210:1444-55. [PMID: 24799599 DOI: 10.1093/infdis/jiu264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As malaria control is intensified, pregnant women may be less exposed to malaria, thus affecting the acquisition of protective antibody. METHODS Plasma samples were collected from Malawian and Papua New Guinean (PNG) pregnant women enrolled over 7-year periods, during which malaria prevalence fell by over two thirds. Immunoglobulin G (IgG) levels to schizont extract, merozoite antigens, and VAR2CSA-DBL5ε were measured by enzyme-linked immunosorbent assay (ELISA). Levels of IgG to variant surface antigens of infected erythrocytes (IEs) and merozoites and levels of opsonizing IgG to IEs were measured by flow cytometry. RESULTS In both settings, levels of antibodies in pregnant women to recombinant antigens and to intact IEs but not of opsonizing antibodies decreased over time. After adjustment for coverage with insecticide-treated bed nets (ITNs), these differences disappeared in the Malawian cohort, whereas in the PNG cohort, time was independently associated with a decrease in several antibody responses measured by ELISA. CONCLUSIONS The impact of falling parasite prevalence on anti-Plasmodium falciparum serological indicators in pregnant women varies by setting. Increased ITN coverage may affect development of antibodies to recombinant antigens, but levels of opsonizing IgG remained stable over time. Opsonizing IgG against placental-binding IEs may persist, thus offering longer-lasting protection against malaria during pregnancy.
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Affiliation(s)
- Andrew Teo
- Department of Medicine Doherty Institute
| | - Wina Hasang
- Department of Medicine Victorian Infectious Diseases Service Doherty Institute
| | - Louise M Randall
- Department of Medicine Victorian Infectious Diseases Service Doherty Institute
| | | | - Lauren Bell
- Nossal Institute for Global Health, University of Melbourne
| | | | | | | | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville Barcelona Center for International Health Research, Spain
| | - Malcolm E Molyneux
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme College of Medicine, Blantyre Liverpool School of Tropical Medicine, United Kingdom
| | - Graham V Brown
- Nossal Institute for Global Health, University of Melbourne
| | - Stephen J Rogerson
- Department of Medicine Victorian Infectious Diseases Service Doherty Institute
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Chan JA, Fowkes FJI, Beeson JG. Surface antigens of Plasmodium falciparum-infected erythrocytes as immune targets and malaria vaccine candidates. Cell Mol Life Sci 2014; 71:3633-57. [PMID: 24691798 PMCID: PMC4160571 DOI: 10.1007/s00018-014-1614-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 12/19/2022]
Abstract
Understanding the targets and mechanisms of human immunity to malaria caused by Plasmodium falciparum is crucial for advancing effective vaccines and developing tools for measuring immunity and exposure in populations. Acquired immunity to malaria predominantly targets the blood stage of infection when merozoites of Plasmodium spp. infect erythrocytes and replicate within them. During the intra-erythrocytic development of P. falciparum, numerous parasite-derived antigens are expressed on the surface of infected erythrocytes (IEs). These antigens enable P. falciparum-IEs to adhere in the vasculature and accumulate in multiple organs, which is a key process in the pathogenesis of disease. IE surface antigens, often referred to as variant surface antigens, are important targets of acquired protective immunity and include PfEMP1, RIFIN, STEVOR and SURFIN. These antigens are highly polymorphic and encoded by multigene families, which generate substantial antigenic diversity to mediate immune evasion. The most important immune target appears to be PfEMP1, which is a major ligand for vascular adhesion and sequestration of IEs. Studies are beginning to identify specific variants of PfEMP1 linked to disease pathogenesis that may be suitable for vaccine development, but overcoming antigenic diversity in PfEMP1 remains a major challenge. Much less is known about other surface antigens, or antigens on the surface of gametocyte-IEs, the effector mechanisms that mediate immunity, and how immunity is acquired and maintained over time; these are important topics for future research.
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Doritchamou J, Bigey P, Nielsen MA, Gnidehou S, Ezinmegnon S, Burgain A, Massougbodji A, Deloron P, Salanti A, Ndam NT. Differential adhesion-inhibitory patterns of antibodies raised against two major variants of the NTS-DBL2X region of VAR2CSA. Vaccine 2013; 31:4516-22. [PMID: 23933341 DOI: 10.1016/j.vaccine.2013.07.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/19/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND VAR2CSA is a large polymorphic Plasmodium falciparum protein expressed on infected erythrocytes (IE) that allows their binding in the placenta, thus precipitating placental malaria (PM). The N-terminal part of VAR2CSA that contains the binding site to placental chondroitin sulfate A (CSA) is currently recognized as the most attractive region for vaccine development. An ultimate challenge is to define epitopes in this region that induce a broad cross-reactive adhesion inhibitory antibody response. METHODS Based on phylogenetic data that identified a dimorphic sequence motif in the VAR2CSA DBL2X, we raised antibodies against the NTS-DBL2X constructs containing one sequence or the other (3D7 and FCR3) and tested their functional properties on P. falciparum isolates from pregnant women and on laboratory-adapted strains. RESULTS The CSA binding inhibitory capacity of the antibodies induced varied from one parasite isolate to another (range, 10%–100%), but the combined analysis of individual activity highlighted a broader functionality that increased the total number of isolates inhibited. Interestingly, the differential inhibitory effect of the antibodies observed on field isolates resulted in significant inhibition of all field isolates tested, suggesting that optimal inhibitory spectrum on field isolates from pregnant women might be achieved with antibodies targeting limited variants of the N-terminal VAR2CSA. CONCLUSIONS Our findings indicate that the NTS-DBL2X region of VAR2CSA can elicit strain-transcending anti-adhesion antibodies and suggest that the combination of the two major variants used here could represent the basis for an effective bivalent VAR2CSA-based vaccine.
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Affiliation(s)
- Justin Doritchamou
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, France; Institut de Recherche pour le Développement, UMR216 Mère et enfant face aux infections tropicales, Paris, France; Centre d'Etude et de Recherche sur le paludisme associé à la Grossesse et à l'Enfance, Université d'Abomey-Calavi, Cotonou, Benin
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21
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Berger SS, Turner L, Wang CW, Petersen JEV, Kraft M, Lusingu JPA, Mmbando B, Marquard AM, Bengtsson DBAC, Hviid L, Nielsen MA, Theander TG, Lavstsen T. Plasmodium falciparum expressing domain cassette 5 type PfEMP1 (DC5-PfEMP1) bind PECAM1. PLoS One 2013; 8:e69117. [PMID: 23874884 PMCID: PMC3706608 DOI: 10.1371/journal.pone.0069117] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 06/07/2013] [Indexed: 11/18/2022] Open
Abstract
Members of the Plasmodium falciparum Erythrocyte Membrane protein 1 (PfEMP1) family expressed on the surface of malaria-infected erythrocytes mediate binding of the parasite to different receptors on the vascular lining. This process drives pathologies, and severe childhood malaria has been associated with the expression of particular subsets of PfEMP1 molecules. PfEMP1 are grouped into subtypes based on upstream sequences and the presence of semi-conserved PfEMP1 domain compositions named domain cassettes (DCs). Earlier studies have indicated that DC5-containing PfEMP1 (DC5-PfEMP1) are more likely to be expressed in children with severe malaria disease than in children with uncomplicated malaria, but these PfEMP1 subtypes only dominate in a relatively small proportion of the children with severe disease. In this study, we have characterised the genomic sequence characteristic for DC5, and show that two genetically different parasite lines expressing DC5-PfEMP1 bind PECAM1, and that anti-DC5-specific antibodies inhibit binding of DC5-PfEMP1-expressing parasites to transformed human bone marrow endothelial cells (TrHBMEC). We also show that antibodies against each of the four domains characteristic for DC5 react with native PfEMP1 expressed on the surface of infected erythrocytes, and that some of these antibodies are cross-reactive between the two DC5-containing PfEMP1 molecules tested. Finally, we confirm that anti-DC5 antibodies are acquired early in life by individuals living in malaria endemic areas, that individuals having high levels of these antibodies are less likely to develop febrile malaria episodes and that the antibody levels correlate positively with hemoglobin levels.
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Affiliation(s)
- Sanne S. Berger
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
- * E-mail: (SB); (TL)
| | - Louise Turner
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Christian W. Wang
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Jens E. V. Petersen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Maria Kraft
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - John P. A. Lusingu
- National Institute for Medical Research (NIMR), Tanga Medical Research Centre, Tanga, Tanzania
| | - Bruno Mmbando
- National Institute for Medical Research (NIMR), Tanga Medical Research Centre, Tanga, Tanzania
| | - Andrea M. Marquard
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Dominique B. A. C. Bengtsson
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Morten A. Nielsen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Thor G. Theander
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
| | - Thomas Lavstsen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), University of Copenhagen, Copenhagen, Denmark
- * E-mail: (SB); (TL)
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Bengtsson A, Joergensen L, Rask TS, Olsen RW, Andersen MA, Turner L, Theander TG, Hviid L, Higgins MK, Craig A, Brown A, Jensen ATR. A novel domain cassette identifies Plasmodium falciparum PfEMP1 proteins binding ICAM-1 and is a target of cross-reactive, adhesion-inhibitory antibodies. THE JOURNAL OF IMMUNOLOGY 2012; 190:240-9. [PMID: 23209327 DOI: 10.4049/jimmunol.1202578] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cerebral Plasmodium falciparum malaria is characterized by adhesion of infected erythrocytes (IEs) to the cerebral microvasculature. This has been linked to parasites expressing the structurally related group A subset of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) family of IE adhesion ligands and to IEs with affinity for ICAM-1. However, recent evidence has cast doubt on both these associations, tempering hopes of the feasibility of developing a vaccine based on ICAM-1-binding PfEMP1. In this study, we report the identification of a domain cassette (DC) present in group A var genes from six genetically distinct P. falciparum parasites. The three domains in the cassette, which we call DC4, had a high level of sequence identity and cluster together phylogenetically. Erythrocytes infected by these parasites and selected in vitro for expression of DC4 adhered specifically to ICAM-1. The ICAM-1-binding capacity of DC4 was mapped to the C-terminal third of its Duffy-binding-like β3 domain. DC4 was the target of broadly cross-reactive and adhesion-inhibitory IgG Abs, and levels of DC4-specific and adhesion-inhibitory IgG increased with age among P. falciparum-exposed children. Our study challenges earlier conclusions that group A PfEMP1 proteins are not central to ICAM-1-specific IE adhesion and support the feasibility of developing a vaccine preventing cerebral malaria by inhibiting cerebral IE sequestration.
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Affiliation(s)
- Anja Bengtsson
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 1014, Denmark
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Multilaboratory approach to preclinical evaluation of vaccine immunogens for placental malaria. Infect Immun 2012. [PMID: 23208604 DOI: 10.1128/iai.01106-12] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pregnancy malaria is caused by Plasmodium falciparum-infected erythrocytes that adhere to the placental receptor chondroitin sulfate A (CSA) and sequester in the placenta; women become resistant to pregnancy malaria as they acquire antiadhesion antibodies that target surface proteins of placental parasites. VAR2CSA, a member of the P. falciparum EMP1 variant surface antigen family, is the leading candidate for a pregnancy malaria vaccine. Because VAR2CSA is a high-molecular-weight protein, a vaccine based on the full-length protein may not be feasible. An alternative approach has been to develop a vaccine targeting individual Duffy binding-like (DBL) domains. In this study, a consortium of laboratories under the Pregnancy Malaria Initiative compared the functional activity of antiadhesion antibodies elicited by different VAR2CSA domains and variants produced in prokaryotic and eukaryotic expression systems. Antisera were initially tested against laboratory lines of maternal parasites, and the most promising reagents were evaluated in the field against fresh placental parasite samples. Recombinant proteins expressed in Escherichia coli elicited antibody levels similar to those expressed in eukaryotic systems, as did the two allelic forms of the DBL4 and DBL5 domains. The procedures developed for this head-to-head comparison will be useful for future evaluation and down-selection of malaria vaccine immunogens.
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Doritchamou J, Bertin G, Moussiliou A, Bigey P, Viwami F, Ezinmegnon S, Fievet N, Massougbodji A, Deloron P, Tuikue Ndam N. First-trimester Plasmodium falciparum infections display a typical "placental" phenotype. J Infect Dis 2012; 206:1911-9. [PMID: 23045626 DOI: 10.1093/infdis/jis629] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Plasmodium falciparum-infected erythrocytes (IEs) adhere to host cell receptors, allowing parasites to sequester into deep vascular beds of various organs. This defining phenomenon of malaria pathogenesis is key to the severe clinical complications associated with cerebral and placental malaria. The principal ligand associated with the binding to chondroitin sulfate A (CSA) that allows placental sequestration of IEs is a P. falciparum erythrocyte membrane protein 1 (PfEMP1) family member encoded by the var2csa gene. METHODS Here, we investigated the transcription pattern of var genes by real-time polymerase chain reaction, the expression of VAR2CSA, protein by flow cytometry, and the CSA-binding ability of IEs collected at different stages of pregnancy using a static-based Petri dish assay. RESULTS Through comparison with the profiles of isolates from nonpregnant hosts, we report several lines of evidence showing that parasites infecting women during pregnancy preferentially express VAR2CSA protein, and that selection for the capacity to adhere to CSA via VAR2CSA expression occurs early in pregnancy. CONCLUSIONS Our data suggest that the placental tropism of P. falciparum is already established in the first trimester of pregnancy, with consequent implications for the development of the pathology associated with placental malaria.
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Affiliation(s)
- Justin Doritchamou
- PRES Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
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Plasmodium falciparum erythrocyte membrane protein 1 domain cassettes 8 and 13 are associated with severe malaria in children. Proc Natl Acad Sci U S A 2012; 109:E1791-800. [PMID: 22619319 DOI: 10.1073/pnas.1120455109] [Citation(s) in RCA: 202] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The clinical outcome of Plasmodium falciparum infections ranges from asymptomatic parasitemia to severe malaria syndromes associated with high mortality. The virulence of P. falciparum infections is associated with the type of P. falciparum erythrocyte membrane protein 1 (PfEMP1) expressed on the surface of infected erythrocytes to anchor these to the vascular lining. Although var2csa, the var gene encoding the PfEMP1 associated with placental malaria, was discovered in 2003, the identification of the var/PfEMP1 variants associated with severe malaria in children has remained elusive. To identify var/PfEMP1 variants associated with severe disease outcome, we compared var transcript levels in parasites from 88 children with severe malaria and 40 children admitted to the hospital with uncomplicated malaria. Transcript analysis was performed by RT-quantitative PCR using a set of 42 primer pairs amplifying var subtype-specific loci covering most var/PfEMP1 subtypes. In addition, we characterized the near-full-length sequence of the most prominently expressed var genes in three patients diagnosed with severe anemia and/or cerebral malaria. The combined analysis showed that severe malaria syndromes, including severe anemia and cerebral malaria, are associated with high transcript levels of PfEMP1 domain cassette 8-encoding var genes. Transcript levels of group A var genes, including genes encoding domain cassette 13, were also significantly higher in patients with severe syndromes compared with those with uncomplicated malaria. This study specifies the var/PfEMP1 types expressed in severe malaria in children, and thereby provides unique targets for future efforts to prevent and treat severe malaria infections.
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26
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Clausen TM, Christoffersen S, Dahlbäck M, Langkilde AE, Jensen KE, Resende M, Agerbæk MØ, Andersen D, Berisha B, Ditlev SB, Pinto VV, Nielsen MA, Theander TG, Larsen S, Salanti A. Structural and functional insight into how the Plasmodium falciparum VAR2CSA protein mediates binding to chondroitin sulfate A in placental malaria. J Biol Chem 2012; 287:23332-45. [PMID: 22570492 DOI: 10.1074/jbc.m112.348839] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malaria is a major global health problem. Pregnant women are susceptible to infection regardless of previously acquired immunity. Placental malaria is caused by parasites capable of sequestering in the placenta. This is mediated by VAR2CSA, a parasite antigen that interacts with chondroitin sulfate A (CSA). One vaccine strategy is to block this interaction with VAR2CSA-specific antibodies. It is a priority to define a small VAR2CSA fragment that can be used in an adhesion blocking vaccine. In this, the obvious approach is to define regions of VAR2CSA involved in receptor binding. It has been shown that full-length recombinant VAR2CSA binds specifically to CSA with nanomolar affinity, and that the CSA-binding site lies in the N-terminal part of the protein. In this study we define the minimal binding region by truncating VAR2CSA and analyzing CSA binding using biosensor technology. We show that the core CSA-binding site lies within the DBL2X domain and parts of the flanking interdomain regions. This is in contrast to the idea that single domains do not possess the structural requirements for specific CSA binding. Small-angle x-ray scattering measurements enabled modeling of VAR2CSA and showed that the CSA-binding DBL2X domain is situated in the center of the structure. Mutating classic sulfate-binding sites in VAR2CSA, along with testing dependence of ionic interactions, suggest that the CSA binding is not solely dependent on the sulfated CSA structure. Based on these novel PfEMP1 structure-function studies, we have constructed a small VAR2CSA antigen that has the capacity to induce highly adhesion-blocking antibodies.
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Affiliation(s)
- Thomas M Clausen
- Department of Infectious Diseases, Centre for Medical Parasitology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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27
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Ghumra A, Semblat JP, Ataide R, Kifude C, Adams Y, Claessens A, Anong DN, Bull PC, Fennell C, Arman M, Amambua-Ngwa A, Walther M, Conway DJ, Kassambara L, Doumbo OK, Raza A, Rowe JA. Induction of strain-transcending antibodies against Group A PfEMP1 surface antigens from virulent malaria parasites. PLoS Pathog 2012; 8:e1002665. [PMID: 22532802 PMCID: PMC3330128 DOI: 10.1371/journal.ppat.1002665] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 03/08/2012] [Indexed: 12/22/2022] Open
Abstract
Sequence diversity in pathogen antigens is an obstacle to the development of interventions against many infectious diseases. In malaria caused by Plasmodium falciparum, the PfEMP1 family of variant surface antigens encoded by var genes are adhesion molecules that play a pivotal role in malaria pathogenesis and clinical disease. PfEMP1 is a major target of protective immunity, however, development of drugs or vaccines based on PfEMP1 is problematic due to extensive sequence diversity within the PfEMP1 family. Here we identified the PfEMP1 variants transcribed by P. falciparum strains selected for a virulence-associated adhesion phenotype (IgM-positive rosetting). The parasites transcribed a subset of Group A PfEMP1 variants characterised by an unusual PfEMP1 architecture and a distinct N-terminal domain (either DBLα1.5 or DBLα1.8 type). Antibodies raised in rabbits against the N-terminal domains showed functional activity (surface reactivity with live infected erythrocytes (IEs), rosette inhibition and induction of phagocytosis of IEs) down to low concentrations (<10 µg/ml of total IgG) against homologous parasites. Furthermore, the antibodies showed broad cross-reactivity against heterologous parasite strains with the same rosetting phenotype, including clinical isolates from four sub-Saharan African countries that showed surface reactivity with either DBLα1.5 antibodies (variant HB3var6) or DBLα1.8 antibodies (variant TM284var1). These data show that parasites with a virulence-associated adhesion phenotype share IE surface epitopes that can be targeted by strain-transcending antibodies to PfEMP1. The existence of shared surface epitopes amongst functionally similar disease-associated P. falciparum parasite isolates suggests that development of therapeutic interventions to prevent severe malaria is a realistic goal. Malaria remains one of the world's most deadly diseases. Life-threatening malaria is linked to a process called rosetting, in which malaria parasite-infected red blood cells bind to uninfected red cells to form aggregates that block blood flow in vital organs such as the brain. Current efforts to develop drugs or vaccines against rosetting are hindered by variation in the parasite rosette-mediating proteins, found on the surface of infected red cells. We studied these parasite-derived surface proteins and discovered that although they are variable, they share some common features. We raised antibodies against the rosette-mediating proteins, and found that they cross-reacted with multiple rosetting parasite strains from different countries around the world, including samples collected directly from African children with severe malaria. These findings provide new insights into malaria parasite interactions with human cells, and provide proof of principle that variable parasite molecules from virulent malaria parasites can induce strain-transcending antibodies. Hence, this work provides the foundation for the development of new therapies to treat or prevent life-threatening malaria.
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Affiliation(s)
- Ashfaq Ghumra
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jean-Philippe Semblat
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Ricardo Ataide
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Carolyne Kifude
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Yvonne Adams
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Antoine Claessens
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Damian N. Anong
- Biotechnology Unit, Faculty of Science, University of Buea, Buea, Cameroon
| | - Peter C. Bull
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Clare Fennell
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Monica Arman
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Michael Walther
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
| | - David J. Conway
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
| | - Lalla Kassambara
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Ogobara K. Doumbo
- Malaria Research and Training Centre, University of Bamako, Bamako, Mali
| | - Ahmed Raza
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - J. Alexandra Rowe
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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Hviid L. The case for PfEMP1-based vaccines to protect pregnant women against Plasmodium falciparum malaria. Expert Rev Vaccines 2012; 10:1405-14. [PMID: 21988306 DOI: 10.1586/erv.11.113] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccines are very cost-effective tools in combating infectious disease mortality and morbidity. Unfortunately, vaccines efficiently protecting against infection with malaria parasites are not available and are not likely to appear in the near future. An alternative strategy would be vaccines protecting against the disease and its consequences rather than against infection per se, by accelerating the development of the protective immunity that is normally acquired after years of exposure to malaria parasites in areas of stable transmission. This latter strategy is being energetically pursued to develop a vaccine protecting pregnant women and their offspring against mortality and morbidity caused by the accumulation of Plasmodium falciparum-infected erythrocytes in the placenta. It is based on a detailed understanding of the parasite antigen and the host receptor involved in this accumulation, as well as knowledge regarding the protective immune response that is acquired in response to placental P. falciparum infection. Nevertheless, it remains controversial in some quarters whether such a vaccine would have the desired impact, or indeed whether the strategy is meaningful. This article critically examines the relevance of several perceived obstacles to development of a vaccine against placental malaria.
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Affiliation(s)
- Lars Hviid
- Centre for Medical Parasitology, University of Copenhagen and Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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29
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Menéndez C, Moorthy VS, Reed Z, Bardají A, Alonso P, Brown GV. Development of vaccines to prevent malaria in pregnant women: WHO MALVAC meeting report. Expert Rev Vaccines 2012; 10:1271-80. [PMID: 21919617 DOI: 10.1586/erv.11.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The major public health consequences of malaria in pregnancy have long been acknowledged. However, further information is still required for development and implementation of a malaria vaccine specifically directed to prevent malaria in pregnant women and improve maternal, fetal and infant outcomes. The WHO Malaria Vaccine Advisory Committee (MALVAC) provides guidance to the WHO on strategic priorities and research needs for development of vaccines to prevent malaria. Here we summarize the discussions and conclusions of a MALVAC scientific forum meeting on considerations in the development of vaccines to prevent malaria in pregnant women. This report includes brief summaries of what is known, and major knowledge gaps in disease burden estimation, pathogenesis and immunity, and the challenges with current preventive strategies for malaria in pregnancy. We conclude with the formulation of a conceptual framework for research and development for vaccines to prevent malaria in pregnant women.
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Affiliation(s)
- Clara Menéndez
- Barcelona Center for International Health Research (CRESIB), Hospital Clinic/Universitat de Barcelona, Barcelona, Spain
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30
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Rovira-Vallbona E, Dobaño C, Bardají A, Cisteró P, Romagosa C, Serra-Casas E, Quintó L, Bassat Q, Sigaúque B, Alonso PL, Ordi J, Menéndez C, Mayor A. Transcription of var genes other than var2csa in Plasmodium falciparum parasites infecting Mozambican pregnant women. J Infect Dis 2011; 204:27-35. [PMID: 21628655 DOI: 10.1093/infdis/jir217] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Increased susceptibility to Plasmodium falciparum infection during pregnancy has been attributed to the accumulation of infected erythrocytes in the placenta. This phenomenon is mediated by a var gene coding for VAR2CSA, which adheres to chondroitin sulphate A. However, the contribution of parasites transcribing other var genes to maternal infections has not been well characterized. METHODS Transcription of var2csa and var groups A, B, and C was measured by real-time polymerase chain reaction in 30 placental and 21 peripheral P. falciparum isolates from pregnant women and in 42 isolates from nonpregnant adults and children. Associations of infections with non-var2csa isolates with maternal parasitemia and immune responses were assessed. RESULTS Placental parasites showed the highest levels of var2csa. ABC var genes were transcribed by 20 (67%) of 30 placental isolates and were associated with higher parasitemia compared with infections by parasites only transcribing var2csa (P = .004). Peripheral isolates from pregnant women transcribed ABC var genes at levels similar to those of parasites infecting nonpregnant adults with clinical malaria (P[varA] = .420, P[varB] = .808, and P[varC] = .619). CONCLUSIONS Transcripts of var2csa are abundant in pregnancy-associated P. falciparum infections; however, ABC var types are also common, especially in peripheral blood, with transcription levels similar to those of infections out of pregnancy. These findings are of interest for the design of malaria vaccines for pregnant women.
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Affiliation(s)
- Eduard Rovira-Vallbona
- Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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31
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Janes JH, Wang CP, Levin-Edens E, Vigan-Womas I, Guillotte M, Melcher M, Mercereau-Puijalon O, Smith JD. Investigating the host binding signature on the Plasmodium falciparum PfEMP1 protein family. PLoS Pathog 2011; 7:e1002032. [PMID: 21573138 PMCID: PMC3088720 DOI: 10.1371/journal.ppat.1002032] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 03/01/2011] [Indexed: 12/03/2022] Open
Abstract
The Plasmodium falciparum erythrocyte membrane protein 1
(PfEMP1) family plays a central role in antigenic variation and cytoadhesion of
P. falciparum infected erythrocytes. PfEMP1
proteins/var genes are classified into three main
subfamilies (UpsA, UpsB, and UpsC) that are hypothesized to have different roles
in binding and disease. To investigate whether these subfamilies have diverged
in binding specificity and test if binding could be predicted by adhesion domain
classification, we generated a panel of 19 parasite lines that primarily
expressed a single dominant var transcript and assayed binding
against 12 known host receptors. By limited dilution cloning, only UpsB and UpsC
var genes were isolated, indicating that UpsA
var gene expression is rare under in vitro
culture conditions. Consequently, three UpsA variants were obtained by rosette
purification and selection with specific monoclonal antibodies to create a more
representative panel. Binding assays showed that CD36 was the most common
adhesion partner of the parasite panel, followed by ICAM-1 and TSP-1, and that
CD36 and ICAM-1 binding variants were highly predicted by adhesion domain
sequence classification. Binding to other host receptors, including CSA, VCAM-1,
HABP1, CD31/PECAM, E-selectin, Endoglin, CHO receptor “X”, and
Fractalkine, was rare or absent. Our findings identify a category of larger
PfEMP1 proteins that are under dual selection for ICAM-1 and CD36 binding. They
also support that the UpsA group, in contrast to UpsB and UpsC
var genes, has diverged from binding to the major
microvasculature receptor CD36 and likely uses other mechanisms to sequester in
the microvasculature. These results demonstrate that CD36 and ICAM-1 have left
strong signatures of selection on the PfEMP1 family that can be detected by
adhesion domain sequence classification and have implications for how this
family of proteins is specializing to exploit hosts with varying levels of
anti-malaria immunity. The malaria parasite Plasmodium falciparum persists in the human
host partly by avoiding elimination in the spleen during blood stage infection.
This strategy depends principally upon members of the large and diverse PfEMP1
family of proteins that are exported to the surface of infected erythrocytes.
PfEMP1 proteins are important targets for host protective antibody responses and
encode binding to several different host receptor proteins. Switches in PfEMP1
expression allow parasites to evade host antibodies and may precipitate severe
disease when infected erythrocytes accumulate in brain or placenta.
Consequently, the severity of malaria infection may depend on the type of PfEMP1
protein expressed. In this study, we employ a representative panel of distinct
PfEMP1 types and host receptor proteins to demonstrate that CD36 and ICAM-1
binding properties of full-length PfEMP1 are highly predicted by their domain
composition. We also find that CD36 binding is under strong selection in many
PfEMP1 proteins, but that a group of PfEMP1s associated with more severe
infections does not bind CD36 and may utilize alternative means to sequester
infected erythrocytes. These findings have implications for understanding the
molecular basis for severe malaria.
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Affiliation(s)
- Joel H. Janes
- Department of Global Health, University of Washington, Seattle,
Washington, United States of America
| | - Christopher P. Wang
- Seattle Biomedical Research Institute, Seattle, Washington, United States
of America
| | - Emily Levin-Edens
- Seattle Biomedical Research Institute, Seattle, Washington, United States
of America
| | - Inès Vigan-Womas
- Institut Pasteur, Unité d'Immunologie Moléculaire des
Parasites, Paris, France
| | - Micheline Guillotte
- Institut Pasteur, Unité d'Immunologie Moléculaire des
Parasites, Paris, France
| | - Martin Melcher
- Seattle Biomedical Research Institute, Seattle, Washington, United States
of America
| | - Odile Mercereau-Puijalon
- Institut Pasteur, Unité d'Immunologie Moléculaire des
Parasites, Paris, France
- CNRS URA 2581, Paris, France
| | - Joseph D. Smith
- Department of Global Health, University of Washington, Seattle,
Washington, United States of America
- Seattle Biomedical Research Institute, Seattle, Washington, United States
of America
- * E-mail:
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Pinto VV, Ditlev SB, Jensen KE, Resende M, Dahlbäck M, Andersen G, Andersen P, Theander TG, Salanti A, Nielsen MA. Differential induction of functional IgG using the Plasmodium falciparum placental malaria vaccine candidate VAR2CSA. PLoS One 2011; 6:e17942. [PMID: 21464946 PMCID: PMC3064590 DOI: 10.1371/journal.pone.0017942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 02/15/2011] [Indexed: 11/18/2022] Open
Abstract
Background In Plasmodium falciparum malaria endemic areas placental malaria (PM) is an important complication of malaria. The recurrence of malaria in primigravidae women irrespective of acquired protection during childhood is caused by the interaction between the parasite-expressed VAR2CSA antigen and chondroitin sulfate A (CSA) in the placental intervillous space and lack of protective antibodies. PM impairs fetal development mainly by excessive inflammation processes. After infections during pregnancy women acquire immunity to PM conferred by antibodies against VAR2CSA. Ideally, a vaccine against PM will induce antibody-mediated immune responses that block the adhesion of infected erythrocytes (IE) in the placenta. Principal Findings We have previously shown that antibodies raised in rat against individual domains of VAR2CSA can block IE binding to CSA. In this study we have immunized mice, rats and rabbits with each individual domain and the full-length protein corresponding to the FCR3 VAR2CSA variant. We found there is an inherently higher immunogenicity of C-terminal domains compared to N-terminally located domains. This was irrespective of whether antibodies were induced against single domains or the full-length protein. Species-specific antibody responses were also found, these were mainly directed against single domains and not the full-length VAR2CSA protein. Conclusions/Significance Binding inhibitory antibodies appeared to be against conformational B-cell epitopes. Non-binding inhibitory antibodies reacted highly against the C-terminal end of the VAR2CSA molecule especially the highly polymorphic DBL6ε domain. Differential species-specific induction of antibody responses may allow for more direct analysis of functional versus non-functional B-cell epitopes.
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Affiliation(s)
- Vera V. Pinto
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Sisse B. Ditlev
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Kamilla E. Jensen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Mafalda Resende
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Madeleine Dahlbäck
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Gorm Andersen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Pernille Andersen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thor G. Theander
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ali Salanti
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Morten A. Nielsen
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- * E-mail:
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Avril M, Cartwright MM, Hathaway MJ, Smith JD. Induction of strain-transcendent antibodies to placental-type isolates with VAR2CSA DBL3 or DBL5 recombinant proteins. Malar J 2011; 10:36. [PMID: 21314945 PMCID: PMC3055221 DOI: 10.1186/1475-2875-10-36] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/11/2011] [Indexed: 11/23/2022] Open
Abstract
Background Pregnancy associated malaria is a severe clinical syndrome associated with sequestration of Plasmodium falciparum-infected erythrocytes in the placenta. Placental binding is mediated by VAR2CSA, which adheres to chondroitin sulphate A (CSA). VAR2CSA is a large and polymorphic protein that has six Duffy binding-like (DBL) domains. There is still limited understanding as to how effective individual VAR2CSA domains are at generating inhibitory antibodies or the number of domain variants needed for universal vaccine coverage. Methods To investigate the immunogenic properties of single domain VAR2CSA recombinant proteins, rats or rabbits were immunized with five of the six VAR2CSA domains produced in Pichia pastoris. Immune plasma was analysed against a geographically diverse panel of CSA-binding lab lines to assess antibody breadth and inhibitory activity. Results Of the five domains, DBL3, and to a lesser extent DBL5, induced antibodies that cross-reacted on five diverse CSA-binding parasite lines by flow cytometry. By comparison, anti-DBL6 antibodies were highly strain-specific and anti-DBL1 and anti-DBL4 antibodies were poorly reactive by flow cytometry. From this series of recombinant proteins, adhesion-blocking activity was restricted to a single rat immunized against a DBL4 recombinant protein. Conclusions Single domain VAR2CSA recombinant proteins produced in P. pastoris had limited efficacy in eliciting adhesion blocking antibody responses, but VAR2CSA DBL3 and DBL5 domains contain strain-transcendent epitopes that can be targeted by vaccination and may have application for vaccine development.
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Affiliation(s)
- Marion Avril
- Seattle Biomedical Research Institute, 307 Westlake Ave N, Suite 500, Seattle Washington, 98109-5219, USA
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Avril M, Hathaway MJ, Srivastava A, Dechavanne S, Hommel M, Beeson JG, Smith JD, Gamain B. Antibodies to a full-length VAR2CSA immunogen are broadly strain-transcendent but do not cross-inhibit different placental-type parasite isolates. PLoS One 2011; 6:e16622. [PMID: 21326877 PMCID: PMC3034725 DOI: 10.1371/journal.pone.0016622] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 01/01/2011] [Indexed: 11/22/2022] Open
Abstract
The high molecular weight, multidomain VAR2CSA protein mediating adhesion of Plasmodium falciparum-infected erythrocytes in the placenta is the leading candidate for a pregnancy malaria vaccine. However, it has been difficult so far to generate strong and consistent adhesion blocking antibody responses against most single-domain VAR2CSA immunogens. Recent advances in expression of the full-length recombinant protein showed it binds with much greater specificity and affinity to chondroitin sulphate A (CSA) than individual VAR2CSA domains. This raises the possibility that a specific CSA binding pocket(s) is formed in the full length antigen and could be an important target for vaccine development. In this study, we compared the immunogenicity of a full-length VAR2CSA recombinant protein containing all six Duffy binding-like (DBL) domains to that of a three-domain construct (DBL4-6) in mice and rabbits. Animals immunized with either immunogen acquired antibodies reacting with several VAR2CSA individual domains by ELISA, but antibody responses against the highly conserved DBL4 domain were weaker in animals immunized with full-length DBL1-6 recombinant protein compared to DBL4-6 recombinant protein. Both immunogens induced cross-reactive antibodies to several heterologous CSA-binding parasite lines expressing different VAR2CSA orthologues. However, antibodies that inhibited adhesion of parasites to CSA were only elicited in rabbits immunized with full-length immunogen and inhibition was restricted to the homologous CSA-binding parasite. These findings demonstrate that partial and full-length VAR2CSA immunogens induce cross-reactive antibodies, but inhibitory antibody responses to full-length immunogen were highly allele-specific and variable between animal species.
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MESH Headings
- Amino Acid Sequence/physiology
- Animals
- Antibodies, Protozoan/immunology
- Antibodies, Protozoan/pharmacology
- Antibodies, Protozoan/therapeutic use
- Antibody Specificity/immunology
- Antibody Specificity/physiology
- Antigens, Protozoan/chemistry
- Antigens, Protozoan/immunology
- Antigens, Protozoan/isolation & purification
- Cells, Cultured
- Cross Reactions/immunology
- Female
- Humans
- Immunization
- Malaria Vaccines/immunology
- Malaria Vaccines/pharmacology
- Malaria Vaccines/therapeutic use
- Malaria, Falciparum/parasitology
- Malaria, Falciparum/pathology
- Malaria, Falciparum/prevention & control
- Malaria, Falciparum/transmission
- Mice
- Mice, Inbred BALB C
- Placenta/immunology
- Placenta/parasitology
- Pregnancy
- Pregnancy Complications, Parasitic/parasitology
- Pregnancy Complications, Parasitic/pathology
- Pregnancy Complications, Parasitic/therapy
- Protein Isoforms/immunology
- Rabbits
- Species Specificity
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Affiliation(s)
- Marion Avril
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Marianne J. Hathaway
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Anand Srivastava
- Institut Pasteur, Unité de Biologie des Interactions Hôte-Parasite, Centre National de la Recherche Scientifique (CNRS), Unité de Recherche Associée (URA), 2581, Paris, France
| | - Sébastien Dechavanne
- Institut Pasteur, Unité de Biologie des Interactions Hôte-Parasite, Centre National de la Recherche Scientifique (CNRS), Unité de Recherche Associée (URA), 2581, Paris, France
| | - Mirja Hommel
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - James G. Beeson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Joseph D. Smith
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail: (BG); (JDS)
| | - Benoît Gamain
- Institut Pasteur, Unité de Biologie des Interactions Hôte-Parasite, Centre National de la Recherche Scientifique (CNRS), Unité de Recherche Associée (URA), 2581, Paris, France
- Institut National de la Transfusion Sanguine, Paris, France
- INSERM, UMRS 665, Paris, France
- Université Paris Diderot, Paris 7, Paris, France
- * E-mail: (BG); (JDS)
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Barfod L, Dobrilovic T, Magistrado P, Khunrae P, Viwami F, Bruun J, Dahlbäck M, Bernasconi NL, Fried M, John D, Duffy PE, Salanti A, Lanzavecchia A, Lim CT, Ndam NT, Higgins MK, Hviid L. Chondroitin sulfate A-adhering Plasmodium falciparum-infected erythrocytes express functionally important antibody epitopes shared by multiple variants. THE JOURNAL OF IMMUNOLOGY 2010; 185:7553-61. [PMID: 21078904 DOI: 10.4049/jimmunol.1002390] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acquired protection from Plasmodium falciparum placental malaria, a major cause of maternal, fetal, and infant morbidity, is mediated by IgG specific for the P. falciparum erythrocyte membrane protein 1 variant VAR2CSA. This protein enables adhesion of P. falciparum-infected erythrocytes to chondroitin sulfate A in the intervillous space. Although interclonal variation of the var2csa gene is lower than that among var genes in general, VAR2CSA-specific Abs appear to target mainly polymorphic epitopes. This has raised doubts about the feasibility of VAR2CSA-based vaccines. We used eight human monoclonal IgG Abs from affinity-matured memory B cells of P. falciparum-exposed women to study interclonal variation and functional importance of Ab epitopes among placental and peripheral parasites from East and West Africa. Most placental P. falciparum isolates were labeled by several mAbs, whereas peripheral isolates from children were essentially nonreactive. The mAb reactivity of peripheral isolates from pregnant women indicated that some were placental, whereas others had alternative sequestration foci. Most of the mAbs were comparable in their reactivity with bound infected erythrocytes (IEs) and recombinant VAR2CSA and interfered with IE and/or VAR2CSA binding to chondroitin sulfate A. Pair-wise mAb combinations were more inhibitory than single mAbs, and all of the mAbs together was the most efficient combination. Each mAb could opsonize IEs for phagocytosis, and a combination of the eight mAbs caused phagocytosis similar to that of plasma IgG-opsonized IEs. We conclude that functionally important Ab epitopes are shared by the majority of polymorphic VAR2CSA variants, which supports the feasibility of VAR2CSA-based vaccines against placental malaria.
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Affiliation(s)
- Lea Barfod
- Centre for Medical Parasitology, Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark
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Magistrado PA, Minja D, Doritchamou J, Ndam NT, John D, Schmiegelow C, Massougbodji A, Dahlbäck M, Ditlev SB, Pinto VV, Resende M, Lusingu J, Theander TG, Salanti A, Nielsen MA. High efficacy of anti DBL4ɛ-VAR2CSA antibodies in inhibition of CSA-binding Plasmodium falciparum-infected erythrocytes from pregnant women. Vaccine 2010; 29:437-43. [PMID: 21075162 DOI: 10.1016/j.vaccine.2010.10.080] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 10/26/2010] [Accepted: 10/29/2010] [Indexed: 11/24/2022]
Abstract
Malaria during pregnancy is a major cause of intra-uterine growth-retardation and infant death in sub-Saharan Africa. Ideally, this could be prevented by a vaccine delivered before the first pregnancy. Antibodies against domain DBL4ɛ from VAR2CSA has been shown to inhibit adhesion of laboratory isolates to the placental receptor chondroitin sulfate A. In this study, the binding inhibitory efficacy of IgG elicited by two different DBL4ɛ recombinant proteins was tested on a panel of fresh clinical isolates from pregnant women living in Benin and Tanzania. The most promising recombinant protein elicited antibodies with similar efficacy as pooled plasma from immune multi-gravid African women.
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Affiliation(s)
- Pamela A Magistrado
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.
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37
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Gnidehou S, Jessen L, Gangnard S, Ermont C, Triqui C, Quiviger M, Guitard J, Lund O, Deloron P, Ndam NT. Insight into antigenic diversity of VAR2CSA-DBL5ε domain from multiple Plasmodium falciparum placental isolates. PLoS One 2010; 5. [PMID: 20957045 PMCID: PMC2948511 DOI: 10.1371/journal.pone.0013105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 07/29/2010] [Indexed: 11/18/2022] Open
Abstract
Background Protection against pregnancy associated malaria (PAM) is associated with high levels of anti-VAR2CSA antibodies. This protection is obtained by the parity dependent acquisition of anti-VAR2CSA antibodies. Distinct parity-associated molecular signatures have been identified in VAR2CSA domains. These two observations combined point to the importance of identifying VAR2CSA sequence variation, which facilitate parasitic evasion or subversion of host immune response. Highly conserved domains of VAR2CSA such as DBL5ε are likely to contain conserved epitopes, and therefore do constitute attractive targets for vaccine development. Methodology/Principal Findings VAR2CSA DBL5ε-domain sequences obtained from cDNA of 40 placental isolates were analysed by a combination of experimental and in silico methods. Competition ELISA assays on two DBL5ε variants, using plasma samples from women from two different areas and specific mice hyperimmune plasma, indicated that DBL5ε possess conserved and cross-reactive B cell epitopes. Peptide ELISA identified conserved areas that are recognised by naturally acquired antibodies. Specific antibodies against these peptides labelled the native proteins on the surface of placental parasites. Despite high DBL5ε sequence homology among parasite isolates, sequence analyses identified motifs in DBL5ε that discriminate parasites according to donor's parity. Moreover, recombinant proteins of two VAR2CSA DBL5ε variants displayed diverse recognition patterns by plasma from malaria-exposed women, and diverse proteoglycan binding abilities. Conclusions/Significance This study provides insights into conserved and exposed B cell epitopes in DBL5ε that might be a focus for cross reactivity. The importance of sequence variation in VAR2CSA as a critical challenge for vaccine development is highlighted. VAR2CSA conformation seems to be essential to its functionality. Therefore, identification of sequence variation sites in distinct locations within VAR2CSA, affecting antigenicity and/or binding properties, is critical to the effort of developing an efficient VAR2CSA-based vaccine. Motifs associated with parasite segregation according to parity constitute one such site.
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Affiliation(s)
- Sédami Gnidehou
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
- * E-mail: (SG); (NTN)
| | - Leon Jessen
- Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark
| | - Stéphane Gangnard
- Unité d'Immunologie Structurale, Institut Pasteur, CNRS URA2185, Paris, France
| | - Caroline Ermont
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
| | - Choukri Triqui
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
| | - Mickael Quiviger
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
| | - Juliette Guitard
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
| | - Ole Lund
- Department of Systems Biology, Center for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark
| | - Philippe Deloron
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Université Paris Descartes, Paris, France
| | - Nicaise Tuikue Ndam
- Institut de Recherche pour le Développement, IRD UMR 216, Mère et Enfant Face aux Infections Tropicales, Paris, France
- Institut des Sciences Biomédicale et Appliquées, Cotonou, Benin
- * E-mail: (SG); (NTN)
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Fernandez P, Petres S, Mécheri S, Gysin J, Scherf A. Strain-transcendent immune response to recombinant Var2CSA DBL5-ε domain block P. falciparum adhesion to placenta-derived BeWo cells under flow conditions. PLoS One 2010; 5:e12558. [PMID: 20838433 PMCID: PMC2933227 DOI: 10.1371/journal.pone.0012558] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 08/09/2010] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy-associated malaria (PAM) is a serious consequence of the adhesion to the placental receptor chondroitin sulfate A (CSA) of Plasmodium falciparum-infected erythrocytes (PE) expressing the large cysteine-rich multi-domain protein var2CSA. Women become resistant to PAM, and develop strain-transcending immunity against CSA-binding parasites. The identification of var2CSA regions that could elicit broadly neutralizing and adhesion-blocking antibodies is a key step for the design of prophylactic vaccine strategies. Methodology Escherichia coli expressed var2CSA DBL domains were refolded and purified prior to immunization of mice and a goat. Protein-G-purified antibodies were tested for their ability to block FCR3CSA-infected erythrocytes binding to placental (BeWo) and monkey brain endothelial (ScC2) cell lines using a flow cytoadhesion inhibition assay mimicking closely the physiological conditions present in the placenta at shear stress of 0.05 Pa. DBL5-ε, DBL6-ε and DBL5-6-ε induced cross-reactive antibodies using Alum and Freund as adjuvants, which blocked cytoadhesion at values ranging between 40 to 96% at 0.5 mg IgG per ml. Importantly, antibodies raised against recombinant DBL5-ε from 3 distinct parasites genotypes (HB3, Dd2 and 7G8) showed strain-transcending inhibition ranging from 38 to 64% for the heterologuous FCR3CSA. Conclusions Using single and double DBL domains from var2CSA and Alum as adjuvant, we identified recombinant subunits inducing an immune response in experimental animals which is able to block efficiently parasite adhesion in a flow cytoadhesion assay that mimics closely the erythrocyte flow in the placenta. These subunits show promising features for inclusion into a vaccine aiming to protect against PAM.
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Affiliation(s)
- Pablo Fernandez
- Unité de Biologie des Interactions Hôte-Parasite, Institut Pasteur, Paris, France
- CNRS URA2581, Paris, France
| | - Stéphane Petres
- Host Pathogen Interactions Unit, Institut Pasteur, Abymes, France
| | - Salaheddine Mécheri
- Unité de Biologie des Interactions Hôte-Parasite, Institut Pasteur, Paris, France
- CNRS URA2581, Paris, France
| | - Jürg Gysin
- Host Pathogen Interactions Unit, Institut Pasteur, Abymes, France
| | - Artur Scherf
- Unité de Biologie des Interactions Hôte-Parasite, Institut Pasteur, Paris, France
- CNRS URA2581, Paris, France
- * E-mail:
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39
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Mens PF, Bojtor EC, Schallig HDFH. Molecular interactions in the placenta during malaria infection. Eur J Obstet Gynecol Reprod Biol 2010; 152:126-32. [PMID: 20933151 DOI: 10.1016/j.ejogrb.2010.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/12/2010] [Accepted: 05/24/2010] [Indexed: 10/19/2022]
Abstract
Placental malaria is the placental sequestration of Plasmodium falciparum infected erythrocytes that accumulate in the intervillous space, resulting in pathological alterations. The intervillous space, the main compartment for exchange of nutrients and delivery of oxygen to the fetus, is of utmost importance for fetal development. Events leading to adverse outcomes of placental malaria can be summarized in four steps: (1) accumulation of P. falciparum infected erythrocytes; (2) infiltration of monocytes and macrophages; (3) alteration of the placental cytokine balance and (4) pathogenesis of adverse pregnancy outcomes. These events are triggered by chemokines and cytokines leading to impaired materno-fetal exchange and damage to the placenta. This review describes the events during placental malaria infection at molecular level and presents a simplified model describing all crucial steps leading to adverse pregnancy outcomes based on a review of recent literature (August 2009).
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Affiliation(s)
- Petra F Mens
- Royal Tropical Institute, Department of Biomedical Research, Amsterdam, The Netherlands.
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40
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Guitard J, Andersen P, Ermont C, Gnidehou S, Fievet N, Lund O, Deloron P, Ndam NT. Plasmodium falciparum population dynamics in a cohort of pregnant women in Senegal. Malar J 2010; 9:165. [PMID: 20553578 PMCID: PMC2893538 DOI: 10.1186/1475-2875-9-165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pregnant women acquire protective antibodies that cross-react with geographically diverse placental Plasmodium falciparum isolates, suggesting that surface molecules expressed on infected erythrocytes by pregnancy-associated malaria (PAM) parasites have conserved epitopes and, that designing a PAM vaccine may be envisaged. VAR2CSA is the main candidate for a pregnancy malaria vaccine, but vaccine development may be complicated by its sequence polymorphism. METHODS The dynamics of P. falciparum genotypes during pregnancy in 32 women in relation to VAR2CSA polymorphism and immunity was determined. The polymorphism of the msp2 gene and five microsatellites was analysed in consecutive parasite isolates, and the DBL5epsilon + Interdomain 5 (Id5) part of the var2csa gene of the corresponding samples was cloned and sequenced to measure variation. RESULTS In primigravidae, the multiplicity of infection in the placenta was associated with occurrence of low birth weight babies. Some parasite genotypes were able to persist over several weeks and, still be present in the placenta at delivery particularly when the host anti-VAR2CSA antibody level was low. Comparison of diversity among genotyping markers confirmed that some PAM parasites may harbour more than one var2csa gene copy in their genome. CONCLUSIONS Host immunity to VAR2CSA influences the parasite dynamics during pregnancy, suggesting that the acquisition of protective immunity requires pre-exposure to a limited number of parasite variants. Presence of highly conserved residues in surface-exposed areas of the VAR2CSA immunodominant DBL5epsilon domain, suggest its potential in inducing antibodies with broad reactivity.
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Affiliation(s)
- Juliette Guitard
- Institut de Recherche pour le Développement, Université Paris Descartes, France.
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41
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Gangnard S, Tuikue Ndam NG, Gnidehou S, Quiviger M, Juillerat A, Faure G, Baron B, Viwami F, Deloron P, Bentley GA. Functional and immunological characterization of the var2CSA-DBL5epsilon domain of a placental Plasmodium falciparum isolate. Mol Biochem Parasitol 2010; 173:115-22. [PMID: 20562018 DOI: 10.1016/j.molbiopara.2010.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/15/2010] [Accepted: 05/17/2010] [Indexed: 11/15/2022]
Abstract
Pregnancy-associated malaria (PAM) arises from sequestration of Plasmodium falciparum-parasitized erythrocytes (PE) in the placenta, leading to chronic symptoms in the expectant mother and serious consequences for fetal development. Placental sequestration has been linked to binding of chondroitin sulphate A (CSA) by the var2CSA variant of PfEMP1 expressed on the PE surface, and a substantial body of evidence shows that the immune response to var2CSA gives an effective protection against PAM. We have expressed the var2CSA-DBL5epsilon domain, derived from a placental isolate from Senegal, as soluble product in Escherichia coli and have shown using different criteria that the recombinant protein is obtained with the native conformation. Using surface plasmon resonance techniques, we have examined binding of DBL5epsilon to placental chondroitin sulphate proteoglycan and CSA; however, the recombinant protein also binds to other sulphated oligosaccharides, with higher affinity in some cases, indicating that the single domain lacks the specificity for CSA shown by the complete extra-cellular region of var2CSA and placental parasites. Recombinant DBL5epsilon was specifically recognized by sera from malaria-exposed Senegalese women in a parity-dependent manner but by sera not from children or males from the same endemic region. Conversely, DBL5epsilon induced antibodies in mice that recognized placental isolates from Benin but not isolates from children. The presence of universal epitopes thus supports DBL5epsilon as an interesting component of var2CSA to be considered for vaccine development.
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Affiliation(s)
- Stéphane Gangnard
- Institut Pasteur, Unité d'Immunologie Structurale, CNRS URA2185, Paris, France
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Hommel M, Elliott SR, Soma V, Kelly G, Fowkes FJI, Chesson JM, Duffy MF, Bockhorst J, Avril M, Mueller I, Raiko A, Stanisic DI, Rogerson SJ, Smith JD, Beeson JG. Evaluation of the antigenic diversity of placenta-binding Plasmodium falciparum variants and the antibody repertoire among pregnant women. Infect Immun 2010; 78:1963-78. [PMID: 20160014 PMCID: PMC2863515 DOI: 10.1128/iai.01365-09] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/09/2010] [Accepted: 02/10/2010] [Indexed: 11/20/2022] Open
Abstract
Pregnant women are infected by specific variants of Plasmodium falciparum that adhere and accumulate in the placenta. Using serological and molecular approaches, we assessed the global antigenic diversity of surface antigens expressed by placenta-binding isolates to better understand immunity to malaria in pregnancy and evolution of polymorphisms and to inform vaccine development. We found that placenta-binding isolates originating from all major regions where malaria occurs were commonly recognized by antibodies in different populations of pregnant women. There was substantial antigenic overlap and sharing of epitopes between isolates, including isolates from distant geographic locations, suggesting that there are limitations to antigenic diversity; however, differences between populations and isolates were also seen. Many women had cross-reactive antibodies and/or a broad repertoire of antibodies to different isolates. Studying VAR2CSA as the major antigen expressed by placenta-binding isolates, we identified antibody epitopes encoded by variable sequence blocks in the DBL3 domain. Analysis of global var2csa DBL3 sequences demonstrated that there was extensive sharing of variable blocks between Africa, Asia, Papua New Guinea, and Latin America, which likely contributes to the high level of antigenic overlap between different isolates. However, there was also evidence of geographic clustering of sequences and differences in VAR2CSA sequences between populations. The results indicate that there is limited antigenic diversity in placenta-binding isolates and may explain why immunity to malaria in pregnancy can be achieved after exposure during one pregnancy. Inclusion of a limited number of variants in a candidate vaccine may be sufficient for broad population coverage, but geographic considerations may also have to be included in vaccine design.
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MESH Headings
- Animals
- Antibodies, Protozoan/immunology
- Antigenic Variation
- Antigens, Protozoan/genetics
- Antigens, Protozoan/immunology
- Cross Reactions
- DNA, Protozoan/chemistry
- DNA, Protozoan/genetics
- Epitopes/genetics
- Epitopes/immunology
- Female
- Geography
- Humans
- Malaria, Falciparum/immunology
- Malaria, Falciparum/parasitology
- Malawi
- Male
- Molecular Sequence Data
- Placenta/parasitology
- Plasmodium falciparum/classification
- Plasmodium falciparum/genetics
- Plasmodium falciparum/isolation & purification
- Pregnancy
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/parasitology
- Rabbits
- Sequence Analysis, DNA
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Affiliation(s)
- Mirja Hommel
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Salenna R. Elliott
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Viju Soma
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Greg Kelly
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Freya J. I. Fowkes
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Joanne M. Chesson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Michael F. Duffy
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Joseph Bockhorst
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Marion Avril
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Andrew Raiko
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Danielle I. Stanisic
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Stephen J. Rogerson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Joseph D. Smith
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - James G. Beeson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Seattle Biomedical Research Institute, Seattle, Washington, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia, University of Wisconsin, Milwaukee, Wisconsin, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
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Immunization with VAR2CSA-DBL5 recombinant protein elicits broadly cross-reactive antibodies to placental Plasmodium falciparum-infected erythrocytes. Infect Immun 2010; 78:2248-56. [PMID: 20194590 DOI: 10.1128/iai.00410-09] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pregnancy-associated malaria is a severe clinical syndrome associated with the sequestration of Plasmodium falciparum-infected erythrocytes in the placenta. Placental binding is mediated by VAR2CSA, a member of the large and diverse P. falciparum erythrocyte membrane 1 (PfEMP1) protein family. To better understand if conserved regions in VAR2CSA can be targeted by antibodies, we immunized rabbits with VAR2CSA-DBL1 and -DBL5 recombinant proteins produced in Pichia pastoris and developed a panel of seven chondroitin sulfate A (CSA)-binding parasites from diverse geographic origins. Overall, no two parasites in the panel expressed the same VAR2CSA sequence. The DBL1 domains averaged 80% amino acid identity (range, 72 to 89%), and the DBL5 domains averaged 86% amino acid identity (range, 83 to 99%), similar to a broader sampling of VAR2CSA sequences from around the world. Whereas antibodies generated against the VAR2CSA-DBL1 recombinant protein had only limited breadth and reacted with three or four parasites in the panel, immunization with DBL5 recombinant proteins elicited broadly cross-reactive antibodies against all or most parasites in the panel, as well as to fresh clinical isolates from pregnant women. These findings demonstrate that the major PfEMP1 variant expressed by placental isolates exposes strain-transcendent epitopes that can be targeted by vaccination and may have application for pregnancy malaria vaccine development.
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Can any lessons be learned from the ambiguous glycan binding of PfEMP1 domains? Trends Parasitol 2010; 26:230-5. [PMID: 20189879 DOI: 10.1016/j.pt.2010.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/18/2009] [Accepted: 02/04/2010] [Indexed: 11/22/2022]
Abstract
Pregnancy-associated malaria (PAM) is caused by Plasmodium falciparum-infected erythrocytes (IEs) accumulating in the placenta and has dire consequences for both mother and child. The multi-domain antigen VAR2CSA confers specific adhesion of IEs to chondroitin sulphate A (CSA) in the placenta, and is the leading PAM vaccine candidate. Recent data from different laboratories show that the binding properties of individual VAR2CSA domains do not reflect the native CSA-specific adhesion of IEs, which questions the relevance of the information obtained from single domain binding assays and co-crystallization experiments. Here, we discuss the implications of these findings for VAR2CSA vaccine development and highlight the need for studying the native structure of this protein.
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Brolin KJM, Persson KEM, Wahlgren M, Rogerson SJ, Chen Q. Differential recognition of P. falciparum VAR2CSA domains by naturally acquired antibodies in pregnant women from a malaria endemic area. PLoS One 2010; 5:e9230. [PMID: 20169064 PMCID: PMC2821912 DOI: 10.1371/journal.pone.0009230] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 01/25/2010] [Indexed: 11/18/2022] Open
Abstract
Background Plasmodium falciparum infected red blood cells (iRBC)
express variant surface antigens (VSA) of which VAR2CSA is involved in
placental sequestration and causes pregnancy-associated malaria (PAM).
Primigravidae are most susceptible to PAM whereas antibodies associated with
protection are often present at higher levels in multigravid women. However,
HIV co-infection with malaria has been shown to alter this parity-dependent
acquisition of immunity, with more severe symptoms as well as more malaria
episodes in HIV positive women versus HIV negative women of a similar
parity. Methods Using VAR2CSA DBL-domains expressed on the surface of CHO-745 cells we
quantified levels of DBL-domain specific IgG in sera from pregnant Malawian
women by flow cytometry. Dissociations constants of DBL5ε specific
antibodies were determined using a surface plasmon resonance technique, as
an indication of antibody affinities. Results VAR2CSA DBL5ε was recognized in a gender and parity-dependent manner
with anti-DBL5ε IgG correlating significantly with IgG levels to
VSA-PAM on the iRBC surface. HIV positive women had lower levels of
anti-DBL5ε IgG than HIV negative women of similar parity. In
primigravidae, antibodies in HIV positive women also showed significantly
lower affinity to VAR2CSA DBL5ε. Conclusions Pregnant women from a malaria-endemic area had increased levels of
anti-DBL5ε IgG by parity, indicating this domain of VAR2CSA to be a
promising vaccine candidate against PAM. However, it is important to
consider co-infection with HIV, as this seems to change the properties of
antibody response against malaria. Understanding the characteristics of
antibody response against VAR2CSA is undoubtedly imperative in order to
design a functional and efficient vaccine against PAM.
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Affiliation(s)
- Kim J. M. Brolin
- Department of Microbiology, Tumor and Cell Biology, Karolinska
Institutet, Stockholm, Sweden
- Department of Parasitology, Swedish Institute for Infectious Disease
Control (SMI), Stockholm, Sweden
| | - Kristina E. M. Persson
- Department of Microbiology, Tumor and Cell Biology, Karolinska
Institutet, Stockholm, Sweden
- Department of Parasitology, Swedish Institute for Infectious Disease
Control (SMI), Stockholm, Sweden
| | - Mats Wahlgren
- Department of Microbiology, Tumor and Cell Biology, Karolinska
Institutet, Stockholm, Sweden
- Department of Parasitology, Swedish Institute for Infectious Disease
Control (SMI), Stockholm, Sweden
| | - Stephen J. Rogerson
- Department of Medicine (RMH/WH), The University of Melbourne, Melbourne,
Victoria, Australia
- * E-mail: (SJR); (QC)
| | - Qijun Chen
- Department of Microbiology, Tumor and Cell Biology, Karolinska
Institutet, Stockholm, Sweden
- Department of Parasitology, Swedish Institute for Infectious Disease
Control (SMI), Stockholm, Sweden
- Key Laboratory of Zoonosis, Ministry of Education and Jilin University,
Changchun, China
- Institute of Pathogen Biology, Chinese Academy of Medical Science,
Beijing, China
- * E-mail: (SJR); (QC)
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Khunrae P, Dahlbäck M, Nielsen MA, Andersen G, Ditlev SB, Resende M, Pinto VV, Theander TG, Higgins MK, Salanti A. Full-length recombinant Plasmodium falciparum VAR2CSA binds specifically to CSPG and induces potent parasite adhesion-blocking antibodies. J Mol Biol 2010; 397:826-34. [PMID: 20109466 PMCID: PMC3715698 DOI: 10.1016/j.jmb.2010.01.040] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/08/2010] [Accepted: 01/19/2010] [Indexed: 11/27/2022]
Abstract
Plasmodium falciparum malaria remains one of the world's leading causes of human suffering and poverty. Each year, the disease takes 1–3 million lives, mainly in sub-Saharan Africa. The adhesion of infected erythrocytes (IEs) to vascular endothelium or placenta is the key event in the pathogenesis of severe P. falciparum infection. In pregnant women, the parasites express a single and unique member of the P. falciparum erythrocyte membrane protein 1 (PfEMP1) family named VAR2CSA, which is associated with the ability of the IEs to adhere specifically to chondroitin sulphate A (CSA) in the placenta. Several Duffy-binding-like domains from VAR2CSA molecules have been shown in vitro to bind to CSA, but it has also been demonstrated that Duffy-binding-like domains from PfEMP1 proteins other than VAR2CSA can bind CSA. In addition, the specificity of the binding of VAR2CSA domains to glycosaminoglycans does not match that of VAR2CSA-expressing IEs. This has led to speculation that the domains of native VAR2CSA need to come together to form a specific binding site or that VAR2CSA might bind to CSA through a bridging molecule. Here, we describe the expression and purification of the complete extracellular region of VAR2CSA secreted at high yields from insect cells. Using surface plasmon resonance, we demonstrate that VAR2CSA alone binds with nanomolar affinity to human chondroitin sulphate proteoglycan and with significantly weaker affinity to other glycosaminoglycans, showing a specificity similar to that observed for IEs. Antibodies raised against full-length VAR2CSA completely inhibit recombinant VAR2CSA binding, as well as parasite binding to chondroitin sulphate proteoglycan. This is the first study to describe the successful production and functionality of a full-length PfEMP1. The specificity of the binding and anti-adhesion potency of induced IgG, together with high-yield production, encourages the use of full-length PfEMP1 in vaccine development strategies.
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Affiliation(s)
- Pongsak Khunrae
- Department of Biochemistry, University of Cambridge, Cambridge, UK
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Salanti A, Resende M, Ditlev SB, Pinto VV, Dahlbäck M, Andersen G, Manczak T, Theander TG, Nielsen MA. Several domains from VAR2CSA can induce Plasmodium falciparum adhesion-blocking antibodies. Malar J 2010; 9:11. [PMID: 20064234 PMCID: PMC2817698 DOI: 10.1186/1475-2875-9-11] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/11/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria caused by Plasmodium falciparum can result in several different syndromes with severe clinical consequences for the about 200 million individuals infected each year. During pregnancy, women living in endemic areas become susceptible to malaria due to lack of antibodies against a unique P. falciparum membrane protein, named VAR2CSA. This antigen is not expressed in childhood infections, since it binds chondroitin sulphate A (CSA) expressed on the intervillous space in the placenta. A vaccine appears possible because women acquire protective antibodies hindering sequestration in the placenta as a function of parity. A challenge for vaccine development is to design small constructs of this large antigen, which can induce broadly protective antibodies. It has previously been shown that one domain of VAR2CSA, DBL4-FCR3, induces parasite adhesion-blocking antibodies. In this study, it is demonstrated that other domains of VAR2CSA also can induce antibodies with inhibitory activity. METHODS All VAR2CSA domains from the 3D7 and HB3 parasites were produced in Baculovirus-transfected insect cells. Groups of three rats per protein were immunized and anti-sera were tested for surface reactivity against infected erythrocytes expressing FCR3 VAR2CSA and for the ability to inhibit FCR3CSA parasite adhesion to CSA. The fine specificity of the immune sera was analysed by VAR2CSA peptide arrays. RESULTS Inhibitory antibodies were induced by immunization with DBL3-HB3 T1 and DBL1-3D7. However, unlike the previously characterised DBL4-FCR3 response the inhibitory response against DBL1-3D7 and DBL3-HB3 T1 was poorly reproduced in the second rounds of immunizations. CONCLUSION It is possible to induce parasite adhesion-blocking antibodies when immunizing with a number of different VAR2CSA domains. This indicates that the CSA binding site in VAR2CSA is comprised of epitopes from different domains.
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Affiliation(s)
- Ali Salanti
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Abstract
Malaria remains one of the most devastating infectious diseases that threaten humankind. Human malaria is caused by five different species of Plasmodium parasites, each transmitted by the bite of female Anopheles mosquitoes. Plasmodia are eukaryotic protozoans with more than 5000 genes and a complex life cycle that takes place in the mosquito vector and the human host. The life cycle can be divided into pre-erythrocytic stages, erythrocytic stages and mosquito stages. Malaria vaccine research and development faces formidable obstacles because many vaccine candidates will probably only be effective in a specific species at a specific stage. In addition, Plasmodium actively subverts and escapes immune responses, possibly foiling vaccine-induced immunity. Although early successful vaccinations with irradiated, live-attenuated malaria parasites suggested that a vaccine is possible, until recently, most efforts have focused on subunit vaccine approaches. Blood-stage vaccines remain a primary research focus, but real progress is evident in the development of a partially efficacious recombinant pre-erythrocytic subunit vaccine and a live-attenuated sporozoite vaccine. It is unlikely that partially effective vaccines will eliminate malaria; however, they might prove useful in combination with existing control strategies. Elimination of malaria will probably ultimately depend on the development of highly effective vaccines.
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Sander AF, Salanti A, Lavstsen T, Nielsen MA, Magistrado P, Lusingu J, Ndam NT, Arnot DE. Multiple var2csa-type PfEMP1 genes located at different chromosomal loci occur in many Plasmodium falciparum isolates. PLoS One 2009; 4:e6667. [PMID: 19690615 PMCID: PMC2723927 DOI: 10.1371/journal.pone.0006667] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 07/13/2009] [Indexed: 12/03/2022] Open
Abstract
Background The var2csa gene encodes a Plasmodium falciparum adhesion receptor which binds chondroitin sulfate A (CSA). This var gene is more conserved than other PfEMP1/var genes and is found in all P. falciparum isolates. In isolates 3D7, FCR3/It4 and HB3, var2csa is transcribed from a sub-telomeric position on the left arm of chromosome 12, but it is not known if this location is conserved in all parasites. Genome sequencing indicates that the var2csa gene is duplicated in HB3, but whether this is true in natural populations is uncertain. Methodology/Principal Findings To assess global variation in the VAR2CSA protein, sequence variation in the DBL2X region of var2csa genes in 54 P.falciparum samples was analyzed. Chromosome mapping of var2csa loci was carried out and a quantitative PCR assay was developed to estimate the number of var2csa genes in P.falciparum isolates from the placenta of pregnant women and from the peripheral circulation of other malaria patients. Sequence analysis, gene mapping and copy number quantitation in P.falciparum isolates indicate that there are at least two loci and that both var2csa-like genes can be transcribed. All VAR2CSA DBL2X domains fall into one of two distinct phylogenetic groups possessing one or the other variant of a large (∼26 amino acid) dimorphic motif, but whether either motif variant is linked to a specific locus is not known. Conclusions/Significance Two or more related but distinct var2csa-type PfEMP1/var genes exist in many P. falciparum isolates. One gene is on chromosome 12 but additional var2csa-type genes are on different chromosomes in different isolates. Multiplicity of var2csa genes appears more common in infected placentae than in samples from non-pregnant donors indicating a possible advantage of this genotype in pregnancy associated malaria.
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Affiliation(s)
- Adam F. Sander
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ali Salanti
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thomas Lavstsen
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Morten A. Nielsen
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Pamela Magistrado
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- JMP-ENRICA Project, National Institute for Medical Research, Korogwe Laboratory, Tanga, Tanzania
| | - John Lusingu
- JMP-ENRICA Project, National Institute for Medical Research, Korogwe Laboratory, Tanga, Tanzania
| | - Nicaise Tuikue Ndam
- Institut de Recherche pour le Developpment, UR010, Universite Paris Descartes, Paris, France
| | - David E. Arnot
- Centre for Medical Parasitology, Department of International Health, Immunology & Microbiology, Faculty of Health Sciences, University of Copenhagen & Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
- Institute of Immunology & Infection Research, School of Biology, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- * E-mail:
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50
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Soerli J, Barfod L, Lavstsen T, Bernasconi NL, Lanzavecchia A, Hviid L. Human monoclonal IgG selection of Plasmodium falciparum for the expression of placental malaria-specific variant surface antigens. Parasite Immunol 2009; 31:341-6. [PMID: 19493213 PMCID: PMC3001033 DOI: 10.1111/j.1365-3024.2009.01097.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pregnancy-associatedPlasmodium falciparum malaria (PAM) is a major cause of morbidity and mortality in African women and their offspring. PAM is characterized by accumulation of infected erythrocytes (IEs) that adhere to chondroitin sulphate A (CSA) in the placental intervillous space. We show here that human monoclonal IgG antibodies with specificity for variant surface antigens (VSA) specifically expressed by CSA-adhering IEs (VSAPAM) can be used in vitro to select parasites from nonpregnant donors to express VSAPAM and that this selection for VSAPAM expression results in preferential transcription of var2csa. The results corroborate current efforts to develop PAM-specific vaccines based on VAR2CSA.
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Affiliation(s)
- J Soerli
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen Denmark
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