传播阻断型恶性疟疾疫苗的研究进展

迄今为止,恶性疟疾仍然是严重威胁人类健康的传染性疾病之一.由于抗药性疟原虫的出现,研究安全、有效且廉价的恶性疟疾疫苗迫在眉睫.综述了当前在研究中的3种恶性疟疾疫苗,并从候选抗原性质、当前研究中的问题和抗原免疫原性等方面重点介绍了传播阻断型恶性疟疾疫苗的现状,为传播阻断型疟疾疫苗的研发提供了参考.     

疟疾疫苗

疟疾是世界上分布和流行最广的寄生虫性疾病之一,世界上有20亿人口生活在疫区,每年全球大约有5亿人口患病,其中50％是由恶性疟原虫引起的每年死于疟疾的人口约100万－300万,尽管疟原虫的生物学研究仍不甚明晰,疟疾疫苗的研究在最近的30年中仍取得了明显的成果,针对疟原虫的生活各周期的主要保护性抗原,科研人员已研制了一系列的疟疾侯选疫苗,如CSP疟疾疫苗,MSP1疟疾疫苗,pfs25疟疾疫苗和SPf66多期多抗原合成疟疾疫苗等。目前疟疾疫苗主要历经减毒疫苗,亚单位疫苗和DNA疫苗三种形式,因为在疟原虫生活周期不同阶段存在着不同的候选抗原,依此又可将疟疾候选疫苗按其起作用时期分为红细胞前期疫苗,红细胞内期疫苗,配子期疫苗和多期多抗原疫苗,但到目前为止,仍未开发出十分理想的疟疾疫苗,由于疟原虫生活史复杂,抗原多且免疫原性弱,单独应用疟疾疫苗难以取得很好的预防效果,所以必须配合以佐剂来增强其免疫效果,然而不同的佐剂对不同疟疾候选疫苗的免疫增强效果有着明显差异,因此佐剂的选择是疫苗成功与否的关键因素之一,另外,宿主的遗传性限制也影响着疫苗的保护效果。     

传播阻断型疟疾疫苗的研究进展

由于抗药疟原虫和蚊虫的出现,给疟疾防治带来了困难。研发安全有效的疟疾疫苗是当前全球疟疾防治的迫切需求。目前,正在研究的疟疾疫苗主要包括红前期疟疾疫苗、红内期疟疾疫苗和传播阻断型疟疾疫苗。其中传播阻断型疫苗(Transmission-blocking vaccines,TBVs)被认为是一种在疟疾流行地区降低病原体传播的可行策略。近年来,传播阻断型疟疾疫苗的研制取得了很大的进展。本文综述了传播阻断型疟疾疫苗的用途、靶抗原以及传播阻断型恶性疟疾和间日疟疾疫苗研究现状,旨在为传播阻断型疟疾疫苗的研制提供参考。     

疟疾疫苗的研究状况

ＳＰｆ６６疟疾疫苗已进行人体试验。三次免疫后２０天,接种者体内产生特异性抗体,有一定的保护率。大规模接种尚待研究。今后研究优良的疟疾疫苗仍应以单克隆抗体、分子生物学方法筛选能引起保护性抗体应答和细胞免疫应答的抗原决定簇,再用基因重组或人工会成方法制备多价亚单位疫苗。此外,尚需研制阻断疟疾传播的疫苗。     

以ISA720为佐剂甘氨酸作为保护剂的恶性疟疾疫苗AMAl的长期稳定性

恶性疟原虫顶端膜抗原（AMA1）是恶性疟原虫无性繁殖血液期表达的蛋白,是恶性疟疾疫苗的候选抗原。AMA1蛋白是疟原虫FVO和3D7等位基因表达产物,恶性疟疾候选疫苗AMA1-C1／ISA720是AMA1抗原与佐剂MontanideISA720按照1：1（质量比）配伍混合合成的。为了将来在大规模人群中接种的需要,     

疟疾疫苗的研究现状和难度

疟疾疫苗的研究现状和难度朱艳琴综述（常州市卫生局２１３００３）叶炳辉审校（南京医科大学２１００２９）分类号Ｒ５３１．３疟原虫抗药性和蚊媒耐药性的产生和扩散,促使人们重新考虑发展安全有效的疫苗来控制疟疾,特别是淋巴细胞杂交瘤技术研究成功以后,对疟疾疫苗...     

间日疟原虫传播阻断疫苗研究新进展

间日疟原虫是导致人类感染疟疾的4种疟原虫之一。由于间日疟具有较强的遗传多样性和更易复发等特点,间日疟原虫的防治得到人们的日益关注,其中疫苗的研发是重要的防控手段,传播阻断疫苗作为可以阻断传播的疫苗,相关方面的研究却刚刚起步。综述了间日疟传播阻断疫苗研究方面的新进展,旨在为间日疟疫苗的研制提供参考。     

Coexistence of Malaria and Thalassemia in Malaria Endemic Areas of Thailand

Hemoglobinopathy and malaria are commonly found worldwide particularly in malaria endemic areas. Thalassemia, the alteration of globin chain synthesis, has been reported to confer resistance against malaria. The prevalence of thalassemia was investigated in 101 malaria patients with Plasmodium falciparum and Plasmodium vivax along the Thai-Myanmar border to examine protective effect of thalassemia against severe malaria. Hemoglobin typing was performed using low pressure liquid chromatography (LPLC) and α-thalassemia was confirmed by multiplex PCR. Five types of thalassemia were observed in malaria patients. The 2 major types of thalassemia were Hb E (18.8%) and α-thalassemia-2 (11.9%). There was no association between thalassemia hemoglobinopathy and malaria parasitemia, an indicator of malaria disease severity. Thalassemia had no significant association with P. vivax infection, but the parasitemia in patients with coexistence of P. vivax and thalassemia was about 2-3 times lower than those with coexistence of P. falciparum and thalassemia and malaria without thalassemia. Furthermore, the parasitemia of P. vivax in patients with coexistence of Hb E showed lower value than coexistence with other types of thalassemia and malaria without coexistence. Parasitemia, hemoglobin, and hematocrit values in patients with coexistence of thalassemia other than Hb E were significantly lower than those without coexistence of thalassemia. Furthermore, parasitemia with coexistence of Hb E were 2 times lower than those with coexistence of thalassemia other than Hb E. In conclusion, the results may, at least in part, support the protective effect of thalassemia on the development of hyperparasitemia and severe anemia in malaria patients.     

A Locally Acquired Falciparum Malaria via Nosocomial Transmission in Korea

A 57-year old man who was admitted to an emergency room of a tertiary hospital with hemoptysis developed malarial fever 19 days later and then died from severe falciparum malaria 2 days later. He had not traveled outside of Korea for over 30 years. Through intensive interviews and epidemiological surveys, we found that a foreign patient with a recent history of travel to Africa was transferred to the same hospital with severe falciparum malaria. We confirmed through molecular genotyping of the MSP-1 gene that Plasmodium falciparum genotypes of the 2 patients were identical. It is suggested that a breach of standard infection control precautions resulted in this P. falciparum transmission between 2 patients in a hospital environment. This is the first report of a nosocomial transmission of falciparum malaria in Korea.     

Dynamic changes in white blood cell counts in uncomplicated Plasmodium falciparum and P. vivax malaria

Total and differential white blood cell (WBC) counts are basic and essential indicators in any type of illness resulting from infection. In malaria, WBC counts are generally characterized as low to normal during treatment. WBC-counts data, before and during treatment with artemisinin derivatives, was gathered for patients with either Plasmodium falciparum or Plasmodium vivax infection (at 28-day follow-up), to investigate dynamic changes in WBC count. We analyzed and compared the WBC counts of 1310 inpatients presenting with uncomplicated P. falciparum and P. vivax malaria at the Hospital for Tropical Diseases, in Bangkok, Thailand. Before-treatment, a statistically significant negative correlation was found between initial WBC count and highest temperature on admission. Before and during treatment, WBC counts were significantly lower in P. falciparum than P. vivax infection on days 0 and 7, but the numerical difference was small. We also found clinically significantly low WBC counts during the acute stages of both types of malaria, which subsequently normalized by day 28 follow-up. This finding has important clinical implications for the conventional method of estimating parasitemia using an assumed WBC count of 8000 cells/μL. The most significant finding in our analysis is that WBC counts in acute P. falciparum and P. vivax malaria are significantly lower than previously assumed for estimating malaria-parasite density. However, these abnormalities returned to normal within several weeks after artemisinin-derivative-based treatment.     

Prevalence and Clinical Manifestations of Malaria in Aligarh,India

Malaria is one of the most widespread infectious diseases of tropical countries with an estimated 207 million cases globally. In India, there are endemic pockets of this disease, including Aligarh. Hundreds of Plasmodium falciparum and P. vivax cases with severe pathological conditions are recorded every year in this district. The aim of this study is to find out changes in liver enzymes and kidney markers. Specific diagnosis for P. falciparum and P. vivax was made by microscopic examination of Giemsa stained slides. Clinical symptoms were observed in both of these infections. Liver enzymes, such as AST, ALT, and ALP, and kidney function markers, such as creatinine and urea, were estimated by standard biochemical techniques. In Aligarh district, P. vivax, P. falciparum, and mixed infections were 64%, 34%, and 2%, respectively. In case of P. falciparum infection, the incidences of anemia, splenomegaly, renal failure, jaundice, and neurological sequelae were higher compared to those in P. vivax infection. Recrudescence and relapse rates were 18% and 20% in P. falciparum and P. vivax infections, respectively. Liver dysfunctions and renal failures were more common in P. falciparum patients, particularly in elderly patients. Artesunate derivatives must, therefore, be introduced for the treatment of P. falciparum as they resist to chloroquine as well as sulfadoxine-pyrimethamine combinations.     

Malaria: seroepidemiology and serologic diagnosis

Recent advances on the application of serologic methods employing the indirect hemagglutination test with a Plasmodium knowlesi antigen for the study of malaria epidemiology are outlined. Work in progress on the stabilization of malaria antigens and the preparation of gluteraldehyde sensitized cells were reviewed. Fluorescent antibody studies in progress are discussed and work on the cross reactivity of Babesia antigens with malaria is mentioned.     

新型疟疾传播阻断疫苗候选抗原PbPSOP7基因截短片段的克隆及表达特点的研究

传播阻断疫苗(transmission-blocking vaccines,TBVs)可以有效地阻断疟原虫从蚊媒向人的传播,是控制疟疾流行的关键,但目前的TBVs候选抗原十分有限,迫切需要寻找有效的候选抗原。动合子分泌蛋白7(putative secreted ookinete protein 7,PSOP7)在疟原虫有性生殖阶段发挥着至关重要的作用,本研究对伯氏疟原虫抗原PSOP7(Pb PSOP7)进行简要的生物信息学分析,并应用原核表达系统高效表达纯化了截短的重组Pb PSOP7蛋白(r Pb PSOP7),免疫BALB/c小鼠后,获得小鼠高滴度多克隆抗体。经Western Blot方法证实该多克隆抗体可识别疟原虫抗原。间接免疫荧光实验显示,Pb PSOP7主要表达于疟原虫的合子与动合子表面。这些特点符合TBVs的基本设计理念,为确认和证实Pb PSOP7蛋白具有疟疾TBVs候选抗原的潜能奠定基础。     

Imported Malaria over Fifteen Years in an Inner City Teaching Hospital of Washington DC

As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment.