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Alkema M, Smit MJ, Marin-Mogollon C, Totté K, Teelen K, van Gemert GJ, van de Vegte-Bolmer M, Mordmüller BG, Reimer JM, Lövgren-Bengtsson KL, Sauerwein RW, Bousema T, Plieskatt J, Theisen M, Jore MM, McCall MBB. A Pfs48/45-based vaccine to block Plasmodium falciparum transmission: phase 1, open-label, clinical trial. BMC Med 2024; 22:170. [PMID: 38649867 PMCID: PMC11036667 DOI: 10.1186/s12916-024-03379-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The stalling global progress in malaria control highlights the need for novel tools for malaria elimination, including transmission-blocking vaccines. Transmission-blocking vaccines aim to induce human antibodies that block parasite development in the mosquito and mosquitoes becoming infectious. The Pfs48/45 protein is a leading Plasmodium falciparum transmission-blocking vaccine candidate. The R0.6C fusion protein, consisting of Pfs48/45 domain 3 (6C) and the N-terminal region of P. falciparum glutamate-rich protein (R0), has previously been produced in Lactococcus lactis and elicited functional antibodies in rodents. Here, we assess the safety and transmission-reducing efficacy of R0.6C adsorbed to aluminium hydroxide with and without Matrix-M™ adjuvant in humans. METHODS In this first-in-human, open-label clinical trial, malaria-naïve adults, aged 18-55 years, were recruited at the Radboudumc in Nijmegen, the Netherlands. Participants received four intramuscular vaccinations on days 0, 28, 56 and 168 with either 30 µg or 100 µg of R0.6C and were randomised for the allocation of one of the two different adjuvant combinations: aluminium hydroxide alone, or aluminium hydroxide combined with Matrix-M1™ adjuvant. Adverse events were recorded from inclusion until 84 days after the fourth vaccination. Anti-R0.6C and anti-6C IgG titres were measured by enzyme-linked immunosorbent assay. Transmission-reducing activity of participants' serum and purified vaccine-specific immunoglobulin G was assessed by standard membrane feeding assays using laboratory-reared Anopheles stephensi mosquitoes and cultured P. falciparum gametocytes. RESULTS Thirty-one participants completed four vaccinations and were included in the analysis. Administration of all doses was safe and well-tolerated, with one related grade 3 adverse event (transient fever) and no serious adverse events occurring. Anti-R0.6C and anti-6C IgG titres were similar between the 30 and 100 µg R0.6C arms, but higher in Matrix-M1™ arms. Neat participant sera did not induce significant transmission-reducing activity in mosquito feeding experiments, but concentrated vaccine-specific IgGs purified from sera collected two weeks after the fourth vaccination achieved up to 99% transmission-reducing activity. CONCLUSIONS R0.6C/aluminium hydroxide with or without Matrix-M1™ is safe, immunogenic and induces functional Pfs48/45-specific transmission-blocking antibodies, albeit at insufficient serum concentrations to result in transmission reduction by neat serum. Future work should focus on identifying alternative vaccine formulations or regimens that enhance functional antibody responses. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov under identifier NCT04862416.
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Affiliation(s)
- M Alkema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M J Smit
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C Marin-Mogollon
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K Totté
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K Teelen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G J van Gemert
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M van de Vegte-Bolmer
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B G Mordmüller
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - R W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Present Address: TropIQ Health Sciences, Nijmegen, the Netherlands
| | - T Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J Plieskatt
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - M Theisen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - M M Jore
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M B B McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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de Jong GM, Yap XZ, Walk J, Dik WA, McCall MBB, van Genderen PJJ, van Hellemond JJ, Verbon A, Sauerwein RW. Baseline TGF-β correlates with protection after immunization with Plasmodium falciparum sporozoites in the Controlled Human Malaria Infection model. Immunol Lett 2023; 258:20-23. [PMID: 37075916 DOI: 10.1016/j.imlet.2023.04.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/31/2023] [Accepted: 04/15/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Here we assessed a possible relationship between baseline TGF-β concentrations and acquisition of sterile immunity after Plasmodium falciparum sporozoite immunization. METHODS TGF-β concentrations were determined in samples of 65 malaria-naive volunteers in 4 studies either prior to and after challenge infection, or prior to and after first immunizing infection under chemoprophylaxis with P. falciparum sporozoites. RESULTS High baseline TGF-β concentrations were associated with rapid acquisition of sterile protection (p=0.028). CONCLUSION Baseline TGF-β concentrations predict the efficiency of acquisition of sterile immunity following sporozoite immunisation and may represent a steady-state regulatory mechanism to keep in check immune systems with a low threshold for activation.
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Affiliation(s)
- G M de Jong
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, 6500HB, The Netherlands
| | - X Z Yap
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, 6500HB, The Netherlands
| | - J Walk
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, 6500HB, The Netherlands
| | - W A Dik
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC University Medical Center, Rotterdam, 3015GD, the Netherlands
| | - M B B McCall
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, 6500HB, The Netherlands
| | - P J J van Genderen
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, 3015 GD, The Netherlands
| | - J J van Hellemond
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, 3015 GD, The Netherlands
| | - A Verbon
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, 3015 GD, The Netherlands
| | - R W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, 6500HB, The Netherlands.
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McCall MBB, Sauerwein RW. [Development of vaccines against malaria; progress with contributions from the Netherlands]. Ned Tijdschr Geneeskd 2020; 164:D5270. [PMID: 33030326] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Five years ago, the very first malaria vaccine, RTS,S/AS01, received a positive evaluation by the European Medicines Agency. Although this vaccine does not achieve the WHO's target of 75% protection, it does set the standard for all new vaccine candidates. In this article, we describe the progress made in the development of several second-generation malaria vaccines, an area where Dutch research has made major contributions. These include vaccines with live, attenuated Plasmodium falciparumsporozoites and transmission-blocking vaccines. Thanks in part to Dutch contributions, the development of vaccines against malaria has recently made significant progress on the way to the finish line: a vaccine that provides protection to the most vulnerable population - young children in Africa.
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Affiliation(s)
- M B B McCall
- Radboudumc, afd. Medische Microbiologie, Nijmegen
- Contact: M.B.B. McCall
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McCall MBB, van Lith-Verhoeven JJC, van Crevel R, Crama N, Koopmans PP, Hoyng CB, van der Ven AJAM. Ocular syphilis acquired through oral sex in two HIV-infected patients. Neth J Med 2004; 62:206-8. [PMID: 15460502] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Two cases of ocular syphilis are described in HIV-infected individuals after unprotected oral sex. The primary syphilitic lesion remained unnoticed and lues was therefore only diagnosed after visual symptoms developed.
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Affiliation(s)
- M B B McCall
- Department of (General) Internal Medicine, University Medical Centre St Radboud, Nijmegen, the Netherlands
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