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Garrood WT, Cuber P, Willis K, Bernardini F, Page NM, Haghighat-Khah RE. Driving down malaria transmission with engineered gene drives. Front Genet 2022; 13:891218. [PMID: 36338968 PMCID: PMC9627344 DOI: 10.3389/fgene.2022.891218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
The last century has witnessed the introduction, establishment and expansion of mosquito-borne diseases into diverse new geographic ranges. Malaria is transmitted by female Anopheles mosquitoes. Despite making great strides over the past few decades in reducing the burden of malaria, transmission is now on the rise again, in part owing to the emergence of mosquito resistance to insecticides, antimalarial drug resistance and, more recently, the challenges of the COVID-19 pandemic, which resulted in the reduced implementation efficiency of various control programs. The utility of genetically engineered gene drive mosquitoes as tools to decrease the burden of malaria by controlling the disease-transmitting mosquitoes is being evaluated. To date, there has been remarkable progress in the development of CRISPR/Cas9-based homing endonuclease designs in malaria mosquitoes due to successful proof-of-principle and multigenerational experiments. In this review, we examine the lessons learnt from the development of current CRISPR/Cas9-based homing endonuclease gene drives, providing a framework for the development of gene drive systems for the targeted control of wild malaria-transmitting mosquito populations that overcome challenges such as with evolving drive-resistance. We also discuss the additional substantial works required to progress the development of gene drive systems from scientific discovery to further study and subsequent field application in endemic settings.
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Affiliation(s)
- William T. Garrood
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Piotr Cuber
- Department of Molecular Biology, Core Research Laboratories, Natural History Museum, London, United Kingdom
| | - Katie Willis
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Federica Bernardini
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Nicole M. Page
- Department of Life Sciences, Imperial College London, London, United Kingdom
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Concha C, Palavesam A, Guerrero FD, Sagel A, Li F, Osborne JA, Hernandez Y, Pardo T, Quintero G, Vasquez M, Keller GP, Phillips PL, Welch JB, McMillan WO, Skoda SR, Scott MJ. A transgenic male-only strain of the New World screwworm for an improved control program using the sterile insect technique. BMC Biol 2016; 14:72. [PMID: 27576512 PMCID: PMC5004303 DOI: 10.1186/s12915-016-0296-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background The New World screwworm, Cochliomyia hominivorax, is a devastating pest of livestock endemic to subtropical and tropical regions of the Western hemisphere. The larvae of this species feed on the tissue of living animals, including man, and can cause death if untreated. Over 60 years ago, the sterile insect technique (SIT) was developed with the aim of eradicating this pest, initially from Florida but subsequently from all of North and Central America. From the outset it was appreciated that SIT would be more efficient if only sterile males were released in the field, but this was not possible until now. Results Here, we report on the development and evaluation of the first sexing strains of C. hominivorax that produce only males when raised on diet without tetracycline. Transgenic lines have been developed that possess a tetracycline repressible female-lethal genetic system. Ten of these lines show high female lethality at the late larval/pupal stages and three of them present dominant female lethality. Most of the lines were comparable to the wild type parental strain in several fitness parameters that are relevant to mass rearing in a production facility. Further, three lines performed well in male mating success and male competition assays, suggesting they would be sexually competitive in the field. Consequently, one transgenic line has been selected by the New World Screwworm Program for evaluation under mass rearing conditions. Conclusions We conclude that the promising characteristics of the selected sexing strains may contribute to reduce production costs for the existing eradication program and provide more efficient population suppression, which should make a genetic control program more economical in regions were C. hominivorax remains endemic. Electronic supplementary material The online version of this article (doi:10.1186/s12915-016-0296-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Concha
- Department of Entomology, North Carolina State University, Campus Box 7613, Raleigh, NC, 27695-7613, USA.,Panama-United States Commission for the Eradication and Prevention of Screwworm (COPEG), Pacora, Panama.,Smithsonian Tropical Research Institute, Naos Molecular Laboratory, Panama City, Panama
| | - Azhahianambi Palavesam
- USDA-ARS, Tick and Biting Fly Research Unit, Knipling-Bushland Livestock Insects Research Laboratory, 2700 Fredericksburg Rd., Kerrville, TX, 78028, USA.,Present address: Department of Veterinary Parasitology, Madras Veterinary College, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - Felix D Guerrero
- USDA-ARS, Tick and Biting Fly Research Unit, Knipling-Bushland Livestock Insects Research Laboratory, 2700 Fredericksburg Rd., Kerrville, TX, 78028, USA
| | | | - Fang Li
- Department of Entomology, North Carolina State University, Campus Box 7613, Raleigh, NC, 27695-7613, USA
| | - Jason A Osborne
- Department of Statistics, North Carolina State University, Campus Box 8203, Raleigh, NC, 27695-8203, USA
| | - Yillian Hernandez
- Panama-United States Commission for the Eradication and Prevention of Screwworm (COPEG), Pacora, Panama
| | | | | | | | | | - Pamela L Phillips
- USDA-ARS, Screwworm Research Unit, Pacora, Panama.,USDA-ARS, Screwworm Research Unit, Knipling-Bushland Livestock Insects Research Laboratory, 2700 Fredericksburg Rd., Kerrville, TX, 78028, USA
| | - John B Welch
- USDA-APHIS, IS Action Programs, 2881 F&B Road, College Station, TX, 77845, USA
| | - W Owen McMillan
- Smithsonian Tropical Research Institute, Naos Molecular Laboratory, Panama City, Panama
| | - Steven R Skoda
- USDA-ARS, Screwworm Research Unit, Pacora, Panama.,USDA-ARS, Screwworm Research Unit, Knipling-Bushland Livestock Insects Research Laboratory, 2700 Fredericksburg Rd., Kerrville, TX, 78028, USA
| | - Maxwell J Scott
- Department of Entomology, North Carolina State University, Campus Box 7613, Raleigh, NC, 27695-7613, USA.
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Patil PB, Niranjan Reddy BP, Gorman K, Seshu Reddy KV, Barwale SR, Zehr UB, Nimmo D, Naish N, Alphey L. Mating competitiveness and life-table comparisons between transgenic and Indian wild-type Aedes aegypti L. PEST MANAGEMENT SCIENCE 2015; 71:957-65. [PMID: 25078081 PMCID: PMC4657483 DOI: 10.1002/ps.3873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/10/2014] [Accepted: 07/24/2014] [Indexed: 05/23/2023]
Abstract
BACKGROUND OX513A is a genetically engineered strain of Aedes aegypti carrying a repressible, dominantly inherited transgene that confers lethality in immature heterozygous progeny. Released male OX513A adults have proven to be effective for the localised suppression of wild Ae. aegypti, highlighting its potential in vector control. Mating and life-table assessments were used to compare OX513A with reared Ae. aegypti strains collected from New Delhi and Aurangabad regions in India. RESULTS Mating proportions of New Delhi females versus males of OX513A or New Delhi strains were 0.52 and 0.48 respectively, indicating no discrimination by females against either strain, and males of both strains were equally competitive. Developmental time from first instar to adult emergence was significantly longer for OX513A (10.7 ± 0.04 days) than for New Delhi (9.4 ± 0.04 days) and Aurangabad strains (9.1 ± 0.04 days). Differences in mean longevities, female reproductive parameters and population growth parameters between the strains were non-significant. CONCLUSIONS The laboratory study demonstrates that only minor life-table variations of limited biological relevance exist between OX513A and Indian Ae. aegypti populations, and males had equal potential for mating competitiveness. Thus, results support the OX513A strain as a suitable candidate for continued evaluation towards sustainable management of Ae. aegypti populations in India.
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Affiliation(s)
- Prabhakargouda B Patil
- Gangabishan Bhikulal Investment and Trading Limited (GBIT)Jalna, Maharashtra State, India
| | - BP Niranjan Reddy
- Gangabishan Bhikulal Investment and Trading Limited (GBIT)Jalna, Maharashtra State, India
| | | | - KV Seshu Reddy
- Gangabishan Bhikulal Investment and Trading Limited (GBIT)Jalna, Maharashtra State, India
| | - Shirish R Barwale
- Gangabishan Bhikulal Investment and Trading Limited (GBIT)Jalna, Maharashtra State, India
| | - Usha B Zehr
- Gangabishan Bhikulal Investment and Trading Limited (GBIT)Jalna, Maharashtra State, India
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Fitness of transgenic mosquito Aedes aegypti males carrying a dominant lethal genetic system. PLoS One 2013; 8:e62711. [PMID: 23690948 PMCID: PMC3653897 DOI: 10.1371/journal.pone.0062711] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/22/2013] [Indexed: 02/03/2023] Open
Abstract
OX513A is a transgenic strain of Aedes aegypti engineered to carry a dominant, non-sex-specific, late-acting lethal genetic system that is repressed in the presence of tetracycline. It was designed for use in a sterile-insect (SIT) pest control system called RIDL® (Release of Insects carrying a Dominant Lethal gene) by which transgenic males are released in the field to mate with wild females; in the absence of tetracycline, the progeny from such matings will not survive. We investigated the mating fitness of OX513A in the laboratory. Male OX513A were as effective as Rockefeller (ROCK) males at inducing refractoriness to further mating in wild type females and there was no reduction in their ability to inseminate multiple females. They had a lower mating success but yielded more progeny than the wild-type comparator strain (ROCK) when one male of each strain was caged with a ROCK female. Mating success and fertility of groups of 10 males—with different ratios of RIDL to ROCK—competing for five ROCK females was similar, but the median longevity of RIDL males was somewhat (18%) lower. We conclude that the fitness under laboratory conditions of OX513A males carrying a tetracycline repressible lethal gene is comparable to that of males of the wild-type comparator strain.
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Open field release of genetically engineered sterile male Aedes aegypti in Malaysia. PLoS One 2012; 7:e42771. [PMID: 22970102 PMCID: PMC3428326 DOI: 10.1371/journal.pone.0042771] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/11/2012] [Indexed: 12/17/2022] Open
Abstract
Background Dengue is the most important mosquito-borne viral disease. In the absence of specific drugs or vaccines, control focuses on suppressing the principal mosquito vector, Aedes aegypti, yet current methods have not proven adequate to control the disease. New methods are therefore urgently needed, for example genetics-based sterile-male-release methods. However, this requires that lab-reared, modified mosquitoes be able to survive and disperse adequately in the field. Methodology/Principal Findings Adult male mosquitoes were released into an uninhabited forested area of Pahang, Malaysia. Their survival and dispersal was assessed by use of a network of traps. Two strains were used, an engineered ‘genetically sterile’ (OX513A) and a wild-type laboratory strain, to give both absolute and relative data about the performance of the modified mosquitoes. The two strains had similar maximum dispersal distances (220 m), but mean distance travelled of the OX513A strain was lower (52 vs. 100 m). Life expectancy was similar (2.0 vs. 2.2 days). Recapture rates were high for both strains, possibly because of the uninhabited nature of the site. Conclusions/Significance After extensive contained studies and regulatory scrutiny, a field release of engineered mosquitoes was safely and successfully conducted in Malaysia. The engineered strain showed similar field longevity to an unmodified counterpart, though in this setting dispersal was reduced relative to the unmodified strain. These data are encouraging for the future testing and implementation of genetic control strategies and will help guide future field use of this and other engineered strains.
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Martins S, Naish N, Walker AS, Morrison NI, Scaife S, Fu G, Dafa'alla T, Alphey L. Germline transformation of the diamondback moth, Plutella xylostella L., using the piggyBac transposable element. INSECT MOLECULAR BIOLOGY 2012; 21:414-421. [PMID: 22621377 DOI: 10.1111/j.1365-2583.2012.01146.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The diamondback moth, Plutella xylostella, is one of the most economically important agricultural pests. The larvae of this moth cause damage by feeding on the foliage of cruciferous vegetables such as cabbage, broccoli, cauliflower and rapeseed. Control generally comprises chemical treatment; however, the diamondback moth is renowned for rapid development of resistance to pesticides. Other methods, such as biological control, have not been able to provide adequate protection. Germline transformation of pest insects has become available in recent years as an enabling technology for new genetics-based control methods, such as the Release of Insects carrying a Dominant Lethal (RIDL(®) ). In the present study, we report the first transformation of the diamondback moth, using the piggyBac transposable element, by embryo microinjection. In generating transgenic strains using four different constructs, the function of three regulatory sequences in this moth was demonstrated in driving expression of fluorescent proteins. The transformation rates achieved, 0.48-0.68%, are relatively low compared with those described in other Lepidoptera, but not prohibitive, and are likely to increase with experience. We anticipate that germline transformation of the diamondback moth will permit the development of RIDL strains for use against this pest and facilitate the wider use of this species as a model organism for basic studies.
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Affiliation(s)
- S Martins
- Department of Zoology, University of Oxford, Oxford, UK
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Meza JS, Nirmala X, Zimowska GJ, Zepeda-Cisneros CS, Handler AM. Development of transgenic strains for the biological control of the Mexican fruit fly, Anastrepha ludens. Genetica 2010; 139:53-62. [DOI: 10.1007/s10709-010-9484-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 08/07/2010] [Indexed: 12/20/2022]
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Scolari F, Siciliano P, Gabrieli P, Gomulski LM, Bonomi A, Gasperi G, Malacrida AR. Safe and fit genetically modified insects for pest control: from lab to field applications. Genetica 2010; 139:41-52. [PMID: 20725766 DOI: 10.1007/s10709-010-9483-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 08/07/2010] [Indexed: 01/10/2023]
Abstract
Insect transgenesis is continuously being improved to increase the efficacy of population suppression and replacement strategies directed to the control of insect species of economic and sanitary interest. An essential prerequisite for the success of both pest control applications is that the fitness of the transformant individuals is not impaired, so that, once released in the field, they can efficiently compete with or even out-compete their wild-type counterparts for matings in order to reduce the population size, or to spread desirable genes into the target population. Recent research has shown that the production of fit and competitive transformants can now be achieved and that transgenes may not necessarily confer a fitness cost. In this article we review the most recent published results of the fitness assessment of different transgenic insect lines and underline the necessity to fulfill key requirements of ecological safety. Fitness evaluation studies performed in field cages and medium/large-scale rearing will validate the present encouraging laboratory results, giving an indication of the performance of the transgenic insect genotype after release in pest control programmes.
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Affiliation(s)
- F Scolari
- Department of Animal Biology, University of Pavia, Pavia, Italy
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Alphey L, Benedict M, Bellini R, Clark GG, Dame DA, Service MW, Dobson SL. Sterile-insect methods for control of mosquito-borne diseases: an analysis. Vector Borne Zoonotic Dis 2010; 10:295-311. [PMID: 19725763 PMCID: PMC2946175 DOI: 10.1089/vbz.2009.0014] [Citation(s) in RCA: 298] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Effective vector control, and more specifically mosquito control, is a complex and difficult problem, as illustrated by the continuing prevalence (and spread) of mosquito-transmitted diseases. The sterile insect technique and similar methods control certain agricultural insect pest populations in a species-specific, environmentally sound, and effective manner; there is increased interest in applying this approach to vector control. Such an approach, like all others in use and development, is not a one-size-fits-all solution, and will be more appropriate in some situations than others. In addition, the proposed release of pest insects, and more so genetically modified pest insects, is bound to raise questions in the general public and the scientific community as to such a method's efficacy, safety, and sustainability. This article attempts to address these concerns and indicate where sterile-insect methods are likely to be useful for vector control.
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Affiliation(s)
- Luke Alphey
- Oxitec Limited, Oxford, United
Kingdom
- Department of Zoology, University of Oxford, Oxford,
United Kingdom
| | - Mark Benedict
- Entomology Unit, International Atomic Energy Agency,
Vienna, Austria
| | - Romeo Bellini
- Centro Agricoltura Ambiente “G.Nicoli,”
Crevalcore, Italy
| | - Gary G. Clark
- Mosquito and Fly Research Unit, USDA-ARS-CMAVE,
Gainesville, Florida
| | | | - Mike W. Service
- Liverpool School of Tropical Medicine, Liverpool,
United Kingdom
| | - Stephen L. Dobson
- Department of Entomology, University of Kentucky,
Lexington, Kentucky
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Handler AM, Allen ML, Skoda SR. Development and utilization of transgenic New World screwworm, Cochliomyia hominivorax. MEDICAL AND VETERINARY ENTOMOLOGY 2009; 23 Suppl 1:98-105. [PMID: 19335836 DOI: 10.1111/j.1365-2915.2008.00773.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The New World screwworm (NWS), Cochliomyia hominivorax (Coquerel) (Diptera: Calliphoridae), was the first insect to be effectively controlled using the sterile insect technique (SIT). Recent efforts to improve SIT control of this species have centred on the development of genetically transformed strains using the piggyBac transposon vector system. Eight transgenic strains were produced incorporating an enhanced green fluorescent protein (EGFP) marker gene under polyubiquitin regulation that has the potential for use as a genetic marking system for released males. The transgenic strains were genetically and phenotypically characterized, including for life fitness parameters and mating competitiveness. These characteristics were unique for each strain and thus some strains were deemed suitable for incorporation into SIT eradication programmes. The strain with the best attributes is designated 'CLAY'. Four of the strains, including CLAY, have been successfully cryopreserved so that their original characteristics should be unchanged when further evaluation is required. With the demonstration of efficient germ-line transformation in NWS, allowing production of fit and competitive transformants, it is now possible to consider further transgenic strain development to improve SIT that are currently being tested in other dipteran species. This includes strains that allow genetic marking with fluorescent proteins, genetic sexing by female lethality, male-specific fluorescent sorting and male sterility by testis-specific lethality. The SIT may also be improved upon by new strategies resulting in lethality of offspring of released insects using conditional lethal systems based upon temperature-dependent or dietary tetracycline regulation of lethal gene expression. Both the creation of new NWS transgenic strains and the ecological safety of their release will be enhanced by new vector systems that allow specific genomic targeting of vector constructs and their subsequent immobilization, ensuring transgene and strain stability.
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Affiliation(s)
- A M Handler
- Center for Medical, Agricultural and Veterinary Entomology, Agricultural Research Service, U.S. Department of Agriculture, Gainesville, Florida 32608, USA.
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O'Brochta DA, Handler AM. Perspectives on the state of insect transgenics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2008; 627:1-18. [PMID: 18510010 DOI: 10.1007/978-0-387-78225-6_1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Genetic transformation is a critical component to the fundamental genetic analysis of insect species and holds great promise for establishing strains that improve population control and behavior for practical application. This is especially so for insects that are disease vectors, many of which are currently subject to genomic sequence analysis, and intensive population control measures that must be improved for better efficacy and cost-effectiveness. Transposon-mediated germ-line transformation has been the ultimate goal for most fundamental and practical studies, and impressive strides have been made in recent development of transgene vector and marker systems for several mosquito species. This has resulted in rapid advances in functional genomic sequence analysis and new strategies for biological control based on conditional lethality. Importantly, advances have also been made in our ability to use these systems more effectively in terms of enhanced stability and targeting to specific genomic loci. Nevertheless, not all insects are currently amenable to germ-line transformation techniques, and thus advances in transient somatic expression and paratransgenesis have also been critical, if not preferable for some applications. Of particular importance is how this technology will be used for practical application. Early ideas for population replacement of indigenous pests with innocuous transgenic siblings by transposon-vector spread, may require reevaluation in terms of our current knowledge of the behavior of transposons currently available for transformation. The effective implementation of any control program using released transgenics, will also benefit from broadening the perspective of these control measures as being more mainstream than exotic.
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Affiliation(s)
- David A O'Brochta
- University of Maryland Biotechnology Institute, Center for Biosystems Research, Rockville, MD, USA.
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Late-acting dominant lethal genetic systems and mosquito control. BMC Biol 2007; 5:11. [PMID: 17374148 PMCID: PMC1865532 DOI: 10.1186/1741-7007-5-11] [Citation(s) in RCA: 252] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 03/20/2007] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Reduction or elimination of vector populations will tend to reduce or eliminate transmission of vector-borne diseases. One potential method for environmentally-friendly, species-specific population control is the Sterile Insect Technique (SIT). SIT has not been widely used against insect disease vectors such as mosquitoes, in part because of various practical difficulties in rearing, sterilization and distribution. Additionally, vector populations with strong density-dependent effects will tend to be resistant to SIT-based control as the population-reducing effect of induced sterility will tend to be offset by reduced density-dependent mortality. RESULTS We investigated by mathematical modeling the effect of manipulating the stage of development at which death occurs (lethal phase) in an SIT program against a density-dependence-limited insect population. We found late-acting lethality to be considerably more effective than early-acting lethality. No such strains of a vector insect have been described, so as a proof-of-principle we constructed a strain of the principal vector of the dengue and yellow fever viruses, Aedes (Stegomyia) aegypti, with the necessary properties of dominant, repressible, highly penetrant, late-acting lethality. CONCLUSION Conventional SIT induces early-acting (embryonic) lethality, but genetic methods potentially allow the lethal phase to be tailored to the program. For insects with strong density-dependence, we show that lethality after the density-dependent phase would be a considerable improvement over conventional methods. For density-dependent parameters estimated from field data for Aedes aegypti, the critical release ratio for population elimination is modeled to be 27% to 540% greater for early-acting rather than late-acting lethality. Our success in developing a mosquito strain with the key features that the modeling indicated were desirable demonstrates the feasibility of this approach for improved SIT for disease control.
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