Katharine K. Grady

High antibody titer against apical membrane antigen-1 is required to protect against malaria in the Aotus model.

A Plasmodium falciparum 3D7 strain Apical Membrane Antigen-1 (AMA1) vaccine, formulated with AS02A adjuvant, slowed parasite growth in a recent Phase 1/2a trial, however sterile protection was not observed. We tested this AS02A, and a Montanide ISA720 (ISA) formulation of 3D7 AMA1 in Aotus monkeys. The 3D7 parasite does not invade Aotus erythrocytes, hence two heterologous strains, FCH/4 and FVO, were used for challenge, FCH/4 AMA1 being more homologous to 3D7 than FVO AMA1. Following three vaccinations, the monkeys were challenged with 50,000 FCH/4 or 10,000 FVO parasites. Three of the six animals in the AMA+ISA group were protected against FCH/4 challenge. One monkey did not become parasitemic, another showed only a short period of low level parasitemia that self-cured, and a third animal showed a delay before exhibiting its parasitemic phase. This is the first protection shown in primates with a recombinant P. falciparum AMA1 without formulation in Freunds complete adjuvant. No animals in the AMA+AS02A group were protected, but this group exhibited a trend towards reduced growth rate. A second group of monkeys vaccinated with AMA+ISA vaccine was not protected against FVO challenge, suggesting strain-specificity of AMA1-based protection. Protection against FCH/4 strain correlated with the quantity of induced antibodies, as the protected animals were the only ones to have in vitro parasite growth inhibitory activity of >70% at 1∶10 serum dilution; immuno-fluorescence titers >8,000; ELISA titers against full-length AMA1 >300,000 and ELISA titer against AMA1 domains1+2 >100,000. A negative correlation between log ELISA titer and day 11 cumulative parasitemia (Spearman rank r = −0.780, p value = 0.0001), further confirmed the relationship between antibody titer and protection. High titers of cross-strain inhibitory antibodies against AMA1 are therefore critical to confer solid protection, and the Aotus model can be used to down-select future AMA1 formulations, prior to advanced human trials.

Pyrosequencing, a High-Throughput Method for Detecting Single Nucleotide Polymorphisms in the Dihydrofolate Reductase and Dihydropteroate Synthetase Genes of Plasmodium falciparum

ABSTRACT A pyrosequencing protocol was developed as a rapid and reliable method to identify the mutations of the dhfr and dhps genes of Plasmodium falciparum that are associated with antifolate resistance. The accuracy and specificity of this method were tested using six laboratory-cultured P. falciparum isolates harboring known single nucleotide polymorphisms (SNPs) in the genes dhfr (codons 50, 51, 59, 108, and 164) and dhps (codons 436, 437, 540, 581, and 613). The lowest threshold for detection of all the SNPs tested by pyrosequencing was the equivalent of two to four parasite genomes. Also, this method was highly specific for P. falciparum, as it did not amplify any DNA products from the other species of human malaria parasites. We also mixed wild-type and mutant-type parasite DNAs in various proportions to determine how pyrosequencing, restriction fragment length polymorphism (RFLP), and direct conventional sequencing (for dhfr) compared with each other in detecting different SNPs in the mixture. In general, pyrosequencing and RFLP showed comparable sensitivities in detecting most of the SNPs in dhfr except for the 164L mutation, which required at least twice the amount of DNA for pyroseqencing as for RFLP. For detecting SNPs in dhps, pyrosequencing was slightly more sensitive than RFLP and direct sequencing. Overall, pyrosequencing was faster and less expensive than either RFLP or direct sequencing. Thus, pyrosequencing is a practical alternative method that can be used in a high-throughput format for molecular surveillance of antimalarial-drug resistance.

EXPERIMENTAL INFECTION OF ANOPHELES FARAUTI WITH DIFFERENT SPECIES OF PLASMODIUM

Studies were conducted to determine the susceptibility of Anopheles farauti to different species and strains of Plasmodium. Mosquitoes were infected by feeding on animals or cultures infected with different strains of P. vivax, P. falciparum, P. ovale, P. coatneyi, P. gonderi, P. simiovale, P. knowlesi, and P. brasilianum. Infections of P. vivax and P. coatneyi were transmitted via sporozoites from An. farauti to monkeys. Comparative infection studies indicated that An. farauti was less susceptible to infection than An. stephensi, An. gambiae, An. freeborni, and An. dirus with the Salvador I strain of P. vivax, but more susceptible than An. stephensi and An. gambiae to infection with the coindigenous Indonesian XIX strain.

Novel Mutation in Cytochrome B of Plasmodium falciparum in One of Two Atovaquone-Proguanil Treatment Failures in Travelers Returning From Same Site in Nigeria

Background  Atovaquone-proguanil (AP) is the most commonly used treatment for uncomplicated Plasmodium falciparum malaria in the United States. Apparent AP treatment failures were reported 7 months apart in 2 American travelers who stayed in the same compound for foreign workers in Rivers State, Nigeria. Methods  We analyzed pretreatment (day 0) and day of failure samples from both travelers for mutations in the P falciparum cytochrome B (pfcytb) and dihydrofolate reductase (pfdhfr) genes associated with resistance to atovaquone and cycloguanil, the active metabolite of proguanil, respectively. We genotyped the parasites and sequenced their mitochondrial genomes. Results  On day 0, both travelers had proguanil-resistant genotypes but atovaquone-sensitive cytb sequences. Day of failure samples exhibited mutations in cytb for both travelers. One traveler had the common Y268S mutation, whereas the other traveler had a previously unreported mutation, I258M. The travelers had unrelated parasite genotypes and different mitochondrial genomes. Conclusions  Despite the infections likely having been contracted in the same site, there is no evidence that the cases were related. The mutations likely arose independently during the acute infection or treatment. Our results highlight the importance of genotyping parasites and sequencing the full cytb and dhfr genes in AP failures to rule out transmission of AP-resistant strains and identify novel mechanisms of AP resistance.

Adaptation of a strain of Plasmodium falciparum from a Montagnard refugee to Aotus monkeys.

A strain of Plasmodium falciparum from a Montagnard refugee was shown to produce large numbers of gametocytes in culture. Attempts were made to establish this strain in Aotus monkeys via trophozoite and sporozoite inoculation. The Montagnard S-1 strain was readily adapted to A. l. griseimembra monkeys via trophozoite inoculation. Other species of Aotus failed to support the development of high density parasitemia. None of 12 attempts to transmit the infection via sporozoites from Anopheles freeborni or An. dirus mosquitoes was successful; however, developing exoerythrocytic stages were demonstrated in hepatocytes of an A. lemurinus griseimembra monkey.

Cytokine Upregulation of CD36, But Not ICAM-1, Increases Plasmodium Falciparum-Infected Erythrocyte Adherence to Microvascular Endothelial Cells under Shear Conditions

Cytoadherence of parasitized red blood cells (PRBC) to microvascular endothelial cells (MEC) contributes to the pathogenesis of human cerebral malaria (MacPherson et al., 1985). We studied cytoadherence of two strains (HB3 and FC27) of Plasmodium falciparum PRBC to human MEC cultures under shear conditions to elucidate the pathways of adherence to MEC (Wick and Louis, 1991). Using antiICAM-1 and anti-CD36 antibodies, we found that HB3 PRBC bound exclusively to CD36 and ICAM-1 receptors. FC27 PRBC bound to MEC via CD36 (and at least one other pathway) but not to ICAM-1. Stimulation of MEC with interferon gamma (IFNy), which selectively increases CD36 expression, elevated HB3 and FC27 PRBC adherence 64% and 71%, respectively. Conversely, MEC stimulation with tumor necrosis factor (TNF), which selectively upregulates ICAM-1, did not increase HB3 PRBC adherence, in contrast to previous data using large vessel endothelium. Downregulation of CD36 and ICAM-1 expression by phorbol 12, 113-dibutyrate completely abolished HB3 PRBC adherence. These data suggest that cytoadherence to microvascular EC is distinct from adherence to large vessel EC (Berendt et aL, 1989). PRBC adherence to MEC is strain specific, regulatable by cytokines which increase CD36 expression, and abrogated by pharmacologic modulation of MEC receptors. These data have defined the relative contributions of both CD36 and ICAM-1 to PRBC binding to microvascular endothelium and have provided evidence for the presence of an additional adhesion mechanism. antibody therapy of pharmacological manipulation of endothelial cell receptor expression may reduce PBRC adherence to MEC and ameliorate the sequestration associated with human cerebral malaria.