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Oulton T, Mahamar A, Sanogo K, Diallo M, Youssouf A, Niambele SM, Samaké S, Keita S, Sinaba Y, Sacko A, Traore SF, Lanke K, Collins KA, Bradley J, Drakeley C, Stone WJR, Dicko A. Persistence of Plasmodium falciparum HRP-2 antigenaemia after artemisinin combination therapy is not associated with gametocytes. Malar J 2022; 21:372. [PMID: 36474274 PMCID: PMC9724264 DOI: 10.1186/s12936-022-04387-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In some settings, sensitive field diagnostic tools may be needed to achieve elimination of falciparum malaria. To this end, rapid diagnostic tests (RDTs) based on the detection of the Plasmodium falciparum protein HRP-2 are being developed with increasingly lower limits of detection. However, it is currently unclear how parasite stages that are unaffected by standard drug treatments may contribute to HRP-2 detectability and potentially confound RDT results even after clearance of blood stage infection. This study assessed the detectability of HRP-2 in periods of post-treatment residual gametocytaemia. METHODS A cohort of 100 P. falciparum infected, gametocyte positive individuals were treated with or without the gametocytocidal drug primaquine (PQ), alongside standard artemisinin-based combination therapy (ACT), in the context of a randomised clinical trial in Ouelessebougou, Mali. A quantitative ELISA was used to measure levels of HRP-2, and compared time to test negativity using a standard and ultra-sensitive RDT (uRDT) between residual gametocyte positive and negative groups. RESULTS Time to test negativity was longest by uRDT, followed by ELISA and then standard RDT. No significant difference in time to negativity was found between the treatment groups with and without residual gametocytes: uRDT (HR 0.79 [95% CI 0.52-1.21], p = 0.28), RDT (HR 0.77 [95% CI 0.51-1.15], p = 0.20) or ELISA (HR 0.88 [95% CI 0.59-1.32], p = 0.53). Similarly, no difference was observed when adjusting for baseline asexual parasite density. Quantified levels of HRP-2 over time were similar between groups, with differences attributable to asexual parasite densities. Furthermore, no difference in levels of HRP-2 was found between individuals who were or were not infectious to mosquitoes (OR 1.19 [95% CI 0.98-1.46], p = 0.077). CONCLUSIONS Surviving sexual stage parasites after standard ACT treatment do not contribute to the persistence of HRP-2 antigenaemia, and appear to have little impact on RDT results.
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Affiliation(s)
- Tate Oulton
- grid.8991.90000 0004 0425 469XDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Almahamoudou Mahamar
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Koualy Sanogo
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Makonon Diallo
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Ahamadou Youssouf
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi M. Niambele
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Siaka Samaké
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Youssouf Sinaba
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Sacko
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou F. Traore
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Kjerstin Lanke
- grid.10417.330000 0004 0444 9382Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Katharine A. Collins
- grid.10417.330000 0004 0444 9382Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - John Bradley
- grid.8991.90000 0004 0425 469XMRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Drakeley
- grid.8991.90000 0004 0425 469XDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Will J. R. Stone
- grid.8991.90000 0004 0425 469XDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alassane Dicko
- grid.461088.30000 0004 0567 336XMalaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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2
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Stepniewska K, Allen EN, Humphreys GS, Poirot E, Craig E, Kennon K, Yilma D, Bousema T, Guerin PJ, White NJ, Price RN, Raman J, Martensson A, Mwaiswelo RO, Bancone G, Bastiaens GJH, Bjorkman A, Brown JM, D'Alessandro U, Dicko AA, El-Sayed B, Elzaki SE, Eziefula AC, Gonçalves BP, Hamid MMA, Kaneko A, Kariuki S, Khan W, Kwambai TK, Ley B, Ngasala BE, Nosten F, Okebe J, Samuels AM, Smit MR, Stone WJR, Sutanto I, Ter Kuile F, Tine RC, Tiono AB, Drakeley CJ, Gosling R, Stergachis A, Barnes KI, Chen I. Safety of single-dose primaquine as a Plasmodium falciparum gametocytocide: a systematic review and meta-analysis of individual patient data. BMC Med 2022; 20:350. [PMID: 36109733 PMCID: PMC9479278 DOI: 10.1186/s12916-022-02504-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/04/2022] [Accepted: 07/29/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In 2012, the World Health Organization (WHO) recommended single low-dose (SLD, 0.25 mg/kg) primaquine to be added as a Plasmodium (P.) falciparum gametocytocide to artemisinin-based combination therapy (ACT) without glucose-6-phosphate dehydrogenase (G6PD) testing, to accelerate malaria elimination efforts and avoid the spread of artemisinin resistance. Uptake of this recommendation has been relatively slow primarily due to safety concerns. METHODS A systematic review and individual patient data (IPD) meta-analysis of single-dose (SD) primaquine studies for P. falciparum malaria were performed. Absolute and fractional changes in haemoglobin concentration within a week and adverse effects within 28 days of treatment initiation were characterised and compared between primaquine and no primaquine arms using random intercept models. RESULTS Data comprised 20 studies that enrolled 6406 participants, of whom 5129 (80.1%) had received a single target dose of primaquine ranging between 0.0625 and 0.75 mg/kg. There was no effect of primaquine in G6PD-normal participants on haemoglobin concentrations. However, among 194 G6PD-deficient African participants, a 0.25 mg/kg primaquine target dose resulted in an additional 0.53 g/dL (95% CI 0.17-0.89) reduction in haemoglobin concentration by day 7, with a 0.27 (95% CI 0.19-0.34) g/dL haemoglobin drop estimated for every 0.1 mg/kg increase in primaquine dose. Baseline haemoglobin, young age, and hyperparasitaemia were the main determinants of becoming anaemic (Hb < 10 g/dL), with the nadir observed on ACT day 2 or 3, regardless of G6PD status and exposure to primaquine. Time to recovery from anaemia took longer in young children and those with baseline anaemia or hyperparasitaemia. Serious adverse haematological events after primaquine were few (9/3, 113, 0.3%) and transitory. One blood transfusion was reported in the primaquine arms, and there were no primaquine-related deaths. In controlled studies, the proportions with either haematological or any serious adverse event were similar between primaquine and no primaquine arms. CONCLUSIONS Our results support the WHO recommendation to use 0.25 mg/kg of primaquine as a P. falciparum gametocytocide, including in G6PD-deficient individuals. Although primaquine is associated with a transient reduction in haemoglobin levels in G6PD-deficient individuals, haemoglobin levels at clinical presentation are the major determinants of anaemia in these patients. TRIAL REGISTRATION PROSPERO, CRD42019128185.
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Affiliation(s)
- Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, UK.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Elizabeth N Allen
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | - Eugenie Poirot
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
| | - Elaine Craig
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Kalynn Kennon
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Daniel Yilma
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Jimma University Clinical Trial Unit, Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Teun Bousema
- Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, UK
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Jaishree Raman
- Parasitology Reference Laboratory, National Institute for Communicable Diseases, A Division of the National Health Laboratory Services, Johannesburg, South Africa
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Andreas Martensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Richard O Mwaiswelo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Microbiology, Immunology and Parasitology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Germana Bancone
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Guido J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Anders Bjorkman
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Joelle M Brown
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Umberto D'Alessandro
- Medical Research Council Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Alassane A Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
| | - Badria El-Sayed
- Department of Epidemiology, Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Salah-Eldin Elzaki
- Department of Epidemiology, Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Alice C Eziefula
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Bronner P Gonçalves
- Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Akira Kaneko
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI), Kisian, Kenya
| | - Wasif Khan
- Infectious Disease Division, International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Titus K Kwambai
- Centers for Disease Control and Prevention, Department of Parasitic Diseases and Malaria, Kisumu, Kenya
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Billy E Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Joseph Okebe
- Disease Control & Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Aaron M Samuels
- Centers for Disease Control and Prevention, Department of Parasitic Diseases and Malaria, Kisumu, Kenya
| | - Menno R Smit
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Will J R Stone
- Department of Infection and Immunity, London School of Hygiene and Tropical Medicine, London, UK
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge Sutanto
- Department of Parasitology, Faculty of Medicine, University of Indonesia, Depok City, Indonesia
| | | | - Roger C Tine
- Department of Medical Parasitology, Faculty of Medicine, University Cheikh Anta Diop, Dakar, Senegal
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Chris J Drakeley
- Department of Infection Biology, London School of Tropical Medicine and Hygiene, London, UK
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Andy Stergachis
- Departments of Pharmacy & Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, USA
| | - Karen I Barnes
- WorldWide Antimalarial Resistance Network, Oxford, UK
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ingrid Chen
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
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3
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de Jong RM, Singh SK, Teelen K, van de Vegte-Bolmer M, van Gemert GJ, Stone WJR, Locke E, Plieskatt J, Theisen M, Bousema T, Jore MM. Heterologous Expression and Evaluation of Novel Plasmodium falciparum Transmission Blocking Vaccine Candidates. Front Immunol 2022; 13:909060. [PMID: 35812379 PMCID: PMC9259988 DOI: 10.3389/fimmu.2022.909060] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022] Open
Abstract
Malaria transmission blocking vaccines (TBV) aim to induce antibodies that can interrupt Plasmodium falciparum development in the mosquito midgut and thereby prevent onward malaria transmission. A limited number of TBV candidates have been identified and only three (Pfs25, Pfs230 and Pfs48/45) have entered clinical testing. While one of these candidates may emerge as a highly potent TBV candidate, it is premature to determine if they will generate sufficiently potent and sustained responses. It is therefore important to explore novel candidate antigens. We recently analyzed sera from naturally exposed individuals and found that the presence and/or intensity of antibodies against 12 novel putative surface expressed gametocyte antigens was associated with transmission reducing activity. In this study, protein fragments of these novel TBV candidates were designed and heterologously expressed in Drosophila melanogaster S2 cells and Lactococcus lactis. Eleven protein fragments, covering seven TBV candidates, were successfully produced. All tested antigens were recognized by antibodies from individuals living in malaria-endemic areas, indicating that native epitopes are present. All antigens induced antigen-specific antibody responses in mice. Two antigens induced antibodies that recognized a native protein in gametocyte extract, and antibodies elicited by four antigens recognized whole gametocytes. In particular, we found that antigen Pf3D7_0305300, a putative transporter, is abundantly expressed on the surface of gametocytes. However, none of the seven novel TBV candidates expressed here induced an antibody response that reduced parasite development in the mosquito midgut as assessed in the standard membrane feeding assay. Altogether, the antigen fragments used in this study did not prove to be promising transmission blocking vaccine constructs, but led to the identification of two gametocyte surface proteins that may provide new leads for studying gametocyte biology.
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Affiliation(s)
- Roos M. de Jong
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Susheel K. Singh
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Karina Teelen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Geert-Jan van Gemert
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Will J. R. Stone
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emily Locke
- PATH‘s Malaria Vaccine Initiative, Washington, DC, United States
| | - Jordan Plieskatt
- PATH‘s Malaria Vaccine Initiative, Washington, DC, United States
| | - Michael Theisen
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Matthijs M. Jore
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Matthijs M. Jore,
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4
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Stepniewska K, Humphreys GS, Gonçalves BP, Craig E, Gosling R, Guerin PJ, Price RN, Barnes KI, Raman J, Smit MR, D’Alessandro U, Stone WJR, Bjorkman A, Samuels AM, Arroyo-Arroyo MI, Bastiaens GJH, Brown JM, Dicko A, El-Sayed BB, Elzaki SEG, Eziefula AC, Kariuki S, Kwambai TK, Maestre AE, Martensson A, Mosha D, Mwaiswelo RO, Ngasala BE, Okebe J, Roh ME, Sawa P, Tiono AB, Chen I, Drakeley CJ, Bousema T. Efficacy of Single-Dose Primaquine With Artemisinin Combination Therapy on Plasmodium falciparum Gametocytes and Transmission: An Individual Patient Meta-Analysis. J Infect Dis 2020; 225:1215-1226. [PMID: 32778875 PMCID: PMC8974839 DOI: 10.1093/infdis/jiaa498] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Since the World Health Organization recommended single low-dose (0.25 mg/kg) primaquine (PQ) in combination with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant Plasmodium falciparum, several single-site studies have been conducted to assess efficacy. METHODS An individual patient meta-analysis to assess gametocytocidal and transmission-blocking efficacy of PQ in combination with different ACTs was conducted. Random effects logistic regression was used to quantify PQ effect on (1) gametocyte carriage in the first 2 weeks post treatment; and (2) the probability of infecting at least 1 mosquito or of a mosquito becoming infected. RESULTS In 2574 participants from 14 studies, PQ reduced PCR-determined gametocyte carriage on days 7 and 14, most apparently in patients presenting with gametocytemia on day 0 (odds ratio [OR], 0.22; 95% confidence interval [CI], .17-.28 and OR, 0.12; 95% CI, .08-.16, respectively). Rate of decline in gametocyte carriage was faster when PQ was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) (P = .010 for day 7). Addition of 0.25 mg/kg PQ was associated with near complete prevention of transmission to mosquitoes. CONCLUSIONS Transmission blocking is achieved with 0.25 mg/kg PQ. Gametocyte persistence and infectivity are lower when PQ is combined with AL compared to DP.
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Affiliation(s)
- Kasia Stepniewska
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom,Kasia Stepniewska, PhD, WorldWide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine and Global Health, Churchill Hospital, CCVTM, University of Oxford, Old Road, Oxford OX3 7LE, UK
| | - Georgina S Humphreys
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom,Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elaine Craig
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Roly Gosling
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Philippe J Guerin
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Infectious Diseases Data Observatory, Oxford, United Kingdom
| | - Ric N Price
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom,Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Norther Territory, Australia,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Karen I Barnes
- WorldWide Antimalarial Resistance Network, Oxford, United Kingdom,University of Cape Town/Medical Research Council Collaborating Centre for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa,Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jaishree Raman
- University of Cape Town/Medical Research Council Collaborating Centre for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa,Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa,Wits Research Institute for Malaria, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Menno R Smit
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Will J R Stone
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anders Bjorkman
- Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Aaron M Samuels
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Maria I Arroyo-Arroyo
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Guido J H Bastiaens
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Joelle M Brown
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Badria B El-Sayed
- Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Salah-Eldin G Elzaki
- Tropical Medicine Research Institute, National Centre for Research, Khartoum, Sudan
| | - Alice C Eziefula
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Titus K Kwambai
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom,Kenya Medical Research Institute, Kisian, Kenya
| | - Amanda E Maestre
- Grupo Salud y Comunidad, Facultad de Medicina, Universidad de Antioquia, Medellin, Colombia
| | - Andreas Martensson
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Dominic Mosha
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, Tanzania,Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Richard O Mwaiswelo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Billy E Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle E Roh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA,Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Patrick Sawa
- Human Health Division, International Centre for Insect Physiology and Ecology, Mbita Point, Kenya
| | - Alfred B Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Ingrid Chen
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, California, USA
| | - Chris J Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands,Correspondence: Teun Bousema, PhD, Department of Medical Microbiology, Radboud Institute for Health Science, Radboudumc, PO Box 9101, 6500 HB Nijmegen, The Netherlands ()
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5
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Dantzler KW, Ma S, Ngotho P, Stone WJR, Tao D, Rijpma S, De Niz M, Nilsson Bark SK, Jore MM, Raaijmakers TK, Early AM, Ubaida-Mohien C, Lemgruber L, Campo JJ, Teng AA, Le TQ, Walker CL, Hermand P, Deterre P, Davies DH, Felgner P, Morlais I, Wirth DF, Neafsey DE, Dinglasan RR, Laufer M, Huttenhower C, Seydel K, Taylor T, Bousema T, Marti M. Naturally acquired immunity against immature Plasmodium falciparum gametocytes. Sci Transl Med 2020; 11:11/495/eaav3963. [PMID: 31167926 DOI: 10.1126/scitranslmed.aav3963] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/05/2019] [Indexed: 12/11/2022]
Abstract
The recent decline in global malaria burden has stimulated efforts toward Plasmodium falciparum elimination. Understanding the biology of malaria transmission stages may provide opportunities to reduce or prevent onward transmission to mosquitoes. Immature P. falciparum transmission stages, termed stages I to IV gametocytes, sequester in human bone marrow before release into the circulation as mature stage V gametocytes. This process likely involves interactions between host receptors and potentially immunogenic adhesins on the infected red blood cell (iRBC) surface. Here, we developed a flow cytometry assay to examine immune recognition of live gametocytes of different developmental stages by naturally exposed Malawians. We identified strong antibody recognition of the earliest immature gametocyte-iRBCs (giRBCs) but not mature stage V giRBCs. Candidate surface antigens (n = 30), most of them shared between asexual- and gametocyte-iRBCs, were identified by mass spectrometry and mouse immunizations, as well as correlations between responses by protein microarray and flow cytometry. Naturally acquired responses to a subset of candidate antigens were associated with reduced asexual and gametocyte density, and plasma samples from malaria-infected individuals were able to induce immune clearance of giRBCs in vitro. Infected RBC surface expression of select candidate antigens was validated using specific antibodies, and genetic analysis revealed a subset with minimal variation across strains. Our data demonstrate that humoral immune responses to immature giRBCs and shared iRBC antigens are naturally acquired after malaria exposure. These humoral immune responses may have consequences for malaria transmission potential by clearing developing gametocytes, which could be leveraged for malaria intervention.
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Affiliation(s)
- Kathleen W Dantzler
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Siyuan Ma
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Priscilla Ngotho
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Will J R Stone
- Radboud Institute for Health Sciences, Radboud University Medical Center, Netherlands.,Immunology and Infection Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Dingyin Tao
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and the Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD, USA
| | - Sanna Rijpma
- Radboud Institute for Health Sciences, Radboud University Medical Center, Netherlands
| | - Mariana De Niz
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Sandra K Nilsson Bark
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Matthijs M Jore
- Radboud Institute for Health Sciences, Radboud University Medical Center, Netherlands
| | - Tonke K Raaijmakers
- Radboud Institute for Health Sciences, Radboud University Medical Center, Netherlands
| | | | | | - Leandro Lemgruber
- Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Patricia Hermand
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), UMR 1135, ERL CNRS 8255, F-75013 Paris, France
| | - Philippe Deterre
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), UMR 1135, ERL CNRS 8255, F-75013 Paris, France
| | - D Huw Davies
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, CA, USA
| | - Phil Felgner
- Division of Infectious Diseases, Department of Medicine, University of California, Irvine, CA, USA
| | - Isabelle Morlais
- UMR MIVEGEC UM1-CNRS 5290-IRD 224, Institut de Recherche pour le Développement, Montpellier Cedex, France
| | - Dyann F Wirth
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Rhoel R Dinglasan
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and the Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Emerging Pathogens Institute, Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
| | - Miriam Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karl Seydel
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Terrie Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, Netherlands. .,Immunology and Infection Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthias Marti
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Wellcome Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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6
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Dicko A, Roh ME, Diawara H, Mahamar A, Soumare HM, Lanke K, Bradley J, Sanogo K, Kone DT, Diarra K, Keita S, Issiaka D, Traore SF, McCulloch C, Stone WJR, Hwang J, Müller O, Brown JM, Srinivasan V, Drakeley C, Gosling R, Chen I, Bousema T. Efficacy and safety of primaquine and methylene blue for prevention of Plasmodium falciparum transmission in Mali: a phase 2, single-blind, randomised controlled trial. Lancet Infect Dis 2018; 18:627-639. [PMID: 29422384 PMCID: PMC5968371 DOI: 10.1016/s1473-3099(18)30044-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/10/2017] [Accepted: 12/01/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Primaquine and methylene blue are gametocytocidal compounds that could prevent Plasmodium falciparum transmission to mosquitoes. We aimed to assess the efficacy and safety of primaquine and methylene blue in preventing human to mosquito transmission of P falciparum among glucose-6-phosphate dehydrogenase (G6PD)-normal, gametocytaemic male participants. METHODS This was a phase 2, single-blind, randomised controlled trial done at the Clinical Research Centre of the Malaria Research and Training Centre (MRTC) of the University of Bamako (Bamako, Mali). We enrolled male participants aged 5-50 years with asymptomatic P falciparum malaria. G6PD-normal participants with gametocytes detected by blood smear were randomised 1:1:1:1 in block sizes of eight, using a sealed-envelope design, to receive either sulfadoxine-pyrimethamine and amodiaquine, sulfadoxine-pyrimethamine and amodiaquine plus a single dose of 0·25 mg/kg primaquine, dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus 15 mg/kg per day methylene blue for 3 days. Laboratory staff, investigators, and insectary technicians were masked to the treatment group and gametocyte density of study participants. The study pharmacist and treating physician were not masked. Participants could request unmasking. The primary efficacy endpoint, analysed in all infected patients with at least one infectivity measure before and after treatment, was median within-person percentage change in mosquito infectivity 2 and 7 days after treatment, assessed by membrane feeding. This study is registered with ClinicalTrials.gov, number NCT02831023. FINDINGS Between June 27, 2016, and Nov 1, 2016, 80 participants were enrolled and assigned to the sulfadoxine-pyrimethamine and amodiaquine (n=20), sulfadoxine-pyrimethamine and amodiaquine plus primaquine (n=20), dihydroartemisinin-piperaquine (n=20), or dihydroartemisinin-piperaquine plus methylene blue (n=20) groups. Among participants infectious at baseline (54 [68%] of 80), those in the sulfadoxine-pyrimethamine and amodiaquine plus primaquine group (n=19) had a median 100% (IQR 100 to 100) within-person reduction in mosquito infectivity on day 2, a larger reduction than was noted with sulfadoxine-pyrimethamine and amodiaquine alone (n=12; -10·2%, IQR -143·9 to 56·6; p<0·0001). The dihydroartemisinin-piperaquine plus methylene blue (n=11) group had a median 100% (IQR 100 to 100) within-person reduction in mosquito infectivity on day 2, a larger reduction than was noted with dihydroartemisinin-piperaquine alone (n=12; -6·0%, IQR -126·1 to 86·9; p<0·0001). Haemoglobin changes were similar between gametocytocidal arms and their respective controls. After exclusion of blue urine, adverse events were similar across all groups (59 [74%] of 80 participants had 162 adverse events overall, 145 [90%] of which were mild). INTERPRETATION Adding a single dose of 0·25 mg/kg primaquine to sulfadoxine-pyrimethamine and amodiaquine or 3 days of 15 mg/kg per day methylene blue to dihydroartemisinin-piperaquine was highly efficacious for preventing P falciparum transmission. Both primaquine and methylene blue were well tolerated. FUNDING Bill & Melinda Gates Foundation, European Research Council.
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Affiliation(s)
- Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Michelle E Roh
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Halimatou Diawara
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Almahamoudou Mahamar
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Harouna M Soumare
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Kjerstin Lanke
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - John Bradley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Koualy Sanogo
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Daouda T Kone
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Kalifa Diarra
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Djibrilla Issiaka
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Sekou F Traore
- Malaria Research and Training Centre, Faculty of Pharmacy, Medicine, and Dentistry, University of Science, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Will J R Stone
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Jimee Hwang
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, CA, USA; President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Olaf Müller
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Joelle M Brown
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Vinay Srinivasan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - Roly Gosling
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Ingrid Chen
- Global Health Group, Malaria Elimination Initiative, University of California, San Francisco, CA, USA
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands; Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
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7
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Stone WJR, Campo JJ, Ouédraogo AL, Meerstein-Kessel L, Morlais I, Da D, Cohuet A, Nsango S, Sutherland CJ, van de Vegte-Bolmer M, Siebelink-Stoter R, van Gemert GJ, Graumans W, Lanke K, Shandling AD, Pablo JV, Teng AA, Jones S, de Jong RM, Fabra-García A, Bradley J, Roeffen W, Lasonder E, Gremo G, Schwarzer E, Janse CJ, Singh SK, Theisen M, Felgner P, Marti M, Drakeley C, Sauerwein R, Bousema T, Jore MM. Publisher Correction: Unravelling the immune signature of Plasmodium falciparum transmission-reducing immunity. Nat Commun 2018; 9:1498. [PMID: 29643330 PMCID: PMC5895811 DOI: 10.1038/s41467-018-03769-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Will J R Stone
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
| | | | | | - Lisette Meerstein-Kessel
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Isabelle Morlais
- Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaoundé, Cameroon.,Institut de Recherche pour le Développement, MIVEGEC (IRD, CNRS, Univ. Montpellier), 911 Avenue Agropolis, 34394, Montpellier, France
| | - Dari Da
- Institut de Recherche en Sciences de la Santé, 399 Avenue de la Liberté, 01 BP 545, Bobo-Dioulasso, Burkina Faso
| | - Anna Cohuet
- Institut de Recherche pour le Développement, MIVEGEC (IRD, CNRS, Univ. Montpellier), 911 Avenue Agropolis, 34394, Montpellier, France.,Institut de Recherche en Sciences de la Santé, 399 Avenue de la Liberté, 01 BP 545, Bobo-Dioulasso, Burkina Faso
| | - Sandrine Nsango
- Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaoundé, Cameroon.,Faculty of Medecine and Pharmaceutical Science, PO Box 2701, Douala, Cameroon
| | - Colin J Sutherland
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Marga van de Vegte-Bolmer
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rianne Siebelink-Stoter
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Geert-Jan van Gemert
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Wouter Graumans
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kjerstin Lanke
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | | - Andy A Teng
- Antigen Discovery Inc., 92618, Irvine, CA, USA
| | - Sophie Jones
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Roos M de Jong
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Amanda Fabra-García
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - John Bradley
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Will Roeffen
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Edwin Lasonder
- School of Biomedical and Healthcare Sciences, Plymouth University, Drakes Circus, PL4 8AA, Plymouth, UK
| | - Giuliana Gremo
- Department of Oncology, University of Torino, Via Santena 5bis, 10126, Torino, Italy
| | - Evelin Schwarzer
- Department of Oncology, University of Torino, Via Santena 5bis, 10126, Torino, Italy
| | - Chris J Janse
- Department of Parasitology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Susheel K Singh
- Department for Congenital Diseases, Statens Serum Institut, DK 2300, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK 2200, Copenhagen, Denmark
| | - Michael Theisen
- Department for Congenital Diseases, Statens Serum Institut, DK 2300, Copenhagen, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK 2200, Copenhagen, Denmark
| | - Phil Felgner
- Department of Medicine, University of California Irvine, 92697, Irvine, CA, USA
| | - Matthias Marti
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, 02115, Boston, MA, USA.,Wellcome Center for Molecular Parasitology, University of Glasgow, G12 8TA, Glasgow, UK
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - Robert Sauerwein
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
| | - Matthijs M Jore
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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8
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Stone WJR, Campo JJ, Ouédraogo AL, Meerstein-Kessel L, Morlais I, Da D, Cohuet A, Nsango S, Sutherland CJ, van de Vegte-Bolmer M, Siebelink-Stoter R, van Gemert GJ, Graumans W, Lanke K, Shandling AD, Pablo JV, Teng AA, Jones S, de Jong RM, Fabra-García A, Bradley J, Roeffen W, Lasonder E, Gremo G, Schwarzer E, Janse CJ, Singh SK, Theisen M, Felgner P, Marti M, Drakeley C, Sauerwein R, Bousema T, Jore MM. Unravelling the immune signature of Plasmodium falciparum transmission-reducing immunity. Nat Commun 2018; 9:558. [PMID: 29422648 PMCID: PMC5805765 DOI: 10.1038/s41467-017-02646-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 06/09/2017] [Accepted: 12/15/2017] [Indexed: 02/02/2023] Open
Abstract
Infection with Plasmodium can elicit antibodies that inhibit parasite survival in the mosquito, when they are ingested in an infectious blood meal. Here, we determine the transmission-reducing activity (TRA) of naturally acquired antibodies from 648 malaria-exposed individuals using lab-based mosquito-feeding assays. Transmission inhibition is significantly associated with antibody responses to Pfs48/45, Pfs230, and to 43 novel gametocyte proteins assessed by protein microarray. In field-based mosquito-feeding assays the likelihood and rate of mosquito infection are significantly lower for individuals reactive to Pfs48/45, Pfs230 or to combinations of the novel TRA-associated proteins. We also show that naturally acquired purified antibodies against key transmission-blocking epitopes of Pfs48/45 and Pfs230 are mechanistically involved in TRA, whereas sera depleted of these antibodies retain high-level, complement-independent TRA. Our analysis demonstrates that host antibody responses to gametocyte proteins are associated with reduced malaria transmission efficiency from humans to mosquitoes.
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Affiliation(s)
- Will J R Stone
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | | | - Lisette Meerstein-Kessel
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Isabelle Morlais
- Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaoundé, Cameroon.,Institut de Recherche pour le Développement, MIVEGEC (IRD, CNRS, Univ. Montpellier), 911 Avenue Agropolis, 34394, Montpellier, France
| | - Dari Da
- Institut de Recherche en Sciences de la Santé, 399 Avenue de la Liberté, 01 BP 545, Bobo-Dioulasso, Burkina Faso
| | - Anna Cohuet
- Institut de Recherche pour le Développement, MIVEGEC (IRD, CNRS, Univ. Montpellier), 911 Avenue Agropolis, 34394, Montpellier, France.,Institut de Recherche en Sciences de la Santé, 399 Avenue de la Liberté, 01 BP 545, Bobo-Dioulasso, Burkina Faso
| | - Sandrine Nsango
- Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale, BP 288, Yaoundé, Cameroon.,Faculty of Medecine and Pharmaceutical Science, PO Box 2701, Douala, Cameroon
| | - Colin J Sutherland
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Marga van de Vegte-Bolmer
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rianne Siebelink-Stoter
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Geert-Jan van Gemert
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Wouter Graumans
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kjerstin Lanke
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | | - Andy A Teng
- Antigen Discovery Inc., Irvine, CA, 92618, USA
| | - Sophie Jones
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Roos M de Jong
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Amanda Fabra-García
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - John Bradley
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Will Roeffen
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Edwin Lasonder
- School of Biomedical and Healthcare Sciences, Plymouth University, Drakes Circus, Plymouth, PL4 8AA, UK
| | - Giuliana Gremo
- Department of Oncology, University of Torino, Via Santena 5bis, 10126, Torino, Italy
| | - Evelin Schwarzer
- Department of Oncology, University of Torino, Via Santena 5bis, 10126, Torino, Italy
| | - Chris J Janse
- Department of Parasitology, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Susheel K Singh
- Department for Congenital Diseases, Statens Serum Institut, Copenhagen, DK 2300, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DK 2200, Denmark
| | - Michael Theisen
- Department for Congenital Diseases, Statens Serum Institut, Copenhagen, DK 2300, Denmark.,Centre for Medical Parasitology at Department of International Health, Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, DK 2200, Denmark
| | - Phil Felgner
- Department of Medicine, University of California Irvine, Irvine, CA, 92697, USA
| | - Matthias Marti
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, 02115, USA.,Wellcome Center for Molecular Parasitology, University of Glasgow, Glasgow, G12 8TA, UK
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Robert Sauerwein
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Teun Bousema
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Matthijs M Jore
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Miura K, Stone WJR, Koolen KM, Deng B, Zhou L, van Gemert GJ, Locke E, Morin M, Bousema T, Sauerwein RW, Long CA, Dechering KJ. An inter-laboratory comparison of standard membrane-feeding assays for evaluation of malaria transmission-blocking vaccines. Malar J 2016; 15:463. [PMID: 27612458 PMCID: PMC5016893 DOI: 10.1186/s12936-016-1515-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 06/30/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An effective malaria transmission-blocking vaccine may play an important role in malaria elimination efforts, and a robust biological assay is essential for its development. The standard membrane-feeding assay (SMFA) for Plasmodium falciparum infection of mosquitoes is considered a "gold standard" assay to measure transmission-blocking activity of test antibodies, and has been utilized widely in both non-clinical and clinical studies. While several studies have discussed the inherent variability of SMFA within a study group, there has been no assessment of inter-laboratory variation. Therefore, there is currently no assurance that SMFA results are comparable between different studies. METHODS Mouse anti-Pfs25 monoclonal antibody (mAb, 4B7 mAb), rat anti-Pfs48/45 mAb (85RF45.1 mAb) and a human polyclonal antibody (pAb) collected from a malaria-exposed adult were tested at the same concentrations (6-94 μg/mL for 4B7, 1.2-31.3 μg/mL for 85RF45.1 and 23-630 μg/mL for human pAb) in two laboratories following their own standardized SMFA protocols. The mAbs and pAb, previously shown to have strong inhibition activities in the SMFA, were tested at three or four concentrations in two or three independent assays in each laboratory, and percent inhibition in mean oocyst intensity relative to a control in the same feed was determined in each feeding experiment. RESULTS Both monoclonal and polyclonal antibodies dose-dependently reduced oocyst intensity in all experiments performed at the two test sites. In both laboratories, the inter-assay variability in percent inhibition in oocyst intensity decreased at higher levels of inhibition, regardless of which antibody was tested. At antibody concentrations that led to a >80 % reduction in oocyst numbers, the inter-laboratory variations were in the same range compared with the inter-assay variation observed within a single laboratory, and the differences in best estimates from multiple feeds between the two laboratories were <5 percentage points. CONCLUSIONS This study confirms previous reports that the precision of the SMFA increases with increasing percent inhibition. Moreover, the variation between the two laboratories is not greater than the variation observed within a laboratory. The findings of this study provide guidance for comparison of SMFA data from different laboratories.
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Affiliation(s)
- Kazutoyo Miura
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 12735 Twinbrook Parkway, Rockville, MD, USA.
| | - Will J R Stone
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Karin M Koolen
- TropIQ Health Science, Transistorweg 5, 6534 AT, Nijmegen, The Netherlands
| | - Bingbing Deng
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 12735 Twinbrook Parkway, Rockville, MD, USA
| | - Luwen Zhou
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 12735 Twinbrook Parkway, Rockville, MD, USA
| | - Geert-Jan van Gemert
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Emily Locke
- PATH Malaria Vaccine Initiative, 455 Massachusetts Avenue NW, Washington, DC, 20001, USA
| | - Merribeth Morin
- PATH Malaria Vaccine Initiative, 455 Massachusetts Avenue NW, Washington, DC, 20001, USA
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Nijmegen Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Carole A Long
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 12735 Twinbrook Parkway, Rockville, MD, USA
| | - Koen J Dechering
- TropIQ Health Science, Transistorweg 5, 6534 AT, Nijmegen, The Netherlands.
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Abstract
In preclinical development, the efficacy of agents with putative effects on Plasmodium transmission is determined using the standard membrane feeding assay (SMFA). Because the end-point of the SMFA is normally the enumeration of oocysts on the mosquito midgut, the assays reliance on mosquito dissections and microscopy makes it slow, labor-intensive, and subjective. Below, we describe a novel method of assessing the transmission of a Plasmodium falciparum strain expressing the firefly luciferase protein in the SMFA. The use of a transgenic parasite strain allows for the elimination of mosquito dissections in favor of a simple approach where whole mosquitoes are homogenized and examined directly for luciferase activity. Measuring the mean luminescence intensity of groups of individual or pooled mosquitoes provides comparable estimates of transmission reducing activity at 5-10-fold the throughput capacity of the standard microscopy based SMFA. This high efficiency protocol may be of interest to groups screening novel drug compounds, vaccine candidates, or sera from malaria exposed individuals for transmission reducing activity (TRA).
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Affiliation(s)
- Will J R Stone
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, GA 6525, The Netherlands
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, GA 6525, The Netherlands. .,Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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11
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Stone WJR, Churcher TS, Graumans W, van Gemert GJ, Vos MW, Lanke KHW, van de Vegte-Bolmer MG, Siebelink-Stoter R, Dechering KJ, Vaughan AM, Camargo N, Kappe SHI, Sauerwein RW, Bousema T. A scalable assessment of Plasmodium falciparum transmission in the standard membrane-feeding assay, using transgenic parasites expressing green fluorescent protein-luciferase. J Infect Dis 2014; 210:1456-63. [PMID: 24829466 DOI: 10.1093/infdis/jiu271] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The development of drugs and vaccines to reduce malaria transmission is an important part of eradication plans. The transmission-reducing activity (TRA) of these agents is currently determined in the standard membrane-feeding assay (SMFA), based on subjective microscopy-based readouts and with limitations in upscaling and throughput. METHODS Using a Plasmodium falciparum strain expressing the firefly luciferase protein, we present a luminescence-based approach to SMFA evaluation that eliminates the requirement for mosquito dissections in favor of a simple approach in which whole mosquitoes are homogenized and examined directly for luciferase activity. RESULTS Analysis of 6860 Anopheles stephensi mosquitoes across 68 experimental feeds shows that the luminescence assay was as sensitive as microscopy for infection detection. The mean luminescence intensity of individual and pooled mosquitoes accurately quantifies mean oocyst intensity and generates comparable TRA estimates. The luminescence assay presented here could increase SMFA throughput so that 10-30 experimental feeds could be evaluated in a single 96-well plate. CONCLUSIONS This new method of assessing Plasmodium infection and transmission intensity could expedite the screening of novel drug compounds, vaccine candidates, and sera from malaria-exposed individuals for TRA. Luminescence-based estimates of oocyst intensity in individual mosquitoes should be interpreted with caution.
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Affiliation(s)
- Will J R Stone
- Department of Medical Microbiology, Radboud University Medical Center
| | - Thomas S Churcher
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London
| | - Wouter Graumans
- Department of Medical Microbiology, Radboud University Medical Center
| | | | - Martijn W Vos
- Department of Medical Microbiology, Radboud University Medical Center TropIQ Health Sciences, Nijmegen, the Netherlands
| | | | | | | | | | | | | | - Stefan H I Kappe
- Seattle Biomedical Research Institute Department of Global Health, University of Washington, Seattle
| | - Robert W Sauerwein
- Department of Medical Microbiology, Radboud University Medical Center TropIQ Health Sciences, Nijmegen, the Netherlands
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Center Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
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Stone WJR, Eldering M, van Gemert GJ, Lanke KHW, Grignard L, van de Vegte-Bolmer MG, Siebelink-Stoter R, Graumans W, Roeffen WFG, Drakeley CJ, Sauerwein RW, Bousema T. The relevance and applicability of oocyst prevalence as a read-out for mosquito feeding assays. Sci Rep 2013; 3:3418. [PMID: 24301557 PMCID: PMC4894383 DOI: 10.1038/srep03418] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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: 09/12/2013] [Accepted: 11/20/2013] [Indexed: 12/02/2022] Open
Abstract
Mosquito feeding assays are important in evaluations of malaria transmission-reducing interventions. The proportion of mosquitoes with midgut oocysts is commonly used as an outcome measure, but in natural low intensity infections the effect of oocyst non-rupture on mosquito infectivity is unclear. By identifying ruptured as well as intact oocysts, we show that in low intensity P. falciparum infections i) 66.7–96.7% of infected mosquitoes experienced oocyst rupture between 11–21 days post-infection, ii) oocyst rupture led invariably to sporozoite release, iii) oocyst rupture led to salivary gland infections in 97.8% of mosquitoes, and iv) 1250 (IQR 313-2400) salivary gland sporozoites were found per ruptured oocyst. These data show that infectivity can be predicted with reasonable certainty from oocyst prevalence in low intensity infections. High throughput methods for detecting infection in whole mosquitoes showed that 18s PCR but not circumsporozoite ELISA gave a reliable approximation of mosquito infection rates on day 7 post-infection.
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Affiliation(s)
- Will J R Stone
- 1] Department of Medical Microbiology, Radboud university medical center, Nijmegen, The Netherlands [2]
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