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Infection and Immunity, July 2002, p. 3939-3943, Vol. 70, No. 7
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.7.3939-3943.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
Purified Malaria Pigment (Hemozoin) Enhances Dendritic Cell Maturation and Modulates the Isotype of Antibodies Induced by a DNA Vaccine
Cevayir Coban,1 Ken J. Ishii,2 David J. Sullivan,1 and Nirbhay Kumar1*
Department of Molecular Microbiology and Immunology, Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, Baltimore,1
Division of Viral Products, Center for Biological Evaluation and Research/Food and Drug Administration, Bethesda, Maryland2
Received 28 January 2002/
Returned for modification 11 March 2002/
Accepted 24 March 2002

ABSTRACT
Hemozoin (malaria pigment) has been implicated in the modulation
of immune responses during malaria infection. This study was
designed to evaluate the effect of purified hemozoin on the
in vitro activation of myeloid dendritic cells. Our study also
revealed that in addition to enhancing the maturation of dendritic
cells, hemozoin also greatly promotes immunoglobulin G2a antibody
responses when coadministered with a DNA vaccine plasmid encoding
Pfs25, a
Plasmodium falciparum transmission-blocking antigen.

TEXT
Malaria-associated immunosuppression has been widely investigated,
and it has been suggested that malaria pigment, also known as
hemozoin (HZ), may participate in the mechanisms underlying
it (
1,
8,
10,
15,
16,
17).
Plasmodium parasites detoxify heme
molecules in the food vacuole into HZ (
13), which persists inside
the parasite. During schizont rupture, intracellular HZ released
into the circulation is subsequently concentrated in the reticuloendothelial
system of the host, where it may persist unchanged in macrophages
for several months (
16). In vivo experiments have shown that
during malaria infection, HZ loading severely impairs the function
of phagocytes. HZ-loaded monocytes are impaired in the generation
of oxidative burst, in the ability to repeat phagocytosis, and
in protein kinase C activity (
1,
14,
15). Other studies have
also revealed that phagocytosis of opsonized HZ impairs the
expression of major histocompatibility complex class II antigen,
CD54, and CD11c in human monocytes (
16).
Recently, it was found that dendritic cell (DC) maturation was severely inhibited by intact Plasmodium falciparum-infected erythrocytes (26). DCs, as crucial antigen-presenting cells, are more effective in activating naïve T cells and thus in initiating adaptive immune responses. They also activate innate immune responses to microbial challenge by producing cytokines such as interleukin-12 (IL-12) and interferons (5, 9, 21). Although the role of HZ when phagocytosed by human monocytes has been examined extensively, the interaction between HZ and DCs has not been examined. DCs are also important for the immunogenicity of DNA vaccine-encoded antigens. They control the interaction between transfected somatic cells and T cells, as well as the delivery of antigen to secondary lymphoid organs (2, 18, 23). The goal of the present investigation was to assess the direct immunomodulatory effect of purified HZ on DC maturation and cytokine production as well as the effect of HZ on DNA vaccine-induced antibody responses.
Since previous studies employed rather crude HZ preparations and parasite lysates, it was difficult to distinguish between the role of HZ and those of contaminating proteins, membranes, and glycosylphosphatidylinositol molecules (11), etc. In the present study, the HZ purification procedure that was employed eliminated all of the above-mentioned copurifying molecules. We also carefully examined the endotoxin levels of purified HZ because human peripheral blood mononuclear cells are extremely sensitive to even trace amounts of lipopolysaccharide (LPS) (19). In contrast to previous findings on the immunosuppressive effects of crude HZ preparations on monocytes and macrophages, we found that purified HZ upregulates DC maturation, as revealed by marked increases in both cell surface molecules and in IL-12 production in DCs.
HZ was purified from P. falciparum (strain 3D7)-infected erythrocytes (25). When the level of parasites, mostly trophozoites, reached more than 10% in the culture, parasites were harvested by saponin lysis as described before (3). Briefly, saponin-lysed parasites were washed three to five times with phosphate-buffered saline (PBS) and sonicated in 2% sodium dodecyl sulfate (SDS). Following seven to eight washes in 2% SDS, the pellet was resuspended in a solution of 10 mM Tris-HCl (pH 8.0), 0.5% SDS, and 1 mM CaCl2 containing 2 mg of proteinase K per ml and was then incubated at 37°C overnight. The pellet was then washed three times in 2% SDS and incubated in 6 M urea for 3 h at room temperature on a shaker. Following three to five washes in 2% SDS and then in distilled water, the HZ pellet was resuspended in distilled water and sonicated again prior to use to minimize aggregation and maintain the HZ in suspension. Previous studies (20) have established the purity of HZ prepared by the method described above. In these experiments, we also used heme (heme monomer) and synthetic ß-hematin as a control to HZ. ß-Hematin was prepared from heme by using an acetic acid treatment described previously (3,4). Heme stock (600 µM) was prepared by dissolving 40 mg of hemin (Sigma) in 300 µl of 1 M NaOH (24). The pH was adjusted to 7.5 by the addition of 1 M HEPES, and the final volume was adjusted to 100 ml with RPMI medium. The concentrations of all solutions were determined by depolymerizing the heme polymers in 1 ml of a 20 mM sodium hydroxide-2% SDS solution for 2 h at room temperature and by measuring the absorbance at 400 nm. The molar extinction coefficient for heme is 105 at 400 nm (22). Initial experiments on DC maturation and cytokine production were done at various concentrations (1, 3, and 10 µM) of various test preparations and revealed a dose-dependent response. We chose to use a 10 µM concentration so that we could observe the direct effect of HZ without any interference from any unknown toxicity or trace amount of LPS. Since monocytes and DCs are extremely sensitive to LPS contaminations, we also employed various solutions prepared in endotoxin-free PBS and water. Endotoxin levels measured by Limulus amoebocyte lysate assays (BioWhittaker, Walkersville, Md.) were below 0.0125 endotoxin unit for each nanomole of HZ used.
Immature human myeloid DCs were obtained from elutriated monocytes that had been cultured for 7 days with human granulocyte-macrophage colony-stimulating factor (GM-CSF; R&D Systems, Minneapolis, Minn.) (100 ng/ml) and human IL-4 (R&D Systems) (25 ng/ml) in RPMI medium containing 10% fetal bovine serum (12). Immature DCs were then stimulated further with 10 µM purified HZ for 36 h at 37°C. Fluorescence-activated cell sorter (FACS) analysis was carried out using fluorescein isothiocyanate-, phycoerythrin-, and/or CyChrome-labeled antibodies against human CD1a, CD83, and CD86 (BD PharMingen, San Diego, Calif.) as recommended by the manufacturer. Cells (104) were analyzed by FACSort (BD Biosciences), and Cell Quest software (BD Biosciences) was used for data analysis. FACS analysis showed that purified HZ upregulated the surface molecules CD83, CD86, and CD1a, which are maturation markers for DCs (Fig. 1). Purified heme or synthetic ß-hematin, on the other hand, did not alter CD83, CD86, or CD1a surface molecules. These experiments were repeated with two independent preparations of purified HZ, and results showed that P. falciparum consistently enhanced in vitro maturation of immature DCs. We also incubated elutriated monocytes with 10 µM heme, ß-hematin, and HZ for 48 h and did not detect any upregulation of DC maturation surface markers (CD86, CD83, or CD1a), further suggesting a direct role for HZ during the in vitro maturation of immature DCs (data not shown).
HZ-mediated enhanced DC maturation, as suggested by the upregulation
of surface markers, was also confirmed by morphological changes
in the cells. Immature DCs were incubated with HZ, LPS, and
HZ plus LPS for 48 h, and slides (cytospin) were fixed with
ethanol. After the slides were stained with Giemsa stain for
20 min, bright-field microscopy (magnification,
x600; Olympus
America, Melville, N.Y.) was used for analysis. Figure
2 shows
the mature DCs after the internalization of HZ. The activation
of DC maturation by HZ is thus similar to that of proinflammatory
cytokines (tumor necrosis factor alpha and IL-1ß)
and bacterial and viral products such as LPS, immunostimulatory
CpG-containing oligodeoxynucleotides, and double-stranded RNA
(
5,
9,
21).
DCs and macrophages are the major source of IL-12 (
5). During
hematopoiesis, monocytes, as a subset of DC precursors, differentiate
into immature myeloid DCs in culture with GM-CSF and IL-4 (
6)
and secrete IL-12 during their further maturation. Immature
DCs obtained from elutriated monocytes by culture in the presence
of GM-CSF and IL-4 for 7 days were incubated with HZ for 36
h; supernatant was then examined for IL-12. Immulon 2 plates
were coated with 5 µg of anti-human IL-12 per ml and blocked
with 1% bovine serum albumin-PBS. Culture supernatants were
tested in triplicate. Following incubation with biotinylated
anti-cytokine antibody (1 µg/ml) and phosphatase-streptavidin
(BD PharMingen), the plates were developed using K-gold substrate
(Neogen, Lexington, Ky.) and absorbance was read at 405 nm.
Figure
3 shows results for DCs from two different donors. The
presence of HZ during LPS stimulation did not alter the LPS-induced
IL-12 response (data not shown).
Since DCs are also important for in vivo immune responses to
antigens, we were interested in testing the effect of HZ on
DNA vaccine-induced humoral immune responses against Pfs25,
a transmission-blocking vaccine antigen (
7). Four- to six-week-old
female BALB/c mice (four mice per group) were immunized intramuscularly
with 25 µg of DNA vaccine (VR1020-Pfs25 encoding Pfs25)
in the presence of 1 or 20 nmol of HZ. Four weeks after this
primary immunization, the mice were given a booster of 25 µg
of DNA vaccine (VR1020-Pfs25) alone. After another 4 weeks,
antibody titers and antibody isotypes were measured by an enzyme-linked
immunosorbent assay (ELISA) as described before (
7). Although
DNA immunization with HZ did not affect antigen-specific total
IgG titers, the isotypes of specific antibodies were significantly
different (Fig
4). The ratio of IgG2a to IgG1 antibodies was
significantly higher in the group injected with 20 nmol of HZ
plus DNA than in the group that received DNA vaccine alone (
P < 0.03).
The primary goal of these studies was to evaluate a direct role
for HZ in the immunomodulation during malaria infection and
its effect on DNA vaccine-induced humoral immune responses.
Urban et al. showed that malaria-infected erythrocytes adhere
to DCs, inhibit the maturation of DCs into fully competent antigen-presenting
cells, and reduce their capacity to stimulate T cells (
26).
In the same study, they also observed that a crude pigment preparation
derived from infected erythrocytes did not have any effect on
the mature DCs induced by LPS. More recent studies have shown
that DC modulation in vitro by infected red blood cells is a
contact-dependent process which requires critical levels of
infected red blood cells and which depends on the infected red
blood cells' affinity for CD36 (
27). While this modulation of
DC may result in impaired antiparasite immune responses, our
studies demonstrate that the internalization of parasite products
like HZ may actually activate DCs. These studies thus raise
the possibility that other parasite components may downregulate
the immune response during malaria infection. The effect of
HZ, when administered during primary immunization with DNA vaccine,
on antibody isotype switching also warrants further investigation
as a potential immunomodulator.

ACKNOWLEDGMENTS
We thank the NIH Blood Bank for supplying elutriated monocytes.
We also thank Mayda Gursel for critical comments as well as
technical support.
These studies were supported partially by NIH grant AI 47089.
C. Coban and K. J. Ishii contributed equally to this work.

FOOTNOTES
* Corresponding author. Mailing address: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205. Phone: (410) 955-7177. Fax: (410) 955-0105. E-mail:
nkumar{at}jhsph.edu.

Editor: W. A. Petri, Jr.

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Infection and Immunity, July 2002, p. 3939-3943, Vol. 70, No. 7
0019-9567/02/$04.00+0 DOI: 10.1128/IAI.70.7.3939-3943.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.
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