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The multiplicity of Plasmodium falciparum infections is associated with acquired immunity to asexual blood stage antigens
Institution:1. Unité de Recherches Médicales, Hôpital Albert Schweitzer, Lambaréné, Gabon;2. Department of Parasitology, Institute for Tropical Medicine, University of Tübingen, Germany;3. Radboud University Nijmegen Medical Centre, Department of Medical Microbiology, Nijmegen, The Netherlands;4. Institute for Tropical Medicine of the French Army, Marseille, France;1. Unité de Recherches Médicales, Hôpital Albert Schweitzer, Lambaréné, Gabon;2. Department of Parasitology, Institute for Tropical Medicine, University of Tübingen, Germany;3. Radboud University Nijmegen Medical Centre, Department of Medical Microbiology, Nijmegen, The Netherlands;4. Institute for Tropical Medicine of the French Army, Marseille, France;1. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK;2. Malaria Research Unit, Medical Research Council, PO Box 70380 Overport 4067, South Africa;1. Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria;2. Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany;1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;1. Oxford University Clinical Research Unit, Wellcome Trust Major Oversea Programme, Ho Chi Minh City, Vietnam;2. Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;3. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK;4. Institute of Malariology, Parasitology, and Entomology (IMPE), Ho Chi Minh City, Vietnam;5. Center for Malariology, Parasitology and Entomology Control, Ninh Thuan Province, Vietnam;1. ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic – Universitat de Barcelona, Barcelona, Spain;2. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
Abstract:We evaluated the relationship between immune response markers and the multiplicity of Plasmodium falciparum infections in order to assess the validity of the latter as an indicator of the acquisition of anti-malarial immunity.Parasite populations present during malaria episodes of 64 Gabonese children who presented with at least 4 such attacks during active follow-up over a 7-year period were characterized using MSP-1 and MSP-2 PCR-based methods. Plasma samples taken at healthy and parasite-free phase were used to measure P. falciparum antigen-specific antibody and cytokine activity.We found evidence of intra- and inter-individual variation in the number of parasite genotypes present in different malaria episodes, although in 72% of isolates no more than 2 parasite genotypes were detectable. Samples with the highest multiplicity were from children with significantly lower (p < 0.03) antibody responses to specific asexual stage antigens. Additionally, the whole blood interferon-γ production capacity was significantly higher (p < 0.02) in those with lower infection multiplicity.Malaria episodes with multiple clones indeed reflect a low level of acquired immunity and a consequently poor capacity to control the infection. These findings suggest that the multiplicity of falciparum infection may be a potentially useful parameter in the evaluation of malaria control interventions.
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