[CITATION][C] Immunology of malaria infections

MM Stevenson, F Zavala - Parasite immunology, 2006 - Wiley Online Library
Parasite immunology, 2006Wiley Online Library
Despite the optimism generated by the completion of sequencing of the genome of
Plasmodium falciparum in 2002 and the annotation of the human genome the previous year
that development of an effective malaria vaccine was within close grasp, significant
challenges still remain before this goal becomes a reality (1, 2). In the meantime, however,
the malaria burden continues to grow, particularly in sub-Saharan Africa where inhabitants
are plagued not only by malaria but also increasingly by tuberculosis and HIV. Extreme …
Despite the optimism generated by the completion of sequencing of the genome of Plasmodium falciparum in 2002 and the annotation of the human genome the previous year that development of an effective malaria vaccine was within close grasp, significant challenges still remain before this goal becomes a reality (1, 2). In the meantime, however, the malaria burden continues to grow, particularly in sub-Saharan Africa where inhabitants are plagued not only by malaria but also increasingly by tuberculosis and HIV. Extreme poverty as well as the lack of economic development and poor access to health care have compounded the devastating effects of malaria in this region. The World Health Organization (WHO) estimates that 300–500 million malaria cases occur annually, with 90% of the cases and 1–2 million deaths per year, primarily because of P. falciparum, occurring among young children and pregnant women in Africa (3). Based on an empirical approach combining data from epidemiological, geographical and demographical studies, it was recently suggested that a substantially higher number of cases of malaria actually occurs both in Africa and other endemic areas (4). The magnitude of the numbers provided by either the data from the WHO (3) or the study of Snow et al.(4), nevertheless, underscores the fact that the global burden of malaria is enormous and continues to grow in a seemingly unchecked manner. This has been attributed to the emergence of drug-resistant strains of Plasmodium, initially P. falciparum but more recently Plasmodium vivax as well, insecticide-resistant Anopheles mosquito vectors, and the lack of an effective malaria vaccine (5). A detailed understanding of the host immune response to malaria parasites is considered to be paramount to achieving the goal of an effective and safe malaria vaccine. Elucidation of the mechanisms of antiparasite immunity and immunopathogenesis as well as of the strategies used by the parasite to evade immunity will be required for the ultimate design of such a vaccine (6–8). From an immunological perspective, this endeavor is complicated by the complex life cycle of the Plasmodium parasite that consists of a sexual phase in the female mosquito vector and a pre-erythrocyticor liver-stage followed by an asexual intra-erythrocytic or blood-stage in the mammalian host. The development of an effective malaria vaccine is also complicated by the fact that there is a strict species-specific relationship between the Plasmodium parasite and its mammalian host. Furthermore, it takes many years for natural immunity to develop, and the immunity is not only species but also stage specific. Other factors, including the age and genetic background of the host, pregnancy, nutritional status and coinfection, may also influence the development of antimalarial immunity and further complicate malaria vaccine development (9). With the tremendous need to develop an effective malaria vaccine in a timely manner to relieve the huge burden of this disease in developing countries in mind, a meeting with the theme,‘Immunology of Malaria Infections: Implications for the design and development of malaria vaccines’ was held on February 8–11, 2005 in Baltimore, MD, USA. The idea for this meeting arose at a gathering of several individuals, including Eleanor Riley, Michael Good, Jean Langhorne and Mary Stevenson and others, who study the immunology of malaria in humans and experimental mouse models and
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