A review of combination adjuvants for malaria vaccines: a promising approach for vaccine development

It is obvious that there is a critical need for an efficient malaria vaccine to accelerate malaria eradication. Currently, recombinant subunit vaccination against malaria using proteins and peptides is gaining attention. However, one of the major drawbacks of this approach is the lack of an efficient and durable immune response. Therefore, subunit vaccines require adjuvants to make the vaccine sufficiently immunogenic. Considering the history of the RTS,S vaccine, it seems likely that no single adjuvant is capable of eliciting all the protective immune responses required in many malarial subunit vaccines and the use of combination adjuvants will be increasingly important as the science of malaria vaccines advances. In light of this, it appears that identifying the most effective mixture of adjuvants with minimal adverse effects offers tremendous opportunities in improving the efficacy of vaccines against malaria. Owing to the importance of a multi-adjuvanted approach in subunit malaria vaccine development, this review paper outlines some of the best known combination adjuvants used in malaria subunit vaccines, focusing on their proposed mechanisms of action, their immunological properties, and their notable results. The aim of the present review is to consolidate these findings to aid the application of these combination adjuvants in experimental malaria vaccines.     

Regulation of immunity to Plasmodium: Implications from mouse models for blood stage malaria vaccine design

Malaria, a disease caused by the protozoan parasite Plasmodium, remains a serious healthcare problem in developing countries worldwide. While the host-parasite relationship in humans has been difficult to determine, the pliability of murine malaria models has enabled valuable contributions to the understanding of the pathogenesis of disease. Although no single model reflects precisely malaria infection of the human, different models collectively provide important information on the mechanisms of protective immunity and immunopathogenesis. This review summarizes progress towards understanding the broad spectrum of immune responsiveness to the blood stages of the malaria parasite during experimental infections in mice and highlights how examination of murine malarias sheds light on the factors involved in the modulation of vaccine-potentiated immunity.     

Vaccine demand driven by vaccine side effects: Dynamic implications for SIR diseases

For infections for which the perceived risk of serious disease is steadily low, the perceived risk of suffering some vaccine side effects might become the driving force of the vaccine demand. We investigate the dynamics of SIR infections in homogeneously mixing populations where the vaccine uptake is a decreasing function of the current (or past) incidence, or prevalence, of vaccine side effects. We define an appropriate model where vaccine side-effects are modelled as functions of the age since vaccination.It happens that the vaccine uptake follows its own dynamics independent of epidemiological variables. We show the conditions under which the vaccine uptake lands on a globally stable equilibrium, or steadily oscillates, and the implications of such behaviour for the dynamics of epidemiological variables. We finally report some unexpected scenarios caused by trends in vaccine side effects.     

Industrial scale production of plasmid DNA for vaccine and gene therapy: plasmid design, production, and purification

The past several years have witnessed a rapidly increasing number of reports on utilizing plasmid DNA as a vector for the introduction of genes into mammalian cells for use in both gene therapy and vaccine applications. “Naked DNA vaccines” allow the foreign genes to be transiently expressed in transfected cells, mimicking intracellular pathogenic infection and triggering both the humoral and cellular immune responses. While considerable attention has been paid to the potential of such vaccines to mitigate a number of infections, substantially less consideration has been given to the practical challenges of producing large amounts of plasmid DNA for therapeutic use in humans, for both clinical studies and, ultimately, full-scale manufacturing. Doses of naked DNA vaccines are on the order of milligrams, while typical small-scale Escherichia coli fermentations may routinely yield only a few mg/l of plasmid DNA. There have been many investigations towards optimizing production of heterologous proteins over the past three decades, but in these cases, the plasmid DNA was not the final product of interest. This review addresses the current state-of-the-art means for the production of plasmid DNA at large scale in compliance with existing regulatory guidelines. The impact of the nature of the plasmid vector on the choice of fermentation protocols is presented, along with the effect of varying cultivation conditions on final plasmid content. Practical considerations for the large-scale purification of plasmid DNA are also discussed.     

Screen-less expanded bed column: new approach for the recovery and purification of a malaria transmission blocking vaccine candidate from Pichia pastoris

An experimental malaria transmission blocking vaccine antigen, Pfs25H, expressed and secreted from Pichia pastoris was recovered and purified using a screenless expanded bed column equipped with a rotating fluid distribution system. This column was able to accommodate feed stock, containing 30% biomass, at a flow rate of 300–400 cm/h without affecting column stability. This capability is three times higher than the capability of the expanded bed column currently in use, which is equipped with a perforated plate fluid distribution system; this design could accommodate biomass concentrations of only up to 10%. The screen-less design did not affect the binding capacity, purification level or process yield and, therefore, shorten the process. Purified Pfs25H of 6.4 g were recovered from 37 l of Pichia pastoris culture in one step.     

Modeling the effect of information quality on risk behavior change and the transmission of infectious diseases

How the quality of information about the prevalence of an infectious disease affects individuals’ incentives to adopt self-protective actions to reduce the risk of infection is studied using an economic/game-theoretic model of epidemics. In the model, agents make inferences regarding the current prevalence of a disease by observing the health status of a subset of the population. Therefore, the higher the number of agents whose infection status can be observed, the better one’s information about the current prevalence is. In particular, it is assumed that an agent’s estimate of the current prevalence depends on observations of the current health status of other agents and on the agent’s estimate of past prevalence, and that the agent places more weight on the current observations in forming an estimate of the prevailing prevalence when the number of observations increases. It is shown that the likelihood of eradicating an infectious disease through behavioral changes depends critically on the amount of information that individuals have access to, which also determines whether prevalence will be relatively stable or will exhibit cyclical patterns over time. Increasing the amount of information that individuals possess may lower the likelihood of eradication.     

Review of the potential of mesenchymal stem cells for the treatment of infectious diseases

The therapeutic value of mesenchymal stem cells (MSCs) for the treatment of infectious diseases and the repair of disease-induced tissue damage has been explored extensively. MSCs inhibit inflammation, reduce pathogen load and tissue damage encountered during infectious diseases through the secretion of antimicrobial factors for pathogen clearance and they phagocytose certain bacteria themselves. MSCs dampen tissue damage during infection by downregulating the levels of pro-inflammatory cytokines, and inhibiting the excessive recruitment of neutrophils and proliferation of T cells at the site of injury. MSCs aid in the regeneration of damaged tissue by differentiating into the damaged cell types or by releasing paracrine factors that direct tissue regeneration, differentiation, and wound healing. In this review, we discuss in detail the various mechanisms by which MSCs help combat pathogens, tissue damage associated with infectious diseases, and challenges in utilizing MSCs for therapy.     

中性粒细胞CD64指数、PCT及NLR在感染性疾病诊断中的价值

目的 探讨中性粒细胞CD64指数、降钙素原（PCT）和中性粒细胞与淋巴细胞比值（NLR）在感染性疾病诊断和鉴别诊断中的临床价值。方法 选取确诊的感染性疾病患者127例和同期健康对照者54例为研究对象,感染性疾病患者按照血培养和微生物检测结果分为病毒感染组（51例）和细菌感染组（76例）。分别检测每一位受试对象的外周血中性粒细胞CD64指数、PCT水平和NLR,应用受试者工作特征曲线（ROC）研究这3项指标在感染性疾病诊断和鉴别中的临床价值。结果 感染性疾病患者中性粒细胞CD64指数、PCT水平和NLR明显高于健康对照组（P<0.01）。细菌感染组患者中性粒细胞CD64指数、PCT水平和NLR明显高于病毒感染组（P<0.01）。ROC曲线显示：当用于诊断感染性疾病时,中性粒细胞CD64指数、PCT和NLR的AUC值分别为0.799、0.655、0.622,灵敏度分别为75.4%、63.5%、60.3%,特异度分别为79.6%、67.4%、60.0%,3项指标联合检测的AUC值为0.812;当用于鉴别诊断细菌感染和病毒感染时,中性粒细胞CD64指数、PCT和NLR的AUC值分别为0.931、0.728、0.551,灵敏度分别为89.1%、70.3%、60.9%,特异度分别为80.0%、64.6%、57.2%,3项指标联合检测的AUC值为0.935。结论 在感染性疾病的诊断和鉴别感染类型中,中性粒细胞CD64指数明显优于PCT和NLR。3项指标联合检测优于任何一个单项指标的检测效果。     

Promotion time models with time-changing exposure and heterogeneity: application to infectious diseases

Promotion time models have been recently adapted to the context of infectious diseases to take into account discrete and multiple exposures. However, Poisson distribution of the number of pathogens transmitted at each exposure was a very strong assumption and did not allow for inter-individual heterogeneity. Bernoulli, the negative binomial, and the compound Poisson distributions were proposed as alternatives to Poisson distribution for the promotion time model with time-changing exposure. All were derived within the frailty model framework. All these distributions have a point mass at zero to take into account non-infected people. Bernoulli distribution, the two-component cure rate model, was extended to multiple exposures. Contrary to the negative binomial and the compound Poisson distributions, Bernoulli distribution did not enable to connect the number of pathogens transmitted to the delay between transmission and infection detection. Moreover, the two former distributions enable to account for inter-individual heterogeneity. The delay to surgical site infection was an example of single exposure. The probability of infection was very low; thus, estimation of the effect of selected risk factors on that probability obtained with Bernoulli and Poisson distributions were very close. The delay to nosocomial urinary tract infection was a multiple exposure example. The probabilities of pathogen transmission during catheter placement and catheter presence were estimated. Inter-individual heterogeneity was very high, and the fit was better with the compound Poisson and the negative binomial distributions. The proposed models proved to be also mechanistic. The negative binomial and the compound Poisson distributions were useful alternatives to account for inter-individual heterogeneity.     

Mining the Leishmania genome for novel antigens and vaccine candidates

Leishmaniasis is a neglected disease with an estimated 12 million infected people. The recent completion of the sequencing of the Leishmania major genome has opened opportunities for the identification of targets for vaccine development. We present here the first attempt at identifying novel vaccine candidates by whole genome analysis. We predicted CD8⁺ T cell epitopes from the L. major proteome and validated in vivo in mice the immunogenicity of some of the best predicted epitopes. Consensus epitope predictions from 8272 annotated protein sequences with 5–8 different algorithms allowed the identification of 78 class I CD8⁺ epitopes. BALB/c mice were immunized with 26 synthetic peptides corresponding to the most likely epitopes. Fourteen (54%) resulted immunogenic, with eight being strong inducers of T cell IFNγ production. None of the proteins from which the epitopes are derived are differentially expressed, only two may be surface proteins, eight have putative enzymatic, and metabolic activities. These epitopes and proteins represent new antigen candidates for further studies. While pathogen genomes have not yet delivered their full promise in terms of human health applications, our study opens the way for extensive genome mining for antigen identification and vaccine development against Leishmania and other pathogens.     

The structure of Plasmodium yoelii merozoite surface protein 119, antibody specificity and implications for malaria vaccine design

Merozoite surface protein 1 (MSP1) has been identified as a target antigen for protective immune responses against asexual blood stage malaria, but effective vaccines based on MSP1 have not been developed so far. We have modified the sequence of Plasmodium yoelii MSP1₁₉ (the C-terminal region of the molecule) and examined the ability of the variant proteins to bind protective monoclonal antibodies and to induce protection by immunization. In parallel, we examined the structure of the protein and the consequences of the amino acid changes. Naturally occurring sequence polymorphisms reduced the binding of individual protective antibodies, indicating that they contribute to immune evasion, but immunization with these variant proteins still provided protective immunity. One variant that resulted in the localized distortion of a loop close to the N-terminus of MSP1₁₉ almost completely ablated protection by immunization, indicating the importance of this region of MSP1₁₉ as a target for protective immunity and in vaccine development.     

Immune interactions in malaria co-infections with other endemic infectious diseases: implications for the development of improved disease interventions

Today targeted research efforts are in progress with the goal to develop vaccines, microbicides, new drugs and alternative treatments for some of the neglected infectious diseases (NIDs). Until now the world is far from having effective cures and/or prophylactic vaccines in place. People living in endemic areas generally are more skewed towards a Th2 profile (i.e. anti-inflammatory) that could greatly affect the induction of an inflammatory Th2 type response needed to combat many infectious microorganisms. Despite this, very little is today known about how co-infections with NID can affect the outcome of the different diseases and the possibilities for prophylactic vaccination and treatment. Thus, if we are to intervene successfully to eradicate infections or prevent immune pathology either by vaccination or other immune intervention therapies it will be crucial to understand how co-infections with different pathogens affect the adaptive immunity and the establishment of immunological memory The aim of this paper is to review what is known about co-infection with malaria and certain other pathogens.     

Seasonality of primarily childhood and young adult infectious diseases in the United States

The Center for Disease Control (CDC) in the United States collects and maintains records of communicable (so-called notifiable) infectious diseases that cause significant morbidity and mortality and impact the national economy. This investigation focused on seasonal patterns in the primarily childhood and young adult infectious diseases of meningococcal meningitis, mumps, pertussis, typhoid fever, streptococcal toxic shock syndrome (1990 to 2003 CDC database), and varicella (1993 to 2003 CDC database). Linear regression was performed to ascertain the trend in the incidence of each disease, and multi-component cosinor analysis was applied to determine and describe periodicities. Significant decreasing trends in incidence were detected in meningococcal meningitis, mumps, typhoid fever, and streptococcal toxic shock syndrome, and increasing trends were found in pertussis and varicella. Significant annual patterns were documented in meningococcal meningitis (January peak), mumps (April peak), pertussis (August peak), varicella (April peak), typhoid fever (August peak), and in the hospital-acquired streptococcal toxic shock syndrome (February peak). Such seasonal patterns and long-term trends in infectious diseases are of practical public health significance in indicating which can benefit from timely prevention interventions.     

Therapeutic vaccines for chronic diseases: successes and technical challenges

Chronic, non-communicable diseases are the major cause of death and disability worldwide and have replaced infectious diseases as the major burden of society in large parts of the world. Despite the complexity of chronic diseases, relatively few predisposing risk factors have been identified by the World Health Organization. Those include smoking, alcohol abuse, obesity, high cholesterol and high blood pressure as the cause of many of these chronic conditions. Here, we discuss several examples of vaccines that target these risk factors with the aim of preventing the associated diseases and some of the challenges they face.     

Parasite annexins--new molecules with potential for drug and vaccine development

In the last few years, annexins have been discovered in several nematodes and other parasites, and distinct differences between the parasite annexins and those of the hosts make them potentially attractive targets for anti-parasite therapeutics. Annexins are ubiquitous proteins found in almost all organisms across all kingdoms.Here, we present an overview of novel annexins from parasitic organisms, and summarize their phylogenetic and biochemical properties, with a view to using them as drug or vaccine targets. Building on structural and biological information that has been accumulated for mammalian and plant annexins, we describe a predicted additional secondary structure element found in many parasite annexins that may confer unique functional properties, and present a specific antigenic epitope for use as a vaccine.     

Towards the endgame and beyond: complexities and challenges for the elimination of infectious diseases

Successful control measures have interrupted the local transmission of human infectious diseases such as measles, malaria and polio, and saved and improved billions of lives. Similarly, control efforts have massively reduced the incidence of many infectious diseases of animals, such as rabies and rinderpest, with positive benefits for human health and livelihoods across the globe. However, disease elimination has proven an elusive goal, with only one human and one animal pathogen globally eradicated. As elimination targets expand to regional and even global levels, hurdles may emerge within the endgame when infections are circulating at very low levels, turning the last mile of these public health marathons into the longest mile. In this theme issue, we bring together recurring challenges that emerge as we move towards elimination, highlighting the unanticipated consequences of particular ecologies and pathologies of infection, and approaches to their management.     

The bright and the dark side of human antibody responses to flaviviruses: lessons for vaccine design

Zika and dengue viruses belong to the Flavivirus genus, a close group of antigenically related viruses that cause significant arthropod‐transmitted diseases throughout the globe. Although infection by a given flavivirus is thought to confer lifelong protection, some of the patient's antibodies cross‐react with other flaviviruses without cross‐neutralizing. The original antigenic sin phenomenon may amplify such antibodies upon subsequent heterologous flavivirus infection, potentially aggravating disease by antibody‐dependent enhancement (ADE). The most striking example is provided by the four different dengue viruses, where infection by one serotype appears to predispose to more severe disease upon infection by a second one. A similar effect was postulated for sequential infections with Zika and dengue viruses. In this review, we analyze the molecular determinants of the dual antibody response to flavivirus infection or vaccination in humans. We highlight the role of conserved partially cryptic epitopes giving rise to cross‐reacting and poorly neutralizing, ADE‐prone antibodies. We end by proposing a strategy for developing an epitope‐focused vaccine approach to avoid eliciting undesirable antibodies while focusing the immune system on producing protective antibodies only.     

Back to the future: antibody-based strategies for the treatment of infectious diseases

Before antibiotics, sera from immune animals and humans were used to treat a variety of infectious diseases, often with successful results. After the discovery of antimicrobial agents, serum therapy for bacterial infections was rapidly forsaken. In the last two decades, problems with treatment of newly emerged, reemerged, or persistent infectious diseases necessitated researchers to develop new and/or improved antibody-based therapeutic approaches. This article reviews some information on the use of antibodies for the treatment of infectious diseases, with special reference to the most seminal discoveries and current advances as well as available treatment approaches in this field.     

Plasmodium yoelii: experimental evidences for the conserved epitopes between mouse and human malaria parasite, Plasmodium falciparum

Bioinformatic analyses of gene homologues have revealed functionally conserved epitopes between human and rodent malaria parasites. Here, we present experimental evidence for the presence of functionally and antigenically conserved domains between Plasmodium falciparum and Plasmodium yoelii asexual blood-stages. Merozoite released soluble proteins (MRSPs) from both P. falciparum and P. yoelii bound to heterologous mouse or human red blood cells, respectively. The presence of conserved antigenic epitopes between the two species of parasites was evident by the inhibitory effect of antibodies, developed against P. yoelii in convalescent mice, on P. falciparum growth and merozoite reinvasion in vitro. Furthermore, mice immunized with P. falciparum MRSPs were protected from infection by a P. yoelii challenge. These data indicate that different species of Plasmodium contain antigenically conserved interspecies domains, which are immunogenic and, thus constitute a potential novel antigen source for vaccine development and testing using a mouse model.