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Freville A, Stewart LB, Tetteh KKA, Treeck M, Cortes A, Voss TS, Tarr SJ, Baker DA, Conway DJ. Expression of the MSPDBL2 antigen in a discrete subset of Plasmodium falciparum schizonts is regulated by GDV1 but may not be linked to sexual commitment. mBio 2024; 15:e0314023. [PMID: 38530030 PMCID: PMC11077968 DOI: 10.1128/mbio.03140-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
The Plasmodium falciparum merozoite surface protein MSPDBL2 is a polymorphic antigen targeted by acquired immune responses, and normally expressed in only a minority of mature schizonts. The potential relationship of MSPDBL2 to sexual commitment is examined, as variable mspdbl2 transcript levels and proportions of MSPDBL2-positive mature schizonts in clinical isolates have previously correlated with levels of many sexual stage parasite gene transcripts, although not with the master regulator ap2-g. It is demonstrated that conditional overexpression of the gametocyte development protein GDV1, which promotes sexual commitment, also substantially increases the proportion of MSPDBL2-positive schizonts in culture. Conversely, truncation of the gdv1 gene is shown to prevent any expression of MSPDBL2. However, across diverse P. falciparum cultured lines, the variable proportions of MSPDBL2 positivity in schizonts do not correlate significantly with variable gametocyte conversion rates, indicating it is not involved in sexual commitment. Confirming this, examining a line with endogenous hemagglutinin-tagged AP2-G showed that the individual schizonts expressing MSPDBL2 are mostly different from those expressing AP2-G. Using a selection-linked integration system, modified P. falciparum lines were engineered to express an intact or disrupted version of MSPDBL2, showing the protein is not required for sexual commitment or early gametocyte development. Asexual parasite multiplication rates were also not affected by expression of either intact or disrupted MSPDBL2 in a majority of schizonts. Occurring alongside sexual commitment, the role of the discrete MSPDBL2-positive schizont subpopulation requires further investigation in natural infections where it is under immune selection. IMPORTANCE Malaria parasites in the blood are remarkably variable, able to switch antigenic targets so they may survive within humans who have already developed specific immune responses. This is one of the challenges in developing vaccines against malaria. MSPDBL2 is a target of naturally acquired immunity expressed in minority proportions of schizonts, the end stages of each 2-day replication cycle in red blood cells which contain merozoites prepared to invade new red blood cells. Results show that the proportion of schizonts expressing MSPDBL2 is positively controlled by the expression of the regulatory gametocyte development protein GDV1. It was previously known that expression of GDV1 leads to increased expression of AP2-G which causes parasites to switch to sexual development, so a surprising finding here is that MSPDBL2-positive parasites are mostly distinct from those that express AP2-G. This discrete antigenic subpopulation of mostly asexual parasites is regulated alongside sexually committed parasites, potentially enabling survival under stress conditions.
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Affiliation(s)
- Aline Freville
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lindsay B. Stewart
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Alfred Cortes
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Catalonia, Spain
- ICREA, Barcelona, Catalonia, Spain
| | - Till S. Voss
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sarah J. Tarr
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David A. Baker
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David J. Conway
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Matambisso G, Brokhattingen N, Maculuve S, Cístero P, Mbeve H, Escoda A, Bambo G, Cuna B, Melembe C, Ndimande N, Tetteh KKA, Drakeley C, Gamain B, Chitnis C, Chauhan V, Quintó L, Macete E, Mayor A. Sustained clinical benefit of malaria chemoprevention with sulfadoxine-pyrimethamine (SP) in pregnant women in a region with high SP resistance markers. J Infect 2024; 88:106144. [PMID: 38574776 DOI: 10.1016/j.jinf.2024.106144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The effectiveness of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is threatened by increasing SP-resistance in Africa. We assessed the level of SP-resistance markers, and the clinical and parasitological effectiveness of IPTp-SP in southern Mozambique. METHODS P. falciparum infection, antimalarial antibodies and dhfr/dhps SP-resistance mutants were detected by quantitative polymerase chain reaction (qPCR), suspension array technology and targeted deep sequencing, respectively, among 4016 HIV-negative women in Maputo province (2016-2019). Univariate and multivariate regression models were used to assess the association between taking the recommended three or more IPTp-SP doses (IPTp3+) and parasitological and clinical outcomes. RESULTS 84.3% (3385/4016) women received three or more IPTp-SP doses. The prevalence of quintuple mutants at first antenatal care (ANC) visit was 94.2%. IPTp3+ was associated with a higher clearance rate of qPCR-detected infections from first ANC visit to delivery (adjusted odds ratio [aOR]=5.9, 95% CI: 1.5-33.3; p = 0.012), lower seroprevalence at delivery of antibodies against the pregnancy-specific antigen VAR2CSADBL34 (aOR=0.72, 95% CI: 0.54-0.95; p = 0.022), and lower prevalence of low birth weight deliveries (aOR: 0.61, 95% CI: 0.41-0.90; p = 0.013). CONCLUSION A sustained parasitological effect of IPTp-SP contributes to the clinical effectiveness of IPTp3+ in areas with high prevalence of SP-resistance markers.
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Affiliation(s)
- Glória Matambisso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Nanna Brokhattingen
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Sónia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Pau Cístero
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Henriques Mbeve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Anna Escoda
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Gizela Bambo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Boaventura Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Cardoso Melembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Nelo Ndimande
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Benoit Gamain
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses, CIMI-Paris, Paris, France
| | - Chetan Chitnis
- Malaria Parasite Biology and Vaccines, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Llorenç Quintó
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique; ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique; National Directare of Health, Ministry of Health, Maputo, Mozambique
| | - Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Moçambique; ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
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Adhikari B, Shrestha L, Bajracharya M, Aryal N, Rajbhandari A, Maharjan RK, Das SK, Sapkota J, Tetteh KKA, Das D. Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal. BMC Health Serv Res 2024; 24:180. [PMID: 38331762 PMCID: PMC10851527 DOI: 10.1186/s12913-024-10663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Improving screening and triage practices is essential for early severity assessments at the first point of contact and ensuring timely attention by healthcare workers (HCWs). The main objective of this study was to explore the triage process among febrile patients and HCWs in the emergency department (ED) of a tertiary care hospital in a resource-constrained setting. METHODS This qualitative study was conducted from March to May 2023 at the ED of Tribhuvan University Teaching Hospital (TUTH), Nepal. The study included in-depth interviews with febrile patients (n = 15) and HCWs (n = 15). Additionally, direct observation notes (n = 20) were collected to document the triage process and patients' experiences in the ED. Data underwent thematic analysis using the Interpretative Phenomenological Analysis (IPA) approach. RESULTS The ED of TUTH offered comprehensive triage services with clear delineation for the severity of febrile patients in line with the World Health Organization (WHO) guidelines. Nonetheless, challenges and constraints were identified. In the ED, evenings were generally the busiest period, and the triage process was not thorough during night shifts. Perception of triage was limited among patients and variable among HCWs. Digitalizing recordings of patient information including payment was deemed necessary for effective management of patients' waiting times at the triage station. High patient throughput added pressure on HCWs and had a potential influence on the delivery of services. Availability of medical equipment and space were also identified as challenges, with patients sometimes compelled to share beds. There were constraints related to waste disposal, hygiene, cleanliness, and the availability and maintenance of washrooms. Febrile patients experienced delays in receiving timely consultations and laboratory investigation reports, which affected their rapid diagnosis and discharge; nonetheless, patients were satisfied with the overall healthcare services received in the ED. CONCLUSIONS Improving current triage management requires resource organization, including optimizing the waiting time of patients through a digitalized system. Urgent priorities involve upgrading visitor facilities, patient consultations, laboratory investigations, hygiene, and sanitation. HCWs' recommendations to resource the ED with more equipment, space, and beds and a dedicated triage officer to ensure 24-hour service, together with training and incentives, warrant further attention.
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Affiliation(s)
- Bipin Adhikari
- Institute of Medicine, Kathmandu, Nepal
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Manjita Bajracharya
- Emergency Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | | | - Ramesh K Maharjan
- Emergency Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Jyotshna Sapkota
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Kevin K A Tetteh
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Debashish Das
- FIND, Campus Biotech, Chemin des Mines 9, 1202, Geneva, Switzerland.
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Byrne I, William T, Chua TH, Patterson C, Hall T, Tan M, Chitnis C, Adams J, Singh SK, Grignard L, Tetteh KKA, Fornace KM, Drakeley CJ. Serological evaluation of risk factors for exposure to malaria in a pre-elimination setting in Malaysian Borneo. Sci Rep 2023; 13:12998. [PMID: 37563178 PMCID: PMC10415323 DOI: 10.1038/s41598-023-39670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
Malaysia has reported no indigenous cases of P. falciparum and P. vivax for over 3 years. When transmission reaches such low levels, it is important to understand the individuals and locations where exposure risks are high, as they may be at greater risk in the case of a resurgence of transmission. Serology is a useful tool in low transmission settings, providing insight into exposure over longer durations than PCR or RDT. We ran blood samples from a 2015 population-based survey in northern Sabah, Malaysian Borneo on a multiplex bead assay. Using supervised machine learning methods, we characterised recent and historic exposure to Plasmodium falciparum and P. vivax and found recent exposure to P. falciparum to be very low, with exposure to both species increasing with age. We performed a risk-factor assessment on environmental, behavioural, demographic and household factors, and identified forest activity and longer travel times to healthcare as common risk-factors for exposure to P. falciparum and P. vivax. In addition, we used remote-sensing derived data and geostatistical models to assess environmental and spatial associations with exposure. We created predictive maps of exposure to recent P. falciparum in the study area and showed 3 clear foci of exposure. This study provides useful insight into the environmental, spatial and demographic risk factors for P. falciparum and P. vivax at a period of low transmission in Malaysian Borneo. The findings would be valuable in the case of resurgence of human malarias in the region.
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Affiliation(s)
- Isabel Byrne
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK.
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia
- Gleneagles Hospital, Kota Kinabalu, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Tock H Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Catriona Patterson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Tom Hall
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Mark Tan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Chetan Chitnis
- Department of Parasites and Insect Vectors, Malaria Parasite Biology and Vaccines, Institut Pasteur, Paris, France
| | - John Adams
- Center for Global Health and Infectious Diseases Research, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Susheel K Singh
- Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lynn Grignard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
| | - Kimberly M Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, Scotland
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, Bloomsbury, London, WCIE 7HT, UK
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Pujol A, Brokhattingen N, Matambisso G, Mbeve H, Cisteró P, Escoda A, Maculuve S, Cuna B, Melembe C, Ndimande N, Munguambe H, Montaña J, Nhamússua L, Simone W, Tetteh KKA, Drakeley C, Gamain B, Chitnis CE, Chauhan V, Quintó L, Chidimatembue A, Martí-Soler H, Galatas B, Guinovart C, Saúte F, Aide P, Macete E, Mayor A. Detecting temporal and spatial malaria patterns from first antenatal care visits. Nat Commun 2023; 14:4004. [PMID: 37414792 PMCID: PMC10326053 DOI: 10.1038/s41467-023-39662-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. We assessed the spatio-temporal relationship between malaria trends at ANC (n = 6471) and in children in the community (n = 3933) and at health facilities (n = 15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC] > 0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, did multigravidae show lower rates than children (PCC = 0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC = 0.74, 95%CI[0.24-0.77]). 60% (9/15) of hotspots detected from health facility data (n = 6662) using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data (n = 3616). Taken together, we show that ANC-based malaria surveillance offers contemporary information on temporal trends and geographic distribution of malaria burden in the community.
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Affiliation(s)
- Arnau Pujol
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Glória Matambisso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Henriques Mbeve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna Escoda
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sónia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Boaventura Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Cardoso Melembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelo Ndimande
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Júlia Montaña
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lídia Nhamússua
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Wilson Simone
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Benoit Gamain
- Université Paris Cité, INSERM, BIGR, F-75014, Paris, France
| | - Chetan E Chitnis
- Malaria Parasite Biology and Vaccines, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | - Beatriz Galatas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
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Lawal BJ, Gallagher KE, Kitonsa J, Tindanbil D, Kasonia K, Drammeh A, Lowe B, Mukadi-Bamuleka D, Patterson C, Greenwood B, Samai M, Leigh B, Tetteh KKA, Ruzagira E, Watson-Jones D, Kavunga-Membo H. Prevalence of immunoglobulin G and M to SARS-CoV-2 and other human coronaviruses in The Democratic Republic of Congo, Sierra Leone, and Uganda: A longitudinal study. Int J Infect Dis 2023; 131:183-192. [PMID: 37001799 PMCID: PMC10060023 DOI: 10.1016/j.ijid.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES We assessed the prevalence of immunoglobulin G (IgG) and IgM against four endemic human coronaviruses and two SARS-CoV-2 antigens among vaccinated and unvaccinated staff at health care centers in Uganda, Sierra Leone, and the Democratic Republic of Congo. METHODS The government health facility staff who had patient contact in Goma (Democratic Republic of Congo), Kambia District (Sierra Leone), and Masaka District (Uganda) were enrolled. Questionnaires and blood samples were collected at three time points over 4 months. Blood samples were analyzed with the Luminex MAGPIXⓇ. RESULTS Among unvaccinated participants, the prevalence of IgG/IgM antibodies against SARS-CoV-2 receptor-binding domain or nucleocapsid protein at enrollment was 70% in Goma (138 of 196), 89% in Kambia (112 of 126), and 89% in Masaka (190 of 213). The IgG responses against endemic human coronaviruses at baseline were not associated with SARS-CoV-2 sero-acquisition during follow-up. Among the vaccinated participants, those who had evidence of SARS-CoV-2 IgG/IgM at baseline tended to have higher IgG responses to vaccination than those who were SARS-CoV-2 seronegative at baseline, controlling for the time of sample collection since vaccination. CONCLUSION The high levels of natural immunity and hybrid immunity should be incorporated into both vaccination policies and prediction models of the impact of subsequent waves of infection in these settings.
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Affiliation(s)
| | - Katherine E Gallagher
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
| | | | - Daniel Tindanbil
- LSHTM-COMAHS Research Partnership, Kambia District, Sierra Leone
| | - Kambale Kasonia
- LSHTM-INRB Research Partnership, Goma, Democratic Republic of the Congo
| | - Abdoulie Drammeh
- LSHTM-COMAHS Research Partnership, Kambia District, Sierra Leone
| | - Brett Lowe
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Daniel Mukadi-Bamuleka
- Laboratoire Rodolphe Merieux-Institute National Research biomedical (INRB), Goma, Democratic Republic of the Congo
| | - Catriona Patterson
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - Mohamed Samai
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - Bailah Leigh
- University of Sierra Leone College of Medicine and Allied Health Sciences (COMAHS), Freetown, Sierra Leone
| | - Kevin K A Tetteh
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Deborah Watson-Jones
- London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Hugo Kavunga-Membo
- Laboratoire Rodolphe Merieux-Institute National Research biomedical (INRB), Goma, Democratic Republic of the Congo
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7
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Rahim MAFA, Munajat MB, Dian ND, Seri Rakna MIM, Wahid W, Ghazali N, Hassan NW, Abdul Manap SNA, Kasri MRM, Mohamed AI, Osman E, Chuangchaiya S, Lubis IND, Divis PCS, Kaneko A, Tetteh KKA, Idris ZM. Naturally acquired antibody response to Plasmodium falciparum and Plasmodium vivax among indigenous Orang Asli communities in Peninsular Malaysia. Front Cell Infect Microbiol 2023; 13:1165634. [PMID: 37153151 PMCID: PMC10157193 DOI: 10.3389/fcimb.2023.1165634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Malaria remains a public health problem in many parts of the world. In Malaysia, the significant progress towards the national elimination programme and effective disease notification on malaria has resulted in zero indigenous human malaria cases since 2018. However, the country still needs to determine the extent of malaria exposure and transmission patterns, particularly in high-risk populations. In this study, a serological method was used to measure transmission levels of Plasmodium falciparum and Plasmodium vivax among indigenous Orang Asli communities in Kelantan, Peninsular Malaysia. A community-based cross-sectional survey was conducted in three Orang Asli communities (i.e., Pos Bihai, Pos Gob, and Pos Kuala Betis) in Kelantan from June to July 2019. Antibody responses to malaria were assessed by enzyme-linked immunosorbent assay (ELISA) using two P. falciparum (PfAMA-1 and PfMSP-119) and two P. vivax (PvAMA-1 and PvMSP-119) antigens. Age-adjusted antibody responses were analysed using a reversible catalytic model to calculate seroconversion rates (SCRs). Multiple logistic regression was used to investigate factors associated with malaria exposure. The overall malaria seroprevalence was 38.8% for PfAMA-1, 36.4% for PfMSP-119, 2.2% for PvAMA-1, and 9.3% for PvMSP-119. Between study areas, the proportion of seropositivity for any P. falciparum and P. vivax antigens was significantly highest in Pos Kuala Betis with 34.7% (p < 0.001) and 13.6% (p < 0.001), respectively. For all parasite antigens except for PvAMA-1, the proportion of seropositive individuals significantly increased with age (all p < 0.001). Based on the SCR, there was a higher level of P. falciparum transmission than P. vivax in the study area. Multivariate regression analyses showed that living in Pos Kuala Betis was associated with both P. falciparum (adjusted odds ratio [aOR] 5.6, p < 0.001) and P. vivax (aOR 2.1, p < 0.001) seropositivities. Significant associations were also found between age and seropositivity to P. falciparum and P. vivax antigens. Analysis of community-based serological data helps describe the level of transmission, heterogeneity, and factors associated with malaria exposure among indigenous communities in Peninsular Malaysia. This approach could be an important adjunct tool for malaria monitoring and surveillance in low malaria transmission settings in the country.
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Affiliation(s)
- Mohd Amirul Fitri A. Rahim
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Bakhtiar Munajat
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nor Diyana Dian
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | | | - Wathiqah Wahid
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nuraffini Ghazali
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Noor Wanie Hassan
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Siti Nor Azreen Abdul Manap
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | | | | | - Emelia Osman
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Sriwipa Chuangchaiya
- Department of Community Health, Faculty of Public Health, Kasetsart University, Sakon Nakhon, Thailand
| | - Inke Nadia D. Lubis
- Department of Paediatric, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Paul C. S. Divis
- Malaria Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Akira Kaneko
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Parasitology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zulkarnain Md Idris
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- *Correspondence: Zulkarnain Md Idris,
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8
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Matambisso G, Brokhattingen N, Maculuve S, Cisteró P, Mbeve H, Escoda A, Miguel J, Buetas E, de Jong I, Cuna B, Melembe C, Ndimande N, Porras G, Chen H, Tetteh KKA, Drakeley C, Gamain B, Chitnis C, Chauhan V, Quintó L, Galatas B, Macete E, Mayor A. Gravidity and malaria trends interact to modify P. falciparum densities and detectability in pregnancy: a 3-year prospective multi-site observational study. BMC Med 2022; 20:396. [PMID: 36376866 PMCID: PMC9664815 DOI: 10.1186/s12916-022-02597-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Low-density Plasmodium falciparum infections prevail in low transmission settings, where immunity is expected to be minimal, suggesting an immune-independent effect on parasite densities. We aimed to describe parasite densities in pregnancy, and determine how gravidity and antibody-mediated immunity affect these, during a period of declining malaria transmission in southern Mozambique. METHODS We documented P. falciparum infections at first antenatal care visits (n = 6471) between November 2016 and October 2019 in Ilha Josina (high-to-moderate transmission area), Manhiça (low transmission area), and Magude (pre-elimination area). Two-way interactions in mixed-effects regression models were used to assess gravidity-dependent differences in quantitative PCR-determined P. falciparum positivity rates (PfPRqPCR) and densities, in the relative proportion of detectable infections (pDi) with current diagnostic tests (≥ 100 parasites/μL) and in antimalarial antibodies. RESULTS PfPRqPCR declined from 28 to 13% in Ilha Josina and from 5-7 to 2% in Magude and Manhiça. In primigravidae, pDi was highest in Ilha Josina at the first study year (p = 0.048), which declined with falling PfPRqPCR (relative change/year: 0.41, 95% CI [0.08; 0.73], p = 0.029), with no differences in antibody levels. Higher parasite densities in primigravidae from Ilha Josina during the first year were accompanied by a larger reduction of maternal hemoglobin levels (- 1.60, 95% CI [- 2.49; - 0.72; p < 0.001), than in Magude (- 0.76, 95% CI [- 1.51; - 0.01]; p = 0.047) and Manhiça (- 0.44, 95% CI [- 0.99; 0.10; p = 0.112). In contrast, multigravidae during the transmission peak in Ilha Josina carried the lowest pDi (p = 0.049). As PfPRqPCR declined, geometric mean of parasite densities increased (4.63, 95% CI [1.28; 16.82], p = 0.020), and antibody levels declined among secundigravidae from Ilha Josina. CONCLUSIONS The proportion of detectable and clinically relevant infections is the highest in primigravid women from high-to-moderate transmission settings and decreases with declining malaria. In contrast, the falling malaria trends are accompanied by increased parasite densities and reduced humoral immunity among secundigravidae. Factors other than acquired immunity thus emerge as potentially important for producing less detectable infections among primigravidae during marked declines in malaria transmission.
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Affiliation(s)
- Glória Matambisso
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Sónia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Henriques Mbeve
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anna Escoda
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Judice Miguel
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Elena Buetas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ianthe de Jong
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Boaventura Cuna
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Cardoso Melembe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Nelo Ndimande
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Gemma Porras
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Haily Chen
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Benoit Gamain
- Université de Paris, Biologie Intégrée du Globule Rouge, UMR_S1134, Inserm, 75015, Paris, France
| | - Chetan Chitnis
- Department of Parasites & Insect Vectors, Malaria Parasite Biology and Vaccines, Institut Pasteur, Paris, France
| | - Virander Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India
| | - Llorenç Quintó
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,National Directare of Health, Ministry of Health, Maputo, Mozambique
| | - Alfredo Mayor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. .,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Department of Physiologic Sciences, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
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9
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Oulton T, Obiero J, Rodriguez I, Ssewanyana I, Dabbs RA, Bachman CM, Greenhouse B, Drakeley C, Felgner PL, Stone W, Tetteh KKA. Plasmodium falciparum serology: A comparison of two protein production methods for analysis of antibody responses by protein microarray. PLoS One 2022; 17:e0273106. [PMID: 36037183 PMCID: PMC9423672 DOI: 10.1371/journal.pone.0273106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
The evaluation of protein antigens as putative serologic biomarkers of infection has increasingly shifted to high-throughput, multiplex approaches such as the protein microarray. In vitro transcription/translation (IVTT) systems-a similarly high-throughput protein expression method-are already widely utilised in the production of protein microarrays, though purified recombinant proteins derived from more traditional whole cell based expression systems also play an important role in biomarker characterisation. Here we have performed a side-by-side comparison of antigen-matched protein targets from an IVTT and purified recombinant system, on the same protein microarray. The magnitude and range of antibody responses to purified recombinants was found to be greater than that of IVTT proteins, and responses between targets from different expression systems did not clearly correlate. However, responses between amino acid sequence-matched targets from each expression system were more closely correlated. Despite the lack of a clear correlation between antigen-matched targets produced in each expression system, our data indicate that protein microarrays produced using either method can be used confidently, in a context dependent manner, though care should be taken when comparing data derived from contrasting approaches.
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Affiliation(s)
- Tate Oulton
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joshua Obiero
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, United States of America
| | - Isabel Rodriguez
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Isaac Ssewanyana
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Rebecca A. Dabbs
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phil L. Felgner
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA, United States of America
| | - Will Stone
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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10
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Rahim MAFA, Chuangchaiya S, Chanpum P, Palawong L, Kantee P, Dian ND, Lubis IND, Divis PCS, Kaneko A, Tetteh KKA, Idris ZM. Seroepidemiological surveillance, community perceptions and associated risk factors of malaria exposure among forest-goers in Northeastern Thailand. Front Cell Infect Microbiol 2022; 12:953585. [PMID: 36093204 PMCID: PMC9450859 DOI: 10.3389/fcimb.2022.953585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Malaria remains a major public health challenge in Thailand. Continuous assessment and understanding of the behavior and perceptions related to malaria exposure in the high-risk group are necessary to achieve the elimination goal. This study aimed to investigate the parasite prevalence, seroprevalence rate, knowledge, attitudes, and practices (KAP), and malaria risk factors in rural communities living close to a forested area in the northeastern part of Thailand. A community-based cross-sectional survey was conducted in three forest-goer communities (i.e., Ban Khok, Ban Koh, and Dong Yang) located in Khamcha-i district, Mukdahan Province, Thailand, from July to August 2019. Demographic, socioeconomic information and KAP data were collected using a structured questionnaire. Parasite prevalence was determined by microscopy. Seroprevalence was determined via ELISA using two Plasmodium falciparum (PfAMA-1 and PfMSP-119) and two Plasmodium vivax (PvAMA-1 and PvMSP-119) antigens. Age-adjusted antibody responses were analyzed using a reversible catalytic model to calculate seroconversion rate (SCR). Malaria parasite was not detected in any of the 345 participants. The overall malaria seroprevalence was 72.2% for PfAMA-1, 18.8% for PfMSP-119, 32.5% for PvAMA-1, and 4.4% for PvMSP-119. The proportion of seroprevalence for P. falciparum and P. vivax antigens was significantly highest in Ban Koh (35.1%, P < 0.001) and Don Yang (18.8%, P < 0.001), respectively. For all parasite antigens except PvMSP-119, the proportion of seropositive individuals significantly increased with age (P < 0.001). Based on the SCRs, there was a higher level of P. falciparum transmission than P. vivax. Regarding KAP, almost all respondents showed adequate knowledge and awareness about malaria. Nevertheless, significant effort is needed to improve positive attitudes and practices concerning malaria prevention measures. Multivariate regression analyses showed that living in Ban Koh was associated with both P. falciparum (adjusted odds ratio [aOR] 12.87, P < 0.001) and P. vivax (aOR 9.78, P < 0.001) seropositivities. We also found significant associations between age and seropositivity against P. falciparum and P. vivax antigens. The data suggest that seroepidemiological surveillance using AMA-1 and MSP-119 antigens may provide further evidence to reconstruct malaria exposure history. The absence of weak evidence of recent malaria transmission in Mukdahan Province is promising in the context of the disease elimination program.
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Affiliation(s)
- Mohd Amirul Fitri A. Rahim
- Deparment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sriwipa Chuangchaiya
- Faculty of Public Health, Kasetsart University, Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand
- *Correspondence: Zulkarnain Md Idris, ; Sriwipa Chuangchaiya,
| | - Paisit Chanpum
- Vector Borne Disease Unit, Ban Koh Sub-District Health Promoting Hospital, Mukdahan, Thailand
| | - Laun Palawong
- Vector Borne Disease Unit, Ban Koh Sub-District Health Promoting Hospital, Mukdahan, Thailand
| | - Panuwat Kantee
- Vector Borne Disease Unit, Ban Koh Sub-District Health Promoting Hospital, Mukdahan, Thailand
| | - Nor Diyana Dian
- Deparment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Inke Nadia D. Lubis
- Department of Paediatric, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Paul C. S. Divis
- Malaria Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Akira Kaneko
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Parasitology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zulkarnain Md Idris
- Deparment of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- *Correspondence: Zulkarnain Md Idris, ; Sriwipa Chuangchaiya,
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11
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Byrne I, Cramer E, Nelli L, Rerolle F, Wu L, Patterson C, Rosado J, Dumont E, Tetteh KKA, Dantzer E, Hongvanthong B, Fornace KM, Stresman G, Lover A, Bennett A, Drakeley C. Characterizing the spatial distribution of multiple malaria diagnostic endpoints in a low-transmission setting in Lao PDR. Front Med (Lausanne) 2022; 9:929366. [PMID: 36059850 PMCID: PMC9433740 DOI: 10.3389/fmed.2022.929366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Abstract
The epidemiology of malaria changes as prevalence falls in low-transmission settings, with remaining infections becoming more difficult to detect and diagnose. At this stage active surveillance is critical to detect residual hotspots of transmission. However, diagnostic tools used in active surveillance generally only detect concurrent infections, and surveys may benefit from sensitive tools such as serological assays. Serology can be used to interrogate and characterize individuals' previous exposure to malaria over longer durations, providing information essential to the detection of remaining foci of infection. We ran blood samples collected from a 2016 population-based survey in the low-transmission setting of northern Lao PDR on a multiplexed bead assay to characterize historic and recent exposures to Plasmodium falciparum and vivax. Using geostatistical methods and remote-sensing data we assessed the environmental and spatial associations with exposure, and created predictive maps of exposure within the study sites. We additionally linked the active surveillance PCR and serology data with passively collected surveillance data from health facility records. We aimed to highlight the added information which can be gained from serology as a tool in active surveillance surveys in low-transmission settings, and to identify priority areas for national surveillance programmes where malaria risk is higher. We also discuss the issues faced when linking malaria data from multiple sources using multiple diagnostic endpoints.
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Affiliation(s)
- Isabel Byrne
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- *Correspondence: Isabel Byrne
| | - Estee Cramer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Luca Nelli
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Francois Rerolle
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catriona Patterson
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason Rosado
- Unit of Malaria: Parasites and Hosts, Institut Pasteur, Paris, France
- Infectious Diseases Epidemiology and Analytics G5 Unit, Institut Pasteur, Paris, France
| | - Elin Dumont
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily Dantzer
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
| | - Bouasy Hongvanthong
- Center for Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Laos
| | - Kimberley M. Fornace
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Lover
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Adam Bennett
- Malaria Elimination Initiative, The Global Health Group, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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12
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Ward D, Gomes AR, Tetteh KKA, Sepúlveda N, Gomez LF, Campino S, Clark TG. Sero-epidemiological study of arbovirus infection following the 2015-2016 Zika virus outbreak in Cabo Verde. Sci Rep 2022; 12:11719. [PMID: 35810191 PMCID: PMC9271056 DOI: 10.1038/s41598-022-16115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022] Open
Abstract
In November 2015, cases of Zika virus infection were recorded in Cabo Verde (Africa), originating from Brazil. The outbreak subsided after seven months with 7580 suspected cases. We performed a serological survey (n = 431) in Praia, the capital city, 3 months after transmission ceased. Serum samples were screened for arbovirus antibodies using ELISA techniques and revealed seroconverted individuals with Zika (10.9%), dengue (1-4) (12.5%), yellow fever (0.2%) and chikungunya (2.6%) infections. Zika seropositivity was predominantly observed amongst females (70%). Using a logistic model, risk factors for increased odds of Zika seropositivity included age, self-reported Zika infection, and dengue seropositivity. Serological data from Zika and dengue virus assays were strongly correlated (Spearman's rs = 0.80), which reduced when using a double antigen binding ELISA (Spearman's rs = 0.54). Overall, our work improves an understanding of how Zika and other arboviruses have spread throughout the Cabo Verde population. It also demonstrates the utility of serological assay formats for outbreak investigations.
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Affiliation(s)
- Daniel Ward
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nuno Sepúlveda
- Warsaw University of Technology, Warsaw, Poland
- Universidade de Lisboa, Lisbon, Portugal
| | | | - Susana Campino
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Taane G Clark
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Bridges DJ, Miller JM, Chalwe V, Moonga H, Hamainza B, Steketee RW, Mambwe B, Mulube C, Wu L, Tetteh KKA, Drakeley C, Chishimba S, Mwenda M, Silumbe K, Larsen DA. Reactive focal drug administration associated with decreased malaria transmission in an elimination setting: Serological evidence from the cluster-randomized CoRE study. PLOS Glob Public Health 2022; 2:e0001295. [PMID: 36962857 PMCID: PMC10021141 DOI: 10.1371/journal.pgph.0001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Efforts to eliminate malaria transmission need evidence-based strategies. However, accurately assessing end-game malaria elimination strategies is challenging due to the low level of transmission and the rarity of infections. We hypothesised that presumptively treating individuals during reactive case detection (RCD) would reduce transmission and that serology would more sensitively detect this change over standard approaches. We conducted a cluster randomised control trial (NCT02654912) of presumptive reactive focal drug administration (RFDA-intervention) compared to the standard of care, reactive focal test and treat (RFTAT-control) in Southern Province, Zambia-an area of low seasonal transmission (overall incidence of ~3 per 1,000). We measured routine malaria incidence from health facilities as well as PCR parasite prevalence / antimalarial seroprevalence in an endline cross-sectional population survey. No significant difference was identified from routine incidence data and endline prevalence by polymerase chain reaction (PCR) had insufficient numbers of malaria infections (i.e., 16 infections among 6,276 children) to assess the intervention. Comparing long-term serological markers, we found a 19% (95% CI = 4-32%) reduction in seropositivity for the RFDA intervention using a difference in differences approach incorporating serological positivity and age. We also found a 37% (95% CI = 2-59%) reduction in seropositivity to short-term serological markers in a post-only comparison. These serological analyses provide compelling evidence that RFDA both has an impact on malaria transmission and is an appropriate end-game malaria elimination strategy. Furthermore, serology provides a more sensitive approach to measure changes in transmission that other approaches miss, particularly in very low transmission settings. Trial Registration: Registered at www.clinicaltrials.gov (NCT02654912, 13/1/2016).
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Affiliation(s)
- Daniel J Bridges
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - John M Miller
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Victor Chalwe
- National Health Research Authority, Paediatric Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Hawela Moonga
- National Malaria Elimination Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka, Zambia
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka, Zambia
| | - Richard W Steketee
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), Seattle, Washington, United States of America
| | - Brenda Mambwe
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Conceptor Mulube
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Lindsey Wu
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K A Tetteh
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Chishimba
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Mulenga Mwenda
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Kafula Silumbe
- PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - David A Larsen
- Syracuse University Department of Public Health, Syracuse, New York, United States of America
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14
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Grigg MJ, Lubis IN, Tetteh KKA, Barber BE, William T, Rajahram GS, Tan AF, Sutherland CJ, Noviyanti R, Drakeley CJ, Britton S, Anstey NM. Plasmodium knowlesi detection methods for human infections-Diagnosis and surveillance. Adv Parasitol 2021; 113:77-130. [PMID: 34620386 DOI: 10.1016/bs.apar.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Within the overlapping geographical ranges of P. knowlesi monkey hosts and vectors in Southeast Asia, an estimated 1.5 billion people are considered at risk of infection. P. knowlesi can cause severe disease and death, the latter associated with delayed treatment occurring from misdiagnosis. Although microscopy is a sufficiently sensitive first-line tool for P. knowlesi detection for most low-level symptomatic infections, misdiagnosis as other Plasmodium species is common, and the majority of asymptomatic infections remain undetected. Current point-of-care rapid diagnostic tests demonstrate insufficient sensitivity and poor specificity for differentiating P. knowlesi from other Plasmodium species. Molecular tools including nested, real-time, and single-step PCR, and loop-mediated isothermal amplification (LAMP), are sensitive for P. knowlesi detection. However, higher cost and inability to provide the timely point-of-care diagnosis needed to guide appropriate clinical management has limited their routine use in most endemic clinical settings. P. knowlesi is likely underdiagnosed across the region, and improved diagnostic and surveillance tools are required. Reference laboratory molecular testing of malaria cases for both zoonotic and non-zoonotic Plasmodium species needs to be more widely implemented by National Malaria Control Programs across Southeast Asia to accurately identify the burden of zoonotic malaria and more precisely monitor the success of human-only malaria elimination programs. The implementation of specific serological tools for P. knowlesi would assist in determining the prevalence and distribution of asymptomatic and submicroscopic infections, the absence of transmission in certain areas, and associations with underlying land use change for future spatially targeted interventions.
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Affiliation(s)
- Matthew J Grigg
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia.
| | - Inke N Lubis
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bridget E Barber
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; Clinical Research Centre, Queen Elizabeth Hospital 1, Kota Kinabalu, Malaysia; Gleneagles Medical Centre, Kota Kinabalu, Malaysia
| | - Giri S Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia; Clinical Research Centre, Queen Elizabeth Hospital 1, Kota Kinabalu, Malaysia; Queen Elizabeth Hospital 2, Kota Kinabalu, Malaysia
| | - Angelica F Tan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Colin J Sutherland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sumudu Britton
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Nicholas M Anstey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
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15
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van den Hoogen LL, Herman C, Présumé J, Romilus I, Existe A, Boncy J, Joseph V, Stresman G, Tetteh KKA, Drakeley C, Chang MA, Lemoine JF, Eisele TP, Rogier E, Ashton RA. Rapid Screening for Non-falciparum Malaria in Elimination Settings Using Multiplex Antigen and Antibody Detection: Post Hoc Identification of Plasmodium malariae in an Infant in Haiti. Am J Trop Med Hyg 2021; 104:2139-2145. [PMID: 33819177 PMCID: PMC8176464 DOI: 10.4269/ajtmh.20-1450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 01/24/2023] Open
Abstract
Haiti is targeting malaria elimination by 2025. The Grand'Anse department in southwestern Haiti experiences one-third to half of all nationally reported Plasmodium falciparum cases. Although there are historical reports of Plasmodium vivax and Plasmodium malariae, today, non-falciparum infections would remain undetected because of extensive use of falciparum-specific histidine-rich protein 2 (HRP2) rapid diagnostic tests (RDT) at health facilities. A recent case-control study was conducted in Grand'Anse to identify risk factors for P. falciparum infection using HRP2-based RDTs (n = 1,107). Post hoc multiplex Plasmodium antigenemia and antibody (IgG) detection by multiplex bead assay revealed one blood sample positive for pan-Plasmodium aldolase, negative for P. falciparum HRP2, and positive for IgG antibodies to P. malariae. Based on this finding, we selected 52 samples with possible P. malariae infection using IgG and antigenemia data and confirmed infection status by species-specific PCR. We confirmed one P. malariae infection in a 6-month-old infant without travel history. Congenital P. malariae could not be excluded. However, our finding-in combination with historical reports of P. malariae-warrants further investigation into the presence and possible extent of non-falciparum malaria in Haiti. Furthermore, we showed the use of multiplex Plasmodium antigen and IgG detection in selecting samples of interest for subsequent PCR analysis, thereby reducing costs as opposed to testing all available samples by PCR. This is of specific use in low-transmission or eliminating settings where infections are rare.
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Affiliation(s)
- Lotus L. van den Hoogen
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | | | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Gillian Stresman
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean F. Lemoine
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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16
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Ssewanyana I, Rek J, Rodriguez I, Wu L, Arinaitwe E, Nankabirwa JI, Beeson JG, Mayanja-Kizza H, Rosenthal PJ, Dorsey G, Kamya MR, Drakeley C, Greenhouse B, Tetteh KKA. Impact of a Rapid Decline in Malaria Transmission on Antimalarial IgG Subclasses and Avidity. Front Immunol 2021; 11:576663. [PMID: 33584643 PMCID: PMC7873448 DOI: 10.3389/fimmu.2020.576663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Understanding how immunity to malaria is affected by declining transmission is important to aid vaccine design and understand disease resurgence. Both IgG subclasses and avidity of antigen-specific responses are important components of an effective immune response. Using a multiplex bead array assay, we measured the total IgG, IgG subclasses, and avidity profiles of responses to 18 P. falciparum blood stage antigens in samples from 160 Ugandans collected at two time points during high malaria transmission and two time points following a dramatic reduction in transmission. Results demonstrated that, for the antigens tested, (i) the rate of decay of total IgG following infection declined with age and was driven consistently by the decrease in IgG3 and occasionally the decrease in IgG1; (ii) the proportion of IgG3 relative to IgG1 in the absence of infection increased with age; (iii) the increase in avidity index (the strength of association between the antibody and antigen) following infection was largely due to a rapid loss of non-avid compared to avid total IgG; and (iv) both avid and non-avid total IgG in the absence of infection increased with age. Further studies are required to understand the functional differences between IgG1 and IgG3 in order to determine their contribution to the longevity of protective immunity to malaria. Measuring changes in antibody avidity may be a better approach of detecting affinity maturation compared to avidity index due to the differential expansion and contraction of high and low avidity total IgG.
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Affiliation(s)
- Isaac Ssewanyana
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Rek
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Isabel Rodriguez
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Lindsey Wu
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emmanuel Arinaitwe
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,School of Medicine, Makerere University, Kampala, Uganda
| | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | - Philip J Rosenthal
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,School of Medicine, Makerere University, Kampala, Uganda
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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17
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Wu L, Mwesigwa J, Affara M, Bah M, Correa S, Hall T, Singh SK, Beeson JG, Tetteh KKA, Kleinschmidt I, D’Alessandro U, Drakeley C. Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration. BMC Med 2020; 18:331. [PMID: 33183292 PMCID: PMC7664049 DOI: 10.1186/s12916-020-01785-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As The Gambia aims to achieve malaria elimination by 2030, serological assays are a useful surveillance tool to monitor trends in malaria incidence and evaluate community-based interventions. METHODS Within a mass drug administration (MDA) study in The Gambia, where reduced malaria infection and clinical disease were observed after the intervention, a serological sub-study was conducted in four study villages. Spatio-temporal variation in transmission was measured with a panel of recombinant Pf antigens on a multiplexed bead-based assay. Village-level antibody levels were quantified as under-15 sero-prevalence, sero-conversion rates, and age-adjusted antibody acquisition rates. Antibody levels prior to MDA were assessed for association with persistent malaria infection after community chemoprophylaxis. RESULTS Seasonal changes in antibodies to Etramp5.Ag1 were observed in children under 15 years in two transmission settings-the West Coast and Upper River Regions (4.32% and 31.30% Pf prevalence, respectively). At the end of the malaria season, short-lived antibody responses to Etramp5.Ag1, GEXP18, HSP40.Ag1, EBA175 RIII-V, and Rh2.2030 were lower amongst 1-15 year olds in the West Coast compared to the Upper River, reflecting known differences in transmission. Prior to MDA, individuals in the top 50th percentile of antibody levels had two-fold higher odds of clinical malaria during the transmission season, consistent with previous findings from the Malaria Transmission Dynamics Study, where individuals infected before the implementation of MDA had two-fold higher odds of re-infection post-MDA. CONCLUSIONS Serological markers can serve dual functions as indicators of malaria exposure and incidence. By monitoring age-specific sero-prevalence, the magnitude of age-stratified antibody levels, or identifying groups of individuals with above-average antibody responses, these antigens have the potential to complement conventional malaria surveillance tools. Further studies, particularly cluster randomised trials, can help establish standardised serological protocols to reliably measure transmission across endemic settings.
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Affiliation(s)
- Lindsey Wu
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT UK
| | - Julia Mwesigwa
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Muna Affara
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Arusha, Tanzania
| | - Mamadou Bah
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Simon Correa
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Tom Hall
- St. George’s University of London (SGUL), London, SW17 0RE UK
| | - Susheel K. Singh
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - James G. Beeson
- Burnet Institute, Melbourne, Victoria 3004 Australia
- Central Clinical School, Monash University, Melbourne, Victoria Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Kevin K. A. Tetteh
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT UK
| | - Immo Kleinschmidt
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT UK
- School of Pathology, Wits Institute for Malaria Research, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Chris Drakeley
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT UK
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18
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Wu L, Mwesigwa J, Affara M, Bah M, Correa S, Hall T, Singh SK, Beeson JG, Tetteh KKA, Kleinschmidt I, D'Alessandro U, Drakeley C. Antibody responses to a suite of novel serological markers for malaria surveillance demonstrate strong correlation with clinical and parasitological infection across seasons and transmission settings in The Gambia. BMC Med 2020; 18:304. [PMID: 32972398 PMCID: PMC7517687 DOI: 10.1186/s12916-020-01724-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/30/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND As malaria transmission declines, sensitive diagnostics are needed to evaluate interventions and monitor transmission. Serological assays measuring malaria antibody responses offer a cost-effective detection method to supplement existing surveillance tools. METHODS A prospective cohort study was conducted from 2013 to 2015 in 12 villages across five administrative regions in The Gambia. Serological analysis included samples from the West Coast Region at the start and end of the season (July and December 2013) and from the Upper River Region in July and December 2013 and April and December 2014. Antigen-specific antibody responses to eight Plasmodium falciparum (P. falciparum) antigens-Etramp5.Ag1, GEXP18, HSP40.Ag1, Rh2.2030, EBA175 RIII-V, PfMSP119, PfAMA1, and PfGLURP.R2-were quantified using a multiplexed bead-based assay. The association between antibody responses and clinical and parasitological endpoints was estimated at the individual, household, and population level. RESULTS Strong associations were observed between clinical malaria and concurrent sero-positivity to Etramp5.Ag1 (aOR 4.60 95% CI 2.98-7.12), PfMSP119 (aOR 4.09 95% CI 2.60-6.44), PfAMA1 (aOR 2.32 95% CI 1.40-3.85), and PfGLURP.R2 (aOR 3.12, 95% CI 2.92-4.95), while asymptomatic infection was associated with sero-positivity to all antigens. Village-level sero-prevalence amongst children 2-10 years against Etramp5.Ag1, HSP40.Ag1, and PfMSP119 showed the highest correlations with clinical and P. falciparum infection incidence rates. For all antigens, there were increased odds of asymptomatic P. falciparum infection in subjects residing in a compound with greater than 50% sero-prevalence, with a 2- to 3-fold increase in odds of infection associated with Etramp5.Ag1, GEXP18, Rh2.2030, PfMSP119, and PfAMA1. For individuals residing in sero-positive compounds, the odds of clinical malaria were reduced, suggesting a protective effect. CONCLUSIONS At low transmission, long-lived antibody responses could indicate foci of malaria transmission that have been ongoing for several seasons or years. In settings where sub-patent infections are prevalent and fluctuate below the detection limit of polymerase chain reaction (PCR), the presence of short-lived antibodies may indicate recent infectivity, particularly in the dry season when clinical cases are rare. Serological responses may reflect a persistent reservoir of infection, warranting community-targeted interventions if individuals are not clinically apparent but have the potential to transmit. Therefore, serological surveillance at the individual and household level may be used to target interventions where there are foci of asymptomatically infected individuals, such as by measuring the magnitude of age-stratified antibody levels or identifying areas with clustering of above-average antibody responses across a diverse range of serological markers.
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Affiliation(s)
- Lindsey Wu
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK.
| | - Julia Mwesigwa
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Muna Affara
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Arusha, Tanzania
| | - Mamadou Bah
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Simon Correa
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Tom Hall
- St. George's University of London (SGUL), London, UK
| | - Susheel K Singh
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - James G Beeson
- Burnet Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin K A Tetteh
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Immo Kleinschmidt
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK.,School of Pathology, Wits Institute for Malaria Research, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Chris Drakeley
- Faculty of Infectious Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
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19
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van den Hoogen LL, Bareng P, Alves J, Reyes R, Macalinao M, Rodrigues JM, Fernandes JM, Goméz LF, Hall T, Singh SK, Fornace K, Luchavez J, Kitchen A, Chiodini P, Espino F, Tetteh KKA, Stresman G, Sepúlveda N, Drakeley C. Comparison of Commercial ELISA Kits to Confirm the Absence of Transmission in Malaria Elimination Settings. Front Public Health 2020; 8:480. [PMID: 33014975 PMCID: PMC7509087 DOI: 10.3389/fpubh.2020.00480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Antimalarial antibody measurements are useful because they reflect historical and recent exposure to malaria. As such, they may provide additional information to assess ongoing transmission in low endemic or pre-elimination settings where cases are rare. In addition, the absence of antibody responses in certain individuals can indicate the cessation of transmission. Commercial malaria enzyme-linked immunosorbent assays (ELISA) detect antimalarial antibodies and are commonly used to screen blood donations for possible malaria infection. However, there is no standardized test to detect antimalarial antibodies for epidemiological use. Here we compared five commercially available ELISA kits (Trinity Biotech, newbio, DiaPro, Cellabs, and NovaTec) in search of a standardized tool for supporting claims of absence of malaria transmission. For comparison, a research-based (RB) ELISA protocol was performed alongside the commercial kits. Results: The commercial kits were first compared using serum samples from known malaria-unexposed individuals (n = 223) and Toxoplasma-infected individuals (n = 191) to assess specificity and cross-reactivity against non-malaria infections. In addition, 134 samples from ≥10-year-olds collected in a hyperendemic region in the Gambia in the early 1990s were used to assess sensitivity. Three out of five kits showed high sensitivity (90–92%), high specificity (98–99%), low cross-reactivity (0–3%) and were considered user-friendly (Trinity Biotech, newbio and NovaTec). Two of these kits (Trinity Biotech and NovaTec) were taken forward for epidemiological evaluation and results were compared to those using the RB-ELISA. Samples from two pre-elimination settings (Praia, Cape Verde; n = 1,396, and Bataan, the Philippines; n = 1,824) were tested. Serological results from both the Trinity Biotech kit and the RB-ELISA concurred with recent passively detected case counts in both settings. Results from the Trinity Biotech kit reflected a significant decrease in the number of reported cases in Bataan in the 1990s better than the RB-ELISA. Results from the NovaTec kit did not reflect transmission patterns in either setting. Conclusion: The Trinity Biotech commercial ELISA kit was considered reliable for epidemiological use and accurately described transmission patterns in two (previously) malaria endemic settings. The use of this simple and standardized serological tool may aid national control and elimination programs by confirming that regions are free from malaria.
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Affiliation(s)
- Lotus L van den Hoogen
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paolo Bareng
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Joana Alves
- National Institute of Public Health, Praia, Cape Verde
| | - Ralph Reyes
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Malou Macalinao
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | | | - José M Fernandes
- Faculty of Science and Technology, University of Cape Verde, Praia, Cape Verde
| | - Lara F Goméz
- Department of Natural, Life and Environmental Sciences, Jean Piaget University of Cape Verde, Praia, Cape Verde
| | - Tom Hall
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susheel K Singh
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Kimberly Fornace
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Luchavez
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Alan Kitchen
- NHS Blood and Transplant, London, United Kingdom
| | - Peter Chiodini
- Hospital for Tropical Diseases and London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fe Espino
- Department of Health, Research Institute for Tropical Medicine, Manila, Philippines
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre of Statistics and Applications, University of Lisbon, Lisbon, Portugal
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Keffale M, Shumie G, Behaksra SW, Chali W, Hoogen LLVD, Hailemeskel E, Mekonnen D, Chanyalew M, Damte D, Fanta T, Ashine T, Chali S, Tetteh KKA, Birhanu DD, Balcha TT, Aseffa A, Drakeley C, Tessema TS, Adamu H, Bousema T, Gadisa E, Tadesse FG. Serological evidence for a decline in malaria transmission following major scale-up of control efforts in a setting selected for Plasmodium vivax and Plasmodium falciparum malaria elimination in Babile district, Oromia, Ethiopia. Trans R Soc Trop Med Hyg 2020; 113:305-311. [PMID: 30927007 PMCID: PMC6580689 DOI: 10.1093/trstmh/trz005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/06/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Following successful malaria control during the last decade, Ethiopia instituted a stepwise malaria elimination strategy in selected low-transmission areas. METHODS Cross-sectional surveys were conducted in Babile district, Oromia, Ethiopia from July to November 2017 to evaluate malaria infection status using microscopy and nested polymerase chain reaction (nPCR) and serological markers of exposure targeting Plasmodium falciparum and Plasmodium vivax apical membrane antigen-1 (AMA-1). RESULTS Parasite prevalence was 1.2% (14/1135) and 5.1% (58/1143) for P. falciparum and 0.4% (5/1135) and 3.6% (41/1143) for P. vivax by microscopy and nPCR, respectively. Antibody prevalence was associated with current infection by nPCR for both P. falciparum (p<0.001) and P. vivax (p=0.014) and showed an age-dependent increase (p<0.001, for both species). Seroconversion curves indicated a decline in malaria exposure 15 y prior to sampling for P. falciparum and 11.5 y prior to sampling for P. vivax, broadly following malaria incidence data from district health offices, with higher antibody titres in adults than children for both species. CONCLUSIONS Malaria transmission declined substantially in the region with continuing heterogeneous but measurable local transmission, arguing in favour of continued and tailored control efforts to accelerate the progress towards elimination efforts.
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Affiliation(s)
- Migbaru Keffale
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Girma Shumie
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Sinknesh Wolde Behaksra
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Wakweya Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Lotus L van den Hoogen
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Elifaged Hailemeskel
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Daniel Mekonnen
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Demekech Damte
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Tiruwork Fanta
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Temesgen Ashine
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Sagni Chali
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Kevin K A Tetteh
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Taye T Balcha
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK
| | - Tesfaye S Tessema
- Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Haileeyesus Adamu
- Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.,Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Endalamaw Gadisa
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia
| | - Fitsum G Tadesse
- Malaria and Neglected Tropical Diseases Directorate, Armauer Hansen Research Institute, POBox 1005, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.,Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Ashton RA, Joseph V, van den Hoogen LL, Tetteh KKA, Stresman G, Worges M, Druetz T, Chang MA, Rogier E, Lemoine JF, Drakeley C, Eisele TP. Risk Factors for Malaria Infection and Seropositivity in the Elimination Area of Grand'Anse, Haiti: A Case-Control Study among Febrile Individuals Seeking Treatment at Public Health Facilities. Am J Trop Med Hyg 2020; 103:767-777. [PMID: 32458784 PMCID: PMC7410432 DOI: 10.4269/ajtmh.20-0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The island of Hispaniola aims to eliminate malaria by 2025; however, there are limited data to describe epidemiologic risk factors for malaria in this setting. A prospective case–control study was conducted at four health facilities in southwest Haiti, aiming to describe factors influencing the risk of current and past malaria infection. Cases were defined as individuals attending facilities with current or recent fever and positive malaria rapid diagnostic test (RDT), while controls were those with current or recent fever and RDT negative. Serological markers of recent and cumulative exposure to Plasmodium were assessed using the multiplex bead assay from dried blood spots and used for alternate case definitions. Kuldorff’s spatial scan statistic was used to identify local clusters of infection or exposure. Logistic regression models were used to assess potential risk factors for RDT positivity and recent exposure markers, including age-group, gender, and recruiting health facility as group-matching variables. A total of 192 cases (RDT positive) and 915 controls (RDT negative) were recruited. Consistent spatial clusters were identified for all three infection and exposure metrics, indicating temporal stability of malaria transmission at these sites. Risk factors included remoteness from health facilities and household construction, furthermore, insecticide-treated net ownership or use was associated with reduced odds of RDT positivity. These findings indicate the malaria risk in Grand’Anse is driven primarily by location. Travel, occupation, and other behavioral factors were not associated with malaria. These data can support the National Malaria Program to refine and target their intervention approaches, and to move toward elimination.
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Affiliation(s)
- Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lotus L van den Hoogen
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matt Worges
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Thomas Druetz
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Canada.,Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Michelle A Chang
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Frantz Lemoine
- Programme National de Contrôle de la Malaria, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
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22
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van den Hoogen LL, Stresman G, Présumé J, Romilus I, Mondélus G, Elismé T, Existe A, Hamre KES, Ashton RA, Druetz T, Joseph V, Beeson JG, Singh SK, Boncy J, Eisele TP, Chang MA, Lemoine JF, Tetteh KKA, Rogier E, Drakeley C. Selection of Antibody Responses Associated With Plasmodium falciparum Infections in the Context of Malaria Elimination. Front Immunol 2020; 11:928. [PMID: 32499783 PMCID: PMC7243477 DOI: 10.3389/fimmu.2020.00928] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/21/2020] [Indexed: 12/30/2022] Open
Abstract
In our aim to eliminate malaria, more sensitive tools to detect residual transmission are quickly becoming essential. Antimalarial antibody responses persist in the blood after a malaria infection and provide a wider window to detect exposure to infection compared to parasite detection metrics. Here, we aimed to select antibody responses associated with recent and cumulative exposure to malaria using cross-sectional survey data from Haiti, an elimination setting. Using a multiplex bead assay, we generated data for antibody responses (immunoglobulin G) to 23 Plasmodium falciparum targets in 29,481 participants across three surveys. This included one community-based survey in which participants were enrolled during household visits and two sentinel group surveys in which participants were enrolled at schools and health facilities. First, we correlated continuous antibody responses with age (Spearman) to determine which showed strong age-related associations indicating accumulation over time with limited loss. AMA-1 and MSP-119 antibody levels showed the strongest correlation with age (0.47 and 0.43, p < 0.001) in the community-based survey, which was most representative of the underlying age structure of the population, thus seropositivity to either of these antibodies was considered representative of cumulative exposure to malaria. Next, in the absence of a gold standard for recent exposure, we included antibody responses to the remaining targets to predict highly sensitive rapid diagnostic test (hsRDT) status using receiver operating characteristic curves. For this, only data from the survey with the highest hsRDT prevalence was used (7.2%; 348/4,849). The performance of the top two antigens in the training dataset (two-thirds of the dataset; n = 3,204)-Etramp 5 ag 1 and GLURP-R0 (area-under-the-curve, AUC, 0.892 and 0.825, respectively)-was confirmed in the test dataset (remaining one-third of the dataset; n = 1,652, AUC 0.903 and 0.848, respectively). As no further improvement was seen by combining seropositivity to GLURP-R0 and Etramp 5 ag 1 (p = 0.266), seropositivity to Etramp 5 ag 1 alone was selected as representative of current or recent exposure to malaria. The validation of antibody responses associated with these exposure histories simplifies analyses and interpretation of antibody data and facilitates the application of results to evaluate programs.
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Affiliation(s)
- Lotus L. van den Hoogen
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Gina Mondélus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Tamara Elismé
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Karen E. S. Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
- CDC Foundation, Atlanta, GA, United States
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, QC, Canada
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - James G. Beeson
- Burnet Institute, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
- Central Clinical School and Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Susheel K. Singh
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jean F. Lemoine
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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23
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Wu L, Hall T, Ssewanyana I, Oulton T, Patterson C, Vasileva H, Singh S, Affara M, Mwesigwa J, Correa S, Bah M, D'Alessandro U, Sepúlveda N, Drakeley C, Tetteh KKA. Optimisation and standardisation of a multiplex immunoassay of diverse Plasmodium falciparum antigens to assess changes in malaria transmission using sero-epidemiology. Wellcome Open Res 2020; 4:26. [PMID: 32518839 PMCID: PMC7255915 DOI: 10.12688/wellcomeopenres.14950.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 09/12/2023] Open
Abstract
Background: Antibody responses have been used to characterise transmission and exposure history in malaria-endemic settings for over a decade. Such studies have typically been conducted on well-standardised enzyme-linked immunosorbent assays (ELISAs). However, recently developed quantitative suspension array technologies (qSAT) are now capable of high-throughput and multiplexed screening of up to hundreds of analytes at a time. This study presents a customised protocol for the Luminex MAGPIX © qSAT using a diverse set of malaria antigens. The aim is to develop a standardised assay for routine serological surveillance that is implementable across laboratories and epidemiological settings. Methods: A panel of eight Plasmodium falciparum recombinant antigens, associated with long- and short-lived antibody responses, was designed for the Luminex MAGPIX © platform. The assay was optimised for key steps in the protocol: antigen-bead coupling concentration, buffer composition, serum sample dilution, and bead storage conditions. Quality control procedures and data normalisation methods were developed to address high-throughput assay processing. Antigen-specific limits of quantification (LOQs) were also estimated using both in-house and WHO reference serum as positive controls. Results: Antigen-specific bead coupling was optimised across five serum dilutions and two positive controls, resulting in concentrations operational within stable analytical ranges. Coupled beads were stable after storage at room temperature (22⁰C) for up to eight weeks. High sensitivity and specificity for distinguishing positive and negative controls at serum sample dilutions of 1:500 (AUC 0.94 95%CI 0.91-0.96) and 1:1000 (AUC 0.96 95%CI 0.94-0.98) were observed. LOQs were also successfully estimated for all analytes but varied by antigen and positive control. Conclusions: This study demonstrates that developing a standardised malaria-specific qSAT protocol for a diverse set of antigens is achievable, though further optimisations may be required. Quality control and data standardisation methods may also be useful for future analysis of large sero-epidemiological surveys.
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Affiliation(s)
- Lindsey Wu
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Tom Hall
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Isaac Ssewanyana
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Infectious Diseases Research Collaboration (IDRC), Kampala, P O. Box 7475, Uganda
| | - Tate Oulton
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Catriona Patterson
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hristina Vasileva
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Susheel Singh
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Centre for Medical Parasitology at Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - Muna Affara
- Infectious Disease Epidemiology Department, Bernhard Nocht Institute for Tropical Medicine, Hamburg, 20359, Germany
| | - Julia Mwesigwa
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Simon Correa
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Mamadou Bah
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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24
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Wu L, Hall T, Ssewanyana I, Oulton T, Patterson C, Vasileva H, Singh S, Affara M, Mwesigwa J, Correa S, Bah M, D'Alessandro U, Sepúlveda N, Drakeley C, Tetteh KKA. Optimisation and standardisation of a multiplex immunoassay of diverse Plasmodium falciparum antigens to assess changes in malaria transmission using sero-epidemiology. Wellcome Open Res 2020; 4:26. [PMID: 32518839 PMCID: PMC7255915 DOI: 10.12688/wellcomeopenres.14950.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Antibody responses have been used to characterise transmission and exposure history in malaria-endemic settings for over a decade. Such studies have typically been conducted on well-standardised enzyme-linked immunosorbent assays (ELISAs). However, recently developed quantitative suspension array technologies (qSAT) are now capable of high-throughput and multiplexed screening of up to hundreds of analytes at a time. This study presents a customised protocol for the Luminex MAGPIX
© qSAT using a diverse set of malaria antigens. The aim is to develop a standardised assay for routine serological surveillance that is implementable across laboratories and epidemiological settings. Methods: A panel of eight
Plasmodium falciparum recombinant antigens, associated with long- and short-lived antibody responses, was designed for the Luminex MAGPIX
© platform. The assay was optimised for key steps in the protocol: antigen-bead coupling concentration, buffer composition, serum sample dilution, and bead storage conditions. Quality control procedures and data normalisation methods were developed to address high-throughput assay processing. Antigen-specific limits of quantification (LOQs) were also estimated using both in-house and WHO reference serum as positive controls. Results: Antigen-specific bead coupling was optimised across five serum dilutions and two positive controls, resulting in concentrations operational within stable analytical ranges. Coupled beads were stable after storage at room temperature (22⁰C) for up to eight weeks. High sensitivity and specificity for distinguishing positive and negative controls at serum sample dilutions of 1:500 (AUC 0.94 95%CI 0.91-0.96) and 1:1000 (AUC 0.96 95%CI 0.94-0.98) were observed. LOQs were also successfully estimated for all analytes but varied by antigen and positive control. Conclusions: This study demonstrates that developing a standardised malaria-specific qSAT protocol for a diverse set of antigens is achievable, though further optimisations may be required. Quality control and data standardisation methods may also be useful for future analysis of large sero-epidemiological surveys.
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Affiliation(s)
- Lindsey Wu
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Tom Hall
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Isaac Ssewanyana
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Infectious Diseases Research Collaboration (IDRC), Kampala, P O. Box 7475, Uganda
| | - Tate Oulton
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Catriona Patterson
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hristina Vasileva
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Susheel Singh
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - Muna Affara
- Infectious Disease Epidemiology Department, Bernhard Nocht Institute for Tropical Medicine, Hamburg, 20359, Germany
| | - Julia Mwesigwa
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Simon Correa
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Mamadou Bah
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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25
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Aniweh Y, Nyarko PB, Charles-Chess E, Ansah F, Osier FHA, Quansah E, Thiam LG, Kamuyu G, Marsh K, Conway DJ, Tetteh KKA, Awandare GA. Plasmodium falciparum Merozoite Associated Armadillo Protein (PfMAAP) Is Apically Localized in Free Merozoites and Antibodies Are Associated With Reduced Risk of Malaria. Front Immunol 2020; 11:505. [PMID: 32318061 PMCID: PMC7155890 DOI: 10.3389/fimmu.2020.00505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
Abstract
Understanding the functional role of proteins expressed by Plasmodium falciparum is an important step toward unlocking potential targets for the development of therapeutic or diagnostic interventions. The armadillo (ARM) repeat protein superfamily is associated with varied functions across the eukaryotes. Therefore, it is important to understand the role of members of this protein family in Plasmodium biology. The Plasmodium falciparum armadillo repeats only (PfARO; Pf3D7_0414900) and P. falciparum merozoite organizing proteins (PfMOP; Pf3D7_0917000) are armadillo-repeat containing proteins previously characterized in P. falciparum. Here, we describe the characterization of another ARM repeat-containing protein in P. falciparum, which we have named the P. falciparum Merozoites-Associated Armadillo repeats protein (PfMAAP). Antibodies raised to three different synthetic peptides of PfMAAP show apical staining of free merozoites and those within the mature infected schizont. We also demonstrate that the antibodies raised to the PfMAAP peptides inhibited invasion of erythrocytes by merozoites from different parasite isolates. In addition, naturally acquired human antibodies to the N- and C- termini of PfMAAP are associated with a reduced risk of malaria in a prospective cohort analysis.
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Affiliation(s)
- Yaw Aniweh
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
| | - Prince B. Nyarko
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Essel Charles-Chess
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Felix Ansah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Faith H. A. Osier
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Biochemistry, Pwani University, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Evelyn Quansah
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Laty Gaye Thiam
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Gathoni Kamuyu
- Division of Medicine, Department of Respiratory Medicine, UCL, London, United Kingdom
| | - Kevin Marsh
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - David J. Conway
- Department of Infection Biology, London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Gordon A. Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
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Surendra H, Supargiyono, Ahmad RA, Kusumasari RA, Rahayujati TB, Damayanti SY, Tetteh KKA, Chitnis C, Stresman G, Cook J, Drakeley C. Using health facility-based serological surveillance to predict receptive areas at risk of malaria outbreaks in elimination areas. BMC Med 2020; 18:9. [PMID: 31987052 PMCID: PMC6986103 DOI: 10.1186/s12916-019-1482-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In order to improve malaria burden estimates in low transmission settings, more sensitive tools and efficient sampling strategies are required. This study evaluated the use of serological measures from repeated health facility-based cross-sectional surveys to investigate Plasmodium falciparum and Plasmodium vivax transmission dynamics in an area nearing elimination in Indonesia. METHODS Quarterly surveys were conducted in eight public health facilities in Kulon Progo District, Indonesia, from May 2017 to April 2018. Demographic data were collected from all clinic patients and their companions, with household coordinates collected using participatory mapping methods. In addition to standard microscopy tests, bead-based serological assays were performed on finger-prick bloodspot samples from 9453 people. Seroconversion rates (SCR, i.e. the proportion of people in the population who are expected to seroconvert per year) were estimated by fitting a simple reversible catalytic model to seroprevalence data. Mixed effects logistic regression was used to examine factors associated with malaria exposure, and spatial analysis was performed to identify areas with clustering of high antibody responses. RESULTS Parasite prevalence by microscopy was extremely low (0.06% (95% confidence interval 0.03-0.14, n = 6) and 0 for P. vivax and P. falciparum, respectively). However, spatial analysis of P. vivax antibody responses identified high-risk areas that were subsequently the site of a P. vivax outbreak in August 2017 (62 cases detected through passive and reactive detection systems). These areas overlapped with P. falciparum high-risk areas and were detected in each survey. General low transmission was confirmed by the SCR estimated from a pool of the four surveys in people aged 15 years old and under (0.020 (95% confidence interval 0.017-0.024) and 0.005 (95% confidence interval 0.003-0.008) for P. vivax and P. falciparum, respectively). The SCR estimates in those over 15 years old were 0.066 (95% confidence interval 0.041-0.105) and 0.032 (95% confidence interval 0.015-0.069) for P. vivax and P. falciparum, respectively. CONCLUSIONS These findings demonstrate the potential use of health facility-based serological surveillance to better identify and target areas still receptive to malaria in an elimination setting. Further implementation research is needed to enable integration of these methods with existing surveillance systems.
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Affiliation(s)
- Henry Surendra
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281 Indonesia
| | - Supargiyono
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281 Indonesia
- Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, 55281 Indonesia
| | - Riris A. Ahmad
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281 Indonesia
- Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, 55281 Indonesia
| | - Rizqiani A. Kusumasari
- Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281 Indonesia
- Department of Parasitology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Sekip Utara, Yogyakarta, 55281 Indonesia
| | | | - Siska Y. Damayanti
- District Health Office of Kulon Progo, Jln. Suparman No 1, Wates, 55611 Indonesia
| | - Kevin K. A. Tetteh
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | | | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Jackie Cook
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
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van den Hoogen LL, Présumé J, Romilus I, Mondélus G, Elismé T, Sepúlveda N, Stresman G, Druetz T, Ashton RA, Joseph V, Eisele TP, Hamre KES, Chang MA, Lemoine JF, Tetteh KKA, Boncy J, Existe A, Drakeley C, Rogier E. Quality control of multiplex antibody detection in samples from large-scale surveys: the example of malaria in Haiti. Sci Rep 2020; 10:1135. [PMID: 31980693 PMCID: PMC6981173 DOI: 10.1038/s41598-020-57876-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022] Open
Abstract
Measuring antimalarial antibodies can estimate transmission in a population. To compare outputs, standardized laboratory testing is required. Here we describe the in-country establishment and quality control (QC) of a multiplex bead assay (MBA) for three sero-surveys in Haiti. Total IgG data against 21 antigens were collected for 32,758 participants. Titration curves of hyperimmune sera were included on assay plates, assay signals underwent 5-parameter regression, and inspection of the median and interquartile range (IQR) for the y-inflection point was used to determine assay precision. The medians and IQRs were similar for Surveys 1 and 2 for most antigens, while the IQRs increased for some antigens in Survey 3. Levey-Jennings charts for selected antigens provided a pass/fail criterion for each assay plate and, of 387 assay plates, 13 (3.4%) were repeated. Individual samples failed if IgG binding to the generic glutathione-S-transferase protein was observed, with 659 (2.0%) samples failing. An additional 455 (1.4%) observations failed due to low bead numbers (<20/analyte). The final dataset included 609,438 anti-malaria IgG data points from 32,099 participants; 96.6% of all potential data points if no QC failures had occurred. The MBA can be deployed with high-throughput data collection and low inter-plate variability while ensuring data quality.
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Affiliation(s)
- Lotus L van den Hoogen
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | - Gina Mondélus
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Tamara Elismé
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Nuno Sepúlveda
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
- Centre of Statistics and Applications, University of Lisbon, Lisbon, Portugal
| | - Gillian Stresman
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Druetz
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Canada
| | - Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana, USA
| | - Karen E S Hamre
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CDC Foundation, Atlanta, Georgia, USA
| | - Michelle A Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean F Lemoine
- Ministère de la santé publique et de la population, Port-au-Prince, Haiti
| | - Kevin K A Tetteh
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Fornace KM, Brock PM, Abidin TR, Grignard L, Herman LS, Chua TH, Daim S, William T, Patterson CLEB, Hall T, Grigg MJ, Anstey NM, Tetteh KKA, Cox J, Drakeley CJ. Environmental risk factors and exposure to the zoonotic malaria parasite Plasmodium knowlesi across northern Sabah, Malaysia: a population-based cross-sectional survey. Lancet Planet Health 2019; 3:e179-e186. [PMID: 31029229 PMCID: PMC6484808 DOI: 10.1016/s2542-5196(19)30045-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Land use changes disrupt ecosystems, altering the transmission of vector-borne diseases. These changes have been associated with increasing incidence of zoonotic malaria caused by Plasmodium knowlesi; however, the population-level distributions of infection and exposure remain unknown. We aimed to measure prevalence of serological exposure to P knowlesi and assess associated risk factors. METHODS We did an environmentally stratified, population-based, cross-sectional survey across households in the Kudat, Kota Marudu, Pitas, and Ranau districts in northern Sabah, Malaysia, encompassing a range of ecologies. Using blood samples, the transmission intensity of P knowlesi and other malaria species was measured by specific antibody prevalence and infection detected using molecular methods. Proportions and configurations of land types were extracted from maps derived from satellite images; a data-mining approach was used to select variables. A Bayesian hierarchical model for P knowlesi seropositivity was developed, incorporating questionnaire data about individual and household-level risk factors with selected landscape factors. FINDINGS Between Sept 17, 2015, and Dec 12, 2015, 10 100 individuals with a median age of 25 years (range 3 months to 105 years) were sampled from 2849 households in 180 villages. 5·1% (95% CI 4·8-5·4) were seropositive for P knowlesi, and marked historical decreases were observed in the transmission of Plasmodium falciparum and Plasmodium vivax. Nine Plasmodium spp infections were detected. Age, male sex, contact with macaques, forest use, and raised house construction were positively associated with P knowlesi exposure, whereas residing at higher geographical elevations and use of insecticide were protective. Agricultural and forest variables, such as proportions and fragmentation of land cover types, predicted exposure at different spatial scales from households. INTERPRETATION Although few infections were detected, P knowlesi exposure was observed in all demographic groups and was associated with occupational factors. Results suggest that agricultural expansion and forest fragmentation affect P knowlesi exposure, supporting linkages between land use change and P knowlesi transmission. FUNDING UK Medical Research Council, Natural Environment Research Council, Economic and Social Research Council, and Biotechnology and Biosciences Research Council.
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Affiliation(s)
- Kimberly M Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Paddy M Brock
- Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tommy R Abidin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Lynn Grignard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Lou S Herman
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tock H Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Sylvia Daim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia; Gleneagles Hospital, Kota Kinabalu, Malaysia; Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
| | - Catriona L E B Patterson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Hall
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Grigg
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Kevin K A Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Cox
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris J Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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van den Hoogen LL, Walk J, Oulton T, Reuling IJ, Reiling L, Beeson JG, Coppel RL, Singh SK, Draper SJ, Bousema T, Drakeley C, Sauerwein R, Tetteh KKA. Antibody Responses to Antigenic Targets of Recent Exposure Are Associated With Low-Density Parasitemia in Controlled Human Plasmodium falciparum Infections. Front Microbiol 2019; 9:3300. [PMID: 30700984 PMCID: PMC6343524 DOI: 10.3389/fmicb.2018.03300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/18/2018] [Indexed: 12/05/2022] Open
Abstract
The majority of malaria infections in low transmission settings remain undetectable by conventional diagnostics. A powerful model to identify antibody responses that allow accurate detection of recent exposure to low-density infections is controlled human malaria infection (CHMI) studies in which healthy volunteers are infected with the Plasmodium parasite. We aimed to evaluate antibody responses in malaria-naïve volunteers exposed to a single CHMI using a custom-made protein microarray. All participants developed a blood-stage infection with peak parasite densities up to 100 parasites/μl in the majority of participants (50/54), while the remaining four participants had peak densities between 100 and 200 parasites/μl. There was a strong correlation between parasite density and antibody responses associated with the most reactive blood-stage targets 1 month after CHMI (Etramp 5, GLURP-R2, MSP4 and MSP1-19; Spearman’s ρ = 0.82, p < 0.001). Most volunteers developed antibodies against a potential marker of recent exposure: Etramp 5 (37/45, 82%). Our findings justify validation in endemic populations to define a minimum set of antigens needed to detect exposure to natural low-density infections.
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Affiliation(s)
- Lotus L van den Hoogen
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jona Walk
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tate Oulton
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Isaie J Reuling
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Ross L Coppel
- Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Susheel K Singh
- Department of Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Department of International Health, Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Simon J Draper
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kevin K A Tetteh
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kamuyu G, Tuju J, Kimathi R, Mwai K, Mburu J, Kibinge N, Chong Kwan M, Hawkings S, Yaa R, Chepsat E, Njunge JM, Chege T, Guleid F, Rosenkranz M, Kariuki CK, Frank R, Kinyanjui SM, Murungi LM, Bejon P, Färnert A, Tetteh KKA, Beeson JG, Conway DJ, Marsh K, Rayner JC, Osier FHA. KILchip v1.0: A Novel Plasmodium falciparum Merozoite Protein Microarray to Facilitate Malaria Vaccine Candidate Prioritization. Front Immunol 2018; 9:2866. [PMID: 30619257 PMCID: PMC6298441 DOI: 10.3389/fimmu.2018.02866] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022] Open
Abstract
Passive transfer studies in humans clearly demonstrated the protective role of IgG antibodies against malaria. Identifying the precise parasite antigens that mediate immunity is essential for vaccine design, but has proved difficult. Completion of the Plasmodium falciparum genome revealed thousands of potential vaccine candidates, but a significant bottleneck remains in their validation and prioritization for further evaluation in clinical trials. Focusing initially on the Plasmodium falciparum merozoite proteome, we used peer-reviewed publications, multiple proteomic and bioinformatic approaches, to select and prioritize potential immune targets. We expressed 109 P. falciparum recombinant proteins, the majority of which were obtained using a mammalian expression system that has been shown to produce biologically functional extracellular proteins, and used them to create KILchip v1.0: a novel protein microarray to facilitate high-throughput multiplexed antibody detection from individual samples. The microarray assay was highly specific; antibodies against P. falciparum proteins were detected exclusively in sera from malaria-exposed but not malaria-naïve individuals. The intensity of antibody reactivity varied as expected from strong to weak across well-studied antigens such as AMA1 and RH5 (Kruskal–Wallis H test for trend: p < 0.0001). The inter-assay and intra-assay variability was minimal, with reproducible results obtained in re-assays using the same chip over a duration of 3 months. Antibodies quantified using the multiplexed format in KILchip v1.0 were highly correlated with those measured in the gold-standard monoplex ELISA [median (range) Spearman's R of 0.84 (0.65–0.95)]. KILchip v1.0 is a robust, scalable and adaptable protein microarray that has broad applicability to studies of naturally acquired immunity against malaria by providing a standardized tool for the detection of antibody correlates of protection. It will facilitate rapid high-throughput validation and prioritization of potential Plasmodium falciparum merozoite-stage antigens paving the way for urgently needed clinical trials for the next generation of malaria vaccines.
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Affiliation(s)
- Gathoni Kamuyu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany
| | - James Tuju
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Department of Biochemistry, Pwani University, Kilifi, Kenya
| | - Rinter Kimathi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Kennedy Mwai
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - James Mburu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Nelson Kibinge
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Marisa Chong Kwan
- Arrayjet, Innovative Microarray Solutions, Edinburgh, United Kingdom
| | - Sam Hawkings
- Arrayjet, Innovative Microarray Solutions, Edinburgh, United Kingdom
| | - Reuben Yaa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Emily Chepsat
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - James M Njunge
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Timothy Chege
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Fatuma Guleid
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Micha Rosenkranz
- Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher K Kariuki
- Department of Tropical and Infectious Diseases, Institute of Primate Research, Nairobi, Kenya.,Cellular and Molecular Immunology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Roland Frank
- Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany
| | - Samson M Kinyanjui
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Department of Biochemistry, Pwani University, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Linda M Murungi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Kevin K A Tetteh
- Immunology and Infection Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - David J Conway
- Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin Marsh
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,African Academy of Sciences, Nairobi, Kenya
| | - Julian C Rayner
- Wellcome Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Faith H A Osier
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,Centre for Infectious Diseases, Parasitology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Biochemistry, Pwani University, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Herman LS, Fornace K, Phelan J, Grigg MJ, Anstey NM, William T, Moon RW, Blackman MJ, Drakeley CJ, Tetteh KKA. Identification and validation of a novel panel of Plasmodium knowlesi biomarkers of serological exposure. PLoS Negl Trop Dis 2018; 12:e0006457. [PMID: 29902183 PMCID: PMC6001954 DOI: 10.1371/journal.pntd.0006457] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/17/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Plasmodium knowlesi is the most common cause of malaria in Malaysian Borneo, with reporting limited to clinical cases presenting to health facilities and scarce data on the true extent of transmission. Serological estimations of transmission have been used with other malaria species to garner information about epidemiological patterns. However, there are a distinct lack of suitable serosurveillance tools for this neglected disease. METHODOLOGY/PRINCIPAL FINDINGS Using in silico tools, we designed and expressed four novel P. knowlesi protein products to address the distinct lack of suitable serosurveillance tools: PkSERA3 antigens 1 and 2, PkSSP2/TRAP and PkTSERA2 antigen 1. Antibody prevalence to these antigens was determined by ELISA for three time-points post-treatment from a hospital-based clinical treatment trial in Sabah, East Malaysia (n = 97 individuals; 241 total samples for all time points). Higher responses were observed for the PkSERA3 antigen 2 (67%, 65/97) across all time-points (day 0: 36.9% 34/92; day 7: 63.8% 46/72; day 28: 58.4% 45/77) with significant differences between the clinical cases and controls (n = 55, mean plus 3 SD) (day 0 p<0.0001; day 7 p<0.0001; day 28 p<0.0001). Using boosted regression trees, we developed models to classify P. knowlesi exposure (cross-validated AUC 88.9%; IQR 86.1-91.3%) and identified the most predictive antibody responses. CONCLUSIONS/SIGNIFICANCE The PkSERA3 antigen 2 had the highest relative variable importance in all models. Further validation of these antigens is underway to determine the specificity of these tools in the context of multi-species infections at the population level.
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Affiliation(s)
- Lou S. Herman
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kimberly Fornace
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jody Phelan
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Grigg
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas M. Anstey
- Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
| | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
- Jesselton Medical Centre, Kota Kinabalu, Sabah, Malaysia
| | - Robert W. Moon
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael J. Blackman
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Malaria Biochemistry Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Chris J. Drakeley
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
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32
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Fornace KM, Herman LS, Abidin TR, Chua TH, Daim S, Lorenzo PJ, Grignard L, Nuin NA, Ying LT, Grigg MJ, William T, Espino F, Cox J, Tetteh KKA, Drakeley CJ. Exposure and infection to Plasmodium knowlesi in case study communities in Northern Sabah, Malaysia and Palawan, The Philippines. PLoS Negl Trop Dis 2018; 12:e0006432. [PMID: 29902171 PMCID: PMC6001952 DOI: 10.1371/journal.pntd.0006432] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primarily impacting poor, rural populations, the zoonotic malaria Plasmodium knowlesi is now the main cause of human malaria within Malaysian Borneo. While data is increasingly available on symptomatic cases, little is known about community-level patterns of exposure and infection. Understanding the true burden of disease and associated risk factors within endemic communities is critical for informing evidence-based control measures. METHODOLOGY/PRINCIPAL FINDINGS We conducted comprehensive surveys in three areas where P. knowlesi transmission is reported: Limbuak, Pulau Banggi and Matunggung, Kudat, Sabah, Malaysia and Bacungan, Palawan, the Philippines. Infection prevalence was low with parasites detected by PCR in only 0.2% (4/2503) of the population. P. knowlesi PkSERA3 ag1 antibody responses were detected in 7.1% (95% CI: 6.2-8.2%) of the population, compared with 16.1% (14.6-17.7%) and 12.6% (11.2-14.1%) for P. falciparum and P. vivax. Sero-prevalence was low in individuals <10 years old for P. falciparum and P. vivax consistent with decreased transmission of non-zoonotic malaria species. Results indicated marked heterogeneity in transmission intensity between sites and P. knowlesi exposure was associated with agricultural work (OR 1.63; 95% CI 1.07-2.48) and higher levels of forest cover (OR 2.40; 95% CI 1.29-4.46) and clearing (OR 2.14; 95% CI 1.35-3.40) around houses. Spatial patterns of P. knowlesi exposure differed from exposure to non-zoonotic malaria and P. knowlesi exposed individuals were younger on average than individuals exposed to non-zoonotic malaria. CONCLUSIONS/SIGNIFICANCE This is the first study to describe serological exposure to P. knowlesi and associated risk factors within endemic communities. Results indicate community-level patterns of infection and exposure differ markedly from demographics of reported cases, with higher levels of exposure among women and children. Further work is needed to understand these variations in risk across a wider population and spatial scale.
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Affiliation(s)
- Kimberly M. Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lou S. Herman
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tommy R. Abidin
- Infectious Diseases Society Kota Kinabalu- Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia
| | - Tock Hing Chua
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Sylvia Daim
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Pauline J. Lorenzo
- Research Institute of Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Lynn Grignard
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nor Afizah Nuin
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Lau Tiek Ying
- Biotechnology Research Institute, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Matthew J. Grigg
- Infectious Diseases Society Kota Kinabalu- Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Timothy William
- Infectious Diseases Society Kota Kinabalu- Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Malaysia
- Jesselton Medical Centre, Kota Kinabalu, Malaysia
| | - Fe Espino
- Research Institute of Tropical Medicine, Department of Health, Muntinlupa City, Philippines
| | - Jonathan Cox
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris J. Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ssewanyana I, Arinaitwe E, Nankabirwa JI, Yeka A, Sullivan R, Kamya MR, Rosenthal PJ, Dorsey G, Mayanja-Kizza H, Drakeley C, Greenhouse B, Tetteh KKA. Avidity of anti-malarial antibodies inversely related to transmission intensity at three sites in Uganda. Malar J 2017; 16:67. [PMID: 28183299 PMCID: PMC5301436 DOI: 10.1186/s12936-017-1721-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background People living in malaria endemic areas acquire protection from severe malaria quickly, but protection from clinical disease and control of parasitaemia is acquired only after many years of repeated infections. Antibodies play a central role in protection from clinical disease; however, protective antibodies are slow to develop. This study sought to investigate the influence of Plasmodium falciparum exposure on the acquisition of high-avidity antibodies to P. falciparum antigens, which may be associated with protection. Methods Cross-sectional surveys were performed in children and adults at three sites in Uganda with varied P. falciparum transmission intensity (entomological inoculation rates; 3.8, 26.6, and 125 infectious bites per person per year). Sandwich ELISA was used to measure antibody responses to two P. falciparum merozoite surface antigens: merozoite surface protein 1-19 (MSP1-19) and apical membrane antigen 1 (AMA1). In individuals with detectable antibody levels, guanidine hydrochloride (GuHCl) was added to measure the relative avidity of antibody responses by ELISA. Results Within a site, there were no significant differences in median antibody levels between the three age groups. Between sites, median antibody levels were generally higher in the higher transmission sites, with differences more apparent for AMA-1 and in ≥5 year group. Similarly, median avidity index (proportion of high avidity antibodies) showed no significant increase with increasing age but was significantly lower at sites of higher transmission amongst participants ≥5 years of age. Using 5 M GuHCl, the median avidity indices in the ≥5 year group at the highest and lowest transmission sites were 19.9 and 26.8, respectively (p = 0.0002) for MSP1-19 and 12.2 and 17.2 (p = 0.0007) for AMA1. Conclusion Avidity to two different P. falciparum antigens was lower in areas of high transmission intensity compared to areas with lower transmission. Appreciation of the mechanisms behind these findings as well as their clinical consequences will require additional investigation, ideally utilizing longitudinal data and investigation of a broader array of responses.
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Affiliation(s)
- Isaac Ssewanyana
- Infectious Diseases Research Collaboration, Kampala, Uganda. .,London School of Hygiene and Tropical Medicine, London, UK.
| | - Emmanuel Arinaitwe
- Infectious Diseases Research Collaboration, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adoke Yeka
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Sullivan
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Philip J Rosenthal
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Grant Dorsey
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Bryan Greenhouse
- Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA
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Helb DA, Tetteh KKA, Felgner PL, Skinner J, Hubbard A, Arinaitwe E, Mayanja-Kizza H, Ssewanyana I, Kamya MR, Beeson JG, Tappero J, Smith DL, Crompton PD, Rosenthal PJ, Dorsey G, Drakeley CJ, Greenhouse B. Novel serologic biomarkers provide accurate estimates of recent Plasmodium falciparum exposure for individuals and communities. Proc Natl Acad Sci U S A 2015; 112:E4438-47. [PMID: 26216993 PMCID: PMC4538641 DOI: 10.1073/pnas.1501705112] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Tools to reliably measure Plasmodium falciparum (Pf) exposure in individuals and communities are needed to guide and evaluate malaria control interventions. Serologic assays can potentially produce precise exposure estimates at low cost; however, current approaches based on responses to a few characterized antigens are not designed to estimate exposure in individuals. Pf-specific antibody responses differ by antigen, suggesting that selection of antigens with defined kinetic profiles will improve estimates of Pf exposure. To identify novel serologic biomarkers of malaria exposure, we evaluated responses to 856 Pf antigens by protein microarray in 186 Ugandan children, for whom detailed Pf exposure data were available. Using data-adaptive statistical methods, we identified combinations of antibody responses that maximized information on an individual's recent exposure. Responses to three novel Pf antigens accurately classified whether an individual had been infected within the last 30, 90, or 365 d (cross-validated area under the curve = 0.86-0.93), whereas responses to six antigens accurately estimated an individual's malaria incidence in the prior year. Cross-validated incidence predictions for individuals in different communities provided accurate stratification of exposure between populations and suggest that precise estimates of community exposure can be obtained from sampling a small subset of that community. In addition, serologic incidence predictions from cross-sectional samples characterized heterogeneity within a community similarly to 1 y of continuous passive surveillance. Development of simple ELISA-based assays derived from the successful selection strategy outlined here offers the potential to generate rich epidemiologic surveillance data that will be widely accessible to malaria control programs.
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Affiliation(s)
- Danica A Helb
- Department of Medicine, University of California, San Francisco, CA 94110; Division of Infectious Diseases, School of Public Health, University of California, Berkeley, CA 94720; Global Health Group, University of California, San Francisco, CA 94158
| | - Kevin K A Tetteh
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Philip L Felgner
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, CA 92697
| | - Jeff Skinner
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA 94720
| | | | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James G Beeson
- Center for Biomedical Research, Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Canada 3004
| | - Jordan Tappero
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850
| | - Peter D Crompton
- Laboratory of Immunogenetics, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852
| | - Philip J Rosenthal
- Department of Medicine, University of California, San Francisco, CA 94110
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, CA 94110
| | - Christopher J Drakeley
- Department Immunology and Infection, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, CA 94110;
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Boyle MJ, Reiling L, Feng G, Langer C, Osier FH, Aspeling-Jones H, Cheng YS, Stubbs J, Tetteh KKA, Conway DJ, McCarthy JS, Muller I, Marsh K, Anders RF, Beeson JG. Human antibodies fix complement to inhibit Plasmodium falciparum invasion of erythrocytes and are associated with protection against malaria. Immunity 2015; 42:580-90. [PMID: 25786180 PMCID: PMC4372259 DOI: 10.1016/j.immuni.2015.02.012] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 12/01/2014] [Accepted: 02/23/2015] [Indexed: 11/26/2022]
Abstract
Antibodies play major roles in immunity to malaria; however, a limited understanding of mechanisms mediating protection is a major barrier to vaccine development. We have demonstrated that acquired human anti-malarial antibodies promote complement deposition on the merozoite to mediate inhibition of erythrocyte invasion through C1q fixation and activation of the classical complement pathway. Antibody-mediated complement-dependent (Ab-C′) inhibition was the predominant invasion-inhibitory activity of human antibodies; most antibodies were non-inhibitory without complement. Inhibitory activity was mediated predominately via C1q fixation, and merozoite surface proteins 1 and 2 were identified as major targets. Complement fixation by antibodies was very strongly associated with protection from both clinical malaria and high-density parasitemia in a prospective longitudinal study of children. Ab-C′ inhibitory activity could be induced by human immunization with a candidate merozoite surface-protein vaccine. Our findings demonstrate that human anti-malarial antibodies have evolved to function by fixing complement for potent invasion-inhibitory activity and protective immunity. Antibodies function with complement to inhibit P. falciparum replication Antibodies fix C1q to block invasion and lyse merozoites Complement-fixing antibodies are strongly associated with immunity in children Antibody-complement inhibition can be induced by human vaccination
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Affiliation(s)
- Michelle J Boyle
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medical Biology, University of Melbourne, Royal Parade, Melbourne, VIC 3010, Australia
| | - Linda Reiling
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Gaoqian Feng
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Christine Langer
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Faith H Osier
- Centre for Geographic Medicine Research, Kenya Medical Research Institute, Coast, PO Box 230, 80108 Kilifi, Kenya
| | | | - Yik Sheng Cheng
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medical Biology, University of Melbourne, Royal Parade, Melbourne, VIC 3010, Australia
| | - Janine Stubbs
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia
| | - Kevin K A Tetteh
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK
| | - David J Conway
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E7HT, UK
| | - James S McCarthy
- QIMR Berghofer Medical Research Institute, University of Queensland, 300 Herston Road, Herston, QLD 4006, Australia
| | - Ivo Muller
- Walter and Eliza Hall Institute, Royal Parade, Melbourne, VIC 3050, Australia
| | - Kevin Marsh
- Centre for Geographic Medicine Research, Kenya Medical Research Institute, Coast, PO Box 230, 80108 Kilifi, Kenya
| | - Robin F Anders
- Department of Biochemistry, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC 3086, Australia
| | - James G Beeson
- The Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC 3004, Australia; Department of Microbiology, Monash University, Clayton, VIC 3800, Australia.
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Longwe H, Jambo KC, Phiri KS, Mbeye N, Gondwe T, Hall T, Tetteh KKA, Drakeley C, Mandala WL. The effect of daily co-trimoxazole prophylaxis on natural development of antibody-mediated immunity against P. falciparum malaria infection in HIV-exposed uninfected Malawian children. PLoS One 2015; 10:e0121643. [PMID: 25807475 PMCID: PMC4373908 DOI: 10.1371/journal.pone.0121643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/02/2015] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives Co-trimoxazole prophylaxis, currently recommended in HIV-exposed, uninfected (HEU) children as protection against opportunistic infections, also has some anti-malarial efficacy. We determined whether daily co-trimoxazole prophylaxis affects the natural development of antibody-mediated immunity to blood-stage Plasmodium falciparum malaria infection. Methods Using an enzyme-linked immunosorbent assay, we measured antibodies to 8Plasmodium falciparum antigens (AMA-1, MSP-119, MSP-3, PfSE, EBA-175RII, GLURP R0, GLURP R2 and CSP) in serum samples from 33 HEU children and 31 HIV-unexposed, uninfected (HUU) children, collected at 6, 12 and 18 months of age. Results Compared to HIV-uninfected children, HEU children had significantly lower levels of specific IgG against AMA-1 at 6 months (p = 0.001), MSP-119 at 12 months (p = 0.041) and PfSE at 6 months (p = 0.038), 12 months (p = 0.0012) and 18 months (p = 0.0097). No differences in the IgG antibody responses against the rest of the antigens were observed between the two groups at all time points. The breadth of specificity of IgG response was reduced in HEU children compared to HUU children during the follow up period. Conclusions Co-trimoxazole prophylaxis seems to reduce IgG antibody responses to P. falciparum blood stage antigens, which could be as a result of a reduction in exposure of those children under this regime. Although antibody responses were regarded as markers of exposure in this study, further studies are required to establish whether these responses are correlated in any way to clinical immunity to malaria.
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Affiliation(s)
- Herbert Longwe
- Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kondwani C. Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Kamija S. Phiri
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nyanyiwe Mbeye
- Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Thandile Gondwe
- Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tom Hall
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wilson L. Mandala
- Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- * E-mail:
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Amambua-Ngwa A, Tetteh KKA, Manske M, Gomez-Escobar N, Stewart LB, Deerhake ME, Cheeseman IH, Newbold CI, Holder AA, Knuepfer E, Janha O, Jallow M, Campino S, MacInnis B, Kwiatkowski DP, Conway DJ. Population genomic scan for candidate signatures of balancing selection to guide antigen characterization in malaria parasites. PLoS Genet 2012; 8:e1002992. [PMID: 23133397 PMCID: PMC3486833 DOI: 10.1371/journal.pgen.1002992] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/13/2012] [Indexed: 11/19/2022] Open
Abstract
Acquired immunity in vertebrates maintains polymorphisms in endemic pathogens, leading to identifiable signatures of balancing selection. To comprehensively survey for genes under such selection in the human malaria parasite Plasmodium falciparum, we generated paired-end short-read sequences of parasites in clinical isolates from an endemic Gambian population, which were mapped to the 3D7 strain reference genome to yield high-quality genome-wide coding sequence data for 65 isolates. A minority of genes did not map reliably, including the hypervariable var, rifin, and stevor families, but 5,056 genes (90.9% of all in the genome) had >70% sequence coverage with minimum read depth of 5 for at least 50 isolates, of which 2,853 genes contained 3 or more single nucleotide polymorphisms (SNPs) for analysis of polymorphic site frequency spectra. Against an overall background of negatively skewed frequencies, as expected from historical population expansion combined with purifying selection, the outlying minority of genes with signatures indicating exceptionally intermediate frequencies were identified. Comparing genes with different stage-specificity, such signatures were most common in those with peak expression at the merozoite stage that invades erythrocytes. Members of clag, PfMC-2TM, surfin, and msp3-like gene families were highly represented, the strongest signature being in the msp3-like gene PF10_0355. Analysis of msp3-like transcripts in 45 clinical and 11 laboratory adapted isolates grown to merozoite-containing schizont stages revealed surprisingly low expression of PF10_0355. In diverse clonal parasite lines the protein product was expressed in a minority of mature schizonts (<1% in most lines and ∼10% in clone HB3), and eight sub-clones of HB3 cultured separately had an intermediate spectrum of positive frequencies (0.9 to 7.5%), indicating phase variable expression of this polymorphic antigen. This and other identified targets of balancing selection are now prioritized for functional study.
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Affiliation(s)
| | - Kevin K. A. Tetteh
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Magnus Manske
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | | | - Lindsay B. Stewart
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M. Elizabeth Deerhake
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ian H. Cheeseman
- Medical Research Council Unit, Fajara, Banjul, The Gambia
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher I. Newbold
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Anthony A. Holder
- Division of Parasitology, MRC National Institute for Medical Research, London, United Kingdom
| | - Ellen Knuepfer
- Division of Parasitology, MRC National Institute for Medical Research, London, United Kingdom
| | - Omar Janha
- Medical Research Council Unit, Fajara, Banjul, The Gambia
| | | | - Susana Campino
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | | | - Dominic P. Kwiatkowski
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - David J. Conway
- Medical Research Council Unit, Fajara, Banjul, The Gambia
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Nogaro SI, Hafalla JC, Walther B, Remarque EJ, Tetteh KKA, Conway DJ, Riley EM, Walther M. The breadth, but not the magnitude, of circulating memory B cell responses to P. falciparum increases with age/exposure in an area of low transmission. PLoS One 2011; 6:e25582. [PMID: 21991321 PMCID: PMC3186790 DOI: 10.1371/journal.pone.0025582] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 09/06/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria caused by Plasmodium falciparum remains a major cause of death in sub-Saharan Africa. Immunity against symptoms of malaria requires repeated exposure, suggesting either that the parasite is poorly immunogenic or that the development of effective immune responses to malaria may be impaired. METHODS We carried out two age-stratified cross-sectional surveys of anti-malarial humoral immune responses in a Gambian village where P. falciparum malaria transmission is low and sporadic. Circulating antibodies and memory B cells (MBC) to four malarial antigens were measured using ELISA and cultured B cell ELISpot. FINDINGS AND CONCLUSIONS The proportion of individuals with malaria-specific MBC and antibodies, and the average number of antigens recognised by each individual, increased with age but the magnitude of these responses did not. Malaria-specific antibody levels did not correlate with either the prevalence or median number of MBC, indicating that these two assays are measuring different aspects of the humoral immune response. Among those with immunological evidence of malaria exposure (defined as a positive response to at least one malarial antigen either by ELISA or ELISPOT), the median number of malaria-specific MBC was similar to median numbers of diphtheria-specific MBC, suggesting that the circulating memory cell pool for malaria antigens is of similar size to that for other antigens.
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Affiliation(s)
- Sarah I. Nogaro
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julius C. Hafalla
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Brigitte Walther
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
| | - Edmond J. Remarque
- Department of Parasitology, Biomedical Primate Research Centre, GJ Rijswijk, The Netherlands
| | - Kevin K. A. Tetteh
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David J. Conway
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eleanor M. Riley
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Walther
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia
- * E-mail:
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Tetteh KKA, Conway DJ. A polyvalent hybrid protein elicits antibodies against the diverse allelic types of block 2 in Plasmodium falciparum merozoite surface protein 1. Vaccine 2011; 29:7811-7. [PMID: 21820475 PMCID: PMC3195258 DOI: 10.1016/j.vaccine.2011.07.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 07/18/2011] [Accepted: 07/23/2011] [Indexed: 01/20/2023]
Abstract
Merozoite surface protein 1 (MSP1) of Plasmodium falciparum has been implicated as an important target of acquired immunity, and candidate components for a vaccine include polymorphic epitopes in the N-terminal polymorphic block 2 region. We designed a polyvalent hybrid recombinant protein incorporating sequences of the three major allelic types of block 2 together with a composite repeat sequence of one of the types and N-terminal flanking T cell epitopes, and compared this with a series of recombinant proteins containing modular sub-components and similarly expressed in Escherichia coli. Immunogenicity of the full polyvalent hybrid protein was tested in both mice and rabbits, and comparative immunogenicity studies of the sub-component modules were performed in mice. The full hybrid protein induced high titre antibodies against each of the major block 2 allelic types expressed as separate recombinant proteins and against a wide range of allelic types naturally expressed by a panel of diverse P. falciparum isolates, while the sub-component modules had partial antigenic coverage as expected. This encourages further development and evaluation of the full MSP1 block 2 polyvalent hybrid protein as a candidate blood-stage component of a malaria vaccine.
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Affiliation(s)
- Kevin K A Tetteh
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Ochola LI, Tetteh KKA, Stewart LB, Riitho V, Marsh K, Conway DJ. Allele frequency-based and polymorphism-versus-divergence indices of balancing selection in a new filtered set of polymorphic genes in Plasmodium falciparum. Mol Biol Evol 2010; 27:2344-51. [PMID: 20457586 PMCID: PMC2944029 DOI: 10.1093/molbev/msq119] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Signatures of balancing selection operating on specific gene loci in endemic pathogens can identify candidate targets of naturally acquired immunity. In malaria parasites, several leading vaccine candidates convincingly show such signatures when subjected to several tests of neutrality, but the discovery of new targets affected by selection to a similar extent has been slow. A small minority of all genes are under such selection, as indicated by a recent study of 26 Plasmodium falciparum merozoite-stage genes that were not previously prioritized as vaccine candidates, of which only one (locus PF10_0348) showed a strong signature. Therefore, to focus discovery efforts on genes that are polymorphic, we scanned all available shotgun genome sequence data from laboratory lines of P. falciparum and chose six loci with more than five single nucleotide polymorphisms per kilobase (including PF10_0348) for in-depth frequency-based analyses in a Kenyan population (allele sample sizes >50 for each locus) and comparison of Hudson-Kreitman-Aguade (HKA) ratios of population diversity (π) to interspecific divergence (K) from the chimpanzee parasite Plasmodium reichenowi. Three of these (the msp3/6-like genes PF10_0348 and PF10_0355 and the surf(4.1) gene PFD1160w) showed exceptionally high positive values of Tajima's D and Fu and Li's F indices and have the highest HKA ratios, indicating that they are under balancing selection and should be prioritized for studies of their protein products as candidate targets of immunity. Combined with earlier results, there is now strong evidence that high HKA ratio (as well as the frequency-independent ratio of Watterson's /K) is predictive of high values of Tajima's D. Thus, the former offers value for use in genome-wide screening when numbers of genome sequences within a species are low or in combination with Tajima's D as a 2D test on large population genomic samples.
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Affiliation(s)
- Lynette Isabella Ochola
- Kenya Medical Research Institute, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
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Duah NO, Weiss HA, Jepson A, Tetteh KKA, Whittle HC, Conway DJ. Heritability of antibody isotype and subclass responses to Plasmodium falciparum antigens. PLoS One 2009; 4:e7381. [PMID: 19812685 PMCID: PMC2753646 DOI: 10.1371/journal.pone.0007381] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/05/2009] [Indexed: 11/19/2022] Open
Abstract
Background It is important to understand the extent to which genetic factors regulate acquired immunity to common infections. A classical twin study design is useful to estimate the heritable component of variation in measurable immune parameters. Methodology/Principal Findings This study assessed the relative heritability of different plasma antibody isotypes and subclasses (IgG1, IgG2, IgG3, IgG4, IgM, IgA and IgE) naturally acquired to P. falciparum blood stage antigens AMA1, MSP1-19, MSP2 (two allelic types) and MSP3 (two allelic types). Separate analyses were performed on plasma from 213 pairs of Gambian adult twins, 199 child twin pairs sampled in a dry season when there was little malaria transmission, and another set of 107 child twin pairs sampled at the end of the annual wet season when malaria was common. There were significantly positive heritability (h2) estimates for 48% (20/42) of the specific antibody assays (for the seven isotypes and subclasses to the six antigens tested) among the adults, 48% (20/42) among the children in the dry season and 31% (13/42) among the children in the wet season. In children, there were significant heritability estimates for IgG4 reactivity against each of the antigens, and this subclass had higher heritability than the other subclasses and isotypes. In adults, 75% (15/20) of the significantly heritable antigen-specific isotype responses were attributable to non-HLA class II genetic variation, whereas none showed a significant HLA contribution. Significance Genome-wide approaches are now warranted to map the major genetic determinants of variable antibody isotype and subclass responses to malaria, alongside evaluation of their impact on infection and disease. Although plasma levels of IgG4 to malaria antigens are generally low, the exceptionally high heritability of levels of this subclass in children deserves particular investigation.
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Affiliation(s)
- Nancy O. Duah
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council Laboratories, Fajara, The Gambia
| | - Helen A. Weiss
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Annette Jepson
- Medical Research Council Laboratories, Fajara, The Gambia
| | - Kevin K. A. Tetteh
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - David J. Conway
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council Laboratories, Fajara, The Gambia
- * E-mail:
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Cheeseman IH, Gomez-Escobar N, Carret CK, Ivens A, Stewart LB, Tetteh KKA, Conway DJ. Gene copy number variation throughout the Plasmodium falciparum genome. BMC Genomics 2009; 10:353. [PMID: 19653891 PMCID: PMC2732925 DOI: 10.1186/1471-2164-10-353] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 08/04/2009] [Indexed: 11/17/2022] Open
Abstract
Background Gene copy number variation (CNV) is responsible for several important phenotypes of the malaria parasite Plasmodium falciparum, including drug resistance, loss of infected erythrocyte cytoadherence and alteration of receptor usage for erythrocyte invasion. Despite the known effects of CNV, little is known about its extent throughout the genome. Results We performed a whole-genome survey of CNV genes in P. falciparum using comparative genome hybridisation of a diverse set of 16 laboratory culture-adapted isolates to a custom designed high density Affymetrix GeneChip array. Overall, 186 genes showed hybridisation signals consistent with deletion or amplification in one or more isolate. There is a strong association of CNV with gene length, genomic location, and low orthology to genes in other Plasmodium species. Sub-telomeric regions of all chromosomes are strongly associated with CNV genes independent from members of previously described multigene families. However, ~40% of CNV genes were located in more central regions of the chromosomes. Among the previously undescribed CNV genes, several that are of potential phenotypic relevance are identified. Conclusion CNV represents a major form of genetic variation within the P. falciparum genome; the distribution of gene features indicates the involvement of highly non-random mutational and selective processes. Additional studies should be directed at examining CNV in natural parasite populations to extend conclusions to clinical settings.
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Affiliation(s)
- Ian H Cheeseman
- Department of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Tetteh KKA, Stewart LB, Ochola LI, Amambua-Ngwa A, Thomas AW, Marsh K, Weedall GD, Conway DJ. Prospective identification of malaria parasite genes under balancing selection. PLoS One 2009; 4:e5568. [PMID: 19440377 PMCID: PMC2679211 DOI: 10.1371/journal.pone.0005568] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 04/13/2009] [Indexed: 11/20/2022] Open
Abstract
Background Endemic human pathogens are subject to strong immune selection, and interrogation of pathogen genome variation for signatures of balancing selection can identify important target antigens. Several major antigen genes in the malaria parasite Plasmodium falciparum have shown such signatures in polymorphism-versus-divergence indices (comparing with the chimpanzee parasite P. reichenowi), and in allele frequency based indices. Methodology/Principal Findings To compare methods for prospective identification of genes under balancing selection, 26 additional genes known or predicted to encode surface-exposed proteins of the invasive blood stage merozoite were first sequenced from a panel of 14 independent P. falciparum cultured lines and P. reichenowi. Six genes at the positive extremes of one or both of the Hudson-Kreitman-Aguade (HKA) and McDonald-Kreitman (MK) indices were identified. Allele frequency based analysis was then performed on a Gambian P. falciparum population sample for these six genes and three others as controls. Tajima's D (TjD) index was most highly positive for the msp3/6-like PF10_0348 (TjD = 1.96) as well as the positive control ama1 antigen gene (TjD = 1.22). Across the genes there was a strong correlation between population TjD values and the relative HKA indices (whether derived from the population or the panel of cultured laboratory isolates), but no correlation with the MK indices. Conclusions/Significance Although few individual parasite genes show significant evidence of balancing selection, analysis of population genomic and comparative sequence data with the HKA and TjD indices should discriminate those that do, and thereby identify likely targets of immunity.
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Affiliation(s)
- Kevin K. A. Tetteh
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lindsay B. Stewart
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lynette Isabella Ochola
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Laboratories, Fajara, Banjul, The Gambia
- KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | | | - Alan W. Thomas
- Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - Kevin Marsh
- KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya
| | - Gareth D. Weedall
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Biological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - David J. Conway
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC Laboratories, Fajara, Banjul, The Gambia
- * E-mail:
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Gray JC, Corran PH, Mangia E, Gaunt MW, Li Q, Tetteh KKA, Polley SD, Conway DJ, Holder AA, Bacarese-Hamilton T, Riley EM, Crisanti A. Profiling the antibody immune response against blood stage malaria vaccine candidates. Clin Chem 2007; 53:1244-53. [PMID: 17510307 DOI: 10.1373/clinchem.2006.081695] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The complexity and diversity of the antibody immune response to the antigen repertoire of a pathogen has long been appreciated. Although it has been recognized that the detection of antibodies against multiple antigens dramatically improves the clinical sensitivity and specificity of diagnostic assays, the prognostic value of serum reactivity profiles against multiple microbial antigens in protection has not been investigated. METHODS Using malaria as a model we investigated whether antigen reactivity profiles in serum of children with different levels of clinical immunity to Plasmodium falciparum malaria correlated with protection. We developed a microarray immunoassay of 18 recombinant antigens derived from 4 leading blood-stage vaccine candidates for P. falciparum [merozoite surface protein 1 (MSP1), MSP2, MSP3, and apical membrane antigen (AMA)-1]. Associations between observed reactivity profiles and clinical status were sought using k-means clustering and phylogenetic networks. RESULTS The antibody immune response was unexpectedly complex, with different combinations of antigens recognized in different children. Serum reactivity to individual antigens did not correlate with immune status. By contrast, combined recognition of AMA-1 and allelic variants of MSP2 was significantly associated with protection against clinical malaria. This finding was confirmed independently by k-means clustering and phylogenetic networking. CONCLUSIONS The analysis of reactivity profiles provides a wealth of novel information about the immune response against microbial organisms that would pass unnoticed in analysis of reactivity to antigens individually. Extension of this approach to a large fraction of the proteome may expedite the identification of correlates of protection and vaccine development against microbial diseases.
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Affiliation(s)
- Julian C Gray
- Faulty of Natural Sciences, Imperial College London, London, United Kingdom
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Polley SD, Tetteh KKA, Lloyd JM, Akpogheneta OJ, Greenwood BM, Bojang KA, Conway DJ. Plasmodium falciparum merozoite surface protein 3 is a target of allele-specific immunity and alleles are maintained by natural selection. J Infect Dis 2006; 195:279-87. [PMID: 17191173 DOI: 10.1086/509806] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 07/31/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Plasmodium falciparum merozoite surface protein (MSP) 3 is an asexual blood-stage malaria vaccine candidate antigen. Sequence polymorphisms divide alleles into 2 major types, but the adaptive and immunological significance of the types has not been defined. METHODS One hundred one msp3 allele sequences were sampled from 2 populations living in areas where malaria is endemic and were analyzed for evidence of natural selection. Recombinant antigens representing full-length sequences of different allelic types and a relatively conserved C-terminal region were produced, to evaluate immunization-induced antibody responses in mice and protective associations for naturally acquired antibodies in a cohort of 319 Gambian children under surveillance for malaria. RESULTS Frequency-based statistical analyses indicated that polymorphisms are maintained by balancing selection in each of the 2 populations studied. Immunization of mice with full-length MSP3 antigens induced predominantly type-specific antibodies, and a large proportion of naturally acquired antibodies to MSP3 in humans also discriminated between the alleles. Among Gambian children, antibodies to allele-specific and conserved epitopes in MSP3 were associated prospectively with protection from clinical malaria, even after adjustment for age and for the presence of antibodies to other merozoite antigens. CONCLUSIONS A vaccine incorporating both major allelic types of this promising candidate antigen could be particularly useful for induction of protective immunity in infants and young children.
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MESH Headings
- Alleles
- Animals
- Antibodies, Protozoan/blood
- Antibodies, Protozoan/immunology
- Antibody Specificity
- Antigens, Protozoan/genetics
- Antigens, Protozoan/immunology
- Antigens, Protozoan/metabolism
- Child
- Child, Preschool
- Gambia
- Humans
- Immunization
- Malaria Vaccines/administration & dosage
- Malaria Vaccines/genetics
- Malaria Vaccines/immunology
- Malaria, Falciparum/immunology
- Malaria, Falciparum/prevention & control
- Mice
- Molecular Sequence Data
- Nigeria
- Plasmodium falciparum/genetics
- Plasmodium falciparum/immunology
- Plasmodium falciparum/metabolism
- Protozoan Proteins/genetics
- Protozoan Proteins/immunology
- Protozoan Proteins/metabolism
- Recombinant Proteins/genetics
- Recombinant Proteins/immunology
- Recombinant Proteins/metabolism
- Selection, Genetic
- Sequence Analysis, DNA
- Thailand
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Affiliation(s)
- Spencer D Polley
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Tetteh KKA, Cavanagh DR, Corran P, Musonda R, McBride JS, Conway DJ. Extensive antigenic polymorphism within the repeat sequence of the Plasmodium falciparum merozoite surface protein 1 block 2 is incorporated in a minimal polyvalent immunogen. Infect Immun 2005; 73:5928-35. [PMID: 16113313 PMCID: PMC1231057 DOI: 10.1128/iai.73.9.5928-5935.2005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Polymorphism in pathogen antigens presents a complex challenge for vaccine design. A prime example is the N-terminal block 2 region of the Plasmodium falciparum merozoite surface protein 1 (MSP1), to which allele-specific antibodies have been associated with protection from malaria. In a Zambian population studied here, 49 of 91 alleles sampled were of the K1-like type (the most common of three block 2 types in all African populations), and most of these had unique sequences due to variation in tri- and hexapeptide repetitive motifs. There were significant negative correlations between allelic sequence lengths of different regions of the repeats, so the complete repeat sequence had less length variation than its component parts, suggesting a constraint on overall length. Diverse epitopes recognized by three murine monoclonal antibodies and 24 individual human sera were then mapped by using a comprehensive panel of synthetic peptides, revealing epitopes in all regions of the repeats. To incorporate these different epitopes in a single molecule, a composite sequence of minimal overall length (78 amino acids) was then designed and expressed as a recombinant antigen. More human immune sera reacted with this "K1-like Super Repeat" antigen than with proteins consisting of single natural allelic sequences, and immunization of mice elicited antibodies that recognized a range of five cultured parasite lines with diverse K1-like MSP1 block 2 repeat sequences. Thus, complex allelic polymorphism was deconstructed and a minimal composite polyvalent antigen was engineered, delivering a designed candidate sequence for inclusion in a malaria vaccine.
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Affiliation(s)
- Kevin K A Tetteh
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, United Kingdom.
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Kimbi HK, Tetteh KKA, Polley SD, Conway DJ. Cross-sectional study of specific antibodies to a polymorphic Plasmodium falciparum antigen and of parasite antigen genotypes in school children on the slope of Mount Cameroon. Trans R Soc Trop Med Hyg 2004; 98:284-9. [PMID: 15109551 DOI: 10.1016/s0035-9203(03)00068-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Revised: 09/29/2003] [Accepted: 10/01/2003] [Indexed: 10/26/2022] Open
Abstract
To investigate relationships between Plasmodium falciparum parasitaemia, parasite genotypes, and specific anti-parasite antibodies, 244 school children (aged 4 to 16 years) were studied in April/May 2002, the peak malaria transmission season in Buea, Cameroon. Antibody reactivities were analysed by ELISA using an array of recombinant antigens representing different sequences from the polymorphic block 2 region of the merozoite surface protein 1 (MSP1), and the blood samples that were slide-positive for P. falciparum were genotyped for msp1 block 2 alleles. The prevalence of antibodies to the specific MSP1 block 2 antigens was significantly higher in children at one particular school (situated at the lowest altitude) compared to the others, although the prevalence of infection or particular parasite genotypes did not differ. Thus, at a population level, the prevalence of these antibodies does not simply reflect prevalence of parasites, but rather may be due to differences in the incidence of past infections. However, there were weak positive associations between specific antibody reactivity and the presence of the corresponding allele in the blood of individuals (statistically significant for the MAD20-type allele of block 2), indicating that antibody specificities are to some extent determined by current parasite infections.
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Affiliation(s)
- Helen K Kimbi
- Department of Life Sciences, University of Buea, P.O. Box 63 Buea, S.W.P., Cameroon.
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Polley SD, Tetteh KKA, Cavanagh DR, Pearce RJ, Lloyd JM, Bojang KA, Okenu DMN, Greenwood BM, McBride JS, Conway DJ. Repeat sequences in block 2 of Plasmodium falciparum merozoite surface protein 1 are targets of antibodies associated with protection from malaria. Infect Immun 2003; 71:1833-42. [PMID: 12654798 PMCID: PMC152097 DOI: 10.1128/iai.71.4.1833-1842.2003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human antibodies to the block 2 region of Plasmodium falciparum merozoite surface protein 1 (MSP1) are associated with a reduced prospective risk of clinical malaria. Block 2 is highly polymorphic, but all known alleles can be grouped into three major types. Two of these types (the K1-like and MAD20-like types) contain type-specific sequences (found in all alleles of a particular type) that flank polymorphic tripeptide repeats. These repeats contain both type-specific and subtype-specific sequences. To evaluate the antibody recognition of these parts of block 2, a new panel of six recombinant proteins was used (fused type-specific flanking sequences and two representative repeat sequences for each of the K1-like and MAD20-like types separately). Extensive testing of these antigens and full-length block 2 antigens showed that human serum immunoglobulin G antibodies induced by infection can recognize (i) type-specific epitopes in the repeats, (ii) subtype-specific epitopes in the repeats, or (iii) type-specific epitopes in flanking sequences. A large prospective study in The Gambia showed that antibodies to the repeats are strongly associated with protection from clinical malaria. The results are important for design of a vaccine to induce protective antibodies, and they address hypotheses about repeat sequences in malaria antigens.
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Affiliation(s)
- Spencer D Polley
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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