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Infection and Immunity, February 2009, p. 817-824, Vol. 77, No. 2
0019-9567/09/$08.00+0 doi:10.1128/IAI.01063-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Huji Xu,1,3,
*
Xueqin Liu,1
Chakrit Hirunpetcharat,4
Anthony Stowers,5 and
Michael F. Good1*
The Queensland Institute of Medical Research, P.O. Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia,1 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand,2 Changzheng Hospital, the Second Military Medical University, 415 Fengyang Road, Shanghai 200003, People's Republic of China,3 Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand,4 Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 208925
Received 27 August 2008/ Returned for modification 4 October 2008/ Accepted 8 November 2008
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An ideal malaria vaccine should effectively induce protective immunity in both naive individuals and those populations living in areas of endemicity. Therefore, immune responses generated in response to vaccination in both naive and exposed individuals should be considered in studies to develop a malaria vaccine. While MSP119 has been shown to be a promising malaria vaccine candidate, we have found that CD4+ T cells specific to a helper epitope on MSP119 are deleted via apoptosis during malaria infection (18). As a result, spleen cells from infected mice respond to parasite antigens significantly less than spleen cells from uninfected mice. This may reflect the situation in humans, where antigen-specific immune responses are suppressed during Plasmodium falciparum infection (10). It is important, therefore, to assess vaccine efficacy in individuals previously exposed.
Conversely, it is important to consider the impact of vaccination on the subsequent ability of the parasite to interact with the immune system and consequently generate both MSP119-specific Abs and Abs specific for other parasite antigens which may contribute in a significant way to the ultimate development of immunity. Francis (4) and Fazekas de St Groth (3) reported almost 50 years ago that prior exposure to one strain of an organism could skew the immune response to subsequent strains toward those antigenic determinants that are shared between the strains at the expense of novel determinants expressed on the new strain. The term "original antigenic sin" was coined to describe this phenomenon. We were interested to explore whether malaria subunit vaccination might prevent the development of protective Abs specific for those antigens other than the subunit vaccine, and if so, to determine the mechanism of the effect.
The experiments in this study were thus designed to model in the mouse those situations where malaria-preexposed individuals receive vaccination and also where vaccinated individuals from a nonmalaria area might travel to regions with malaria transmission.
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Immunization protocol. To investigate the effectiveness of MSP119 vaccination in malaria-preexposed animals, groups of BALB/c mice were infected with P. yoelii YM and were then treated daily 4 days later with three consecutive doses of 0.2 mg/ml pyrimethamine. This procedure is referred to as infection/cure. Three weeks later, all mice were vaccinated with phosphate-buffered saline (PBS) or 20 µg MSP119 formulated in complete Freund's adjuvant (CFA) (Sigma, St Louis, MO). Control groups consisted of mice that were not infected but were vaccinated with the same dose of antigens (Table 1). Five weeks after vaccination, mice were challenged intravenously with 104 P. yoelii YM-parasitized red blood cells (RBC). Vaccination of preexposed mice is hereafter referred to as protocol 1.
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TABLE 1. Experimental protocol for malaria-preexposed mice (protocol 1)a
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TABLE 2. Experimental protocol for prevaccinated mice (protocol 2)a
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Statistical analysis. Comparisons among experimental groups by Student's t test were performed using a statistical analysis program of Sigma Plot. The levels of peak parasitemia were compared among experimental groups. Significance was set at a P value of <0.05.
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The level of Abs against MSP119 or whole parasite antigens in P. yoelii-exposed mice did not change significantly after PBS immunization (Fig. 1C and G). P. yoelii-exposed mice had developed low levels of anti-MSP119 Abs before MSP119 boosting, and the levels of the Abs increased after boosting but did not differ from those for nonexposed animals that received MSP119 immunization (Fig. 1B versus D). Boosting with MSP119 had no effect on the level of anti-P. yoelii Abs in P. yoelii-exposed mice (Fig. 1H). There was no effect of treatment on the distribution of the isotype of the MSP119-specific Abs (Fig. 2).
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FIG. 1. Ab responses specific to MSP119 (A to D) or P. yoelii antigens (E to H). Nonexposed (A, B, E, and F) and P. yoelii-preexposed (C, D, G, and H) mice were immunized with PBS or 20 µg MSP119 as indicated. Sera taken 5 weeks after vaccination were compared with preboost sera by ELISA. The data show the means ± standard errors for five mice. O.D., optical density.
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FIG. 2. Isotypes of Abs specific to MSP119. Malaria-nonexposed or -preexposed mice were immunized with 20 µg MSP119. Pooled sera were diluted 1:5,000 before analysis by ELISA. O.D., optical density.
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Ab responses following infection of MSP119-vaccinated animals. Mice were given a single injection of MSP119 or PBS in CFA as described in Materials and Methods (protocol 2). Infection/cure of PBS-immunized mice only slightly enhanced the levels of Abs against MSP119 (Fig. 3A). Sera from mice that had been primed with MSP119 contained Abs to the antigen, with levels of Abs increasing further following either an infection/cure (Fig. 3B) or MSP119 boosting (Fig. 3C). Levels of Ab against P. yoelii increased in all groups following infection/cure or MSP119 boosting (Fig. 3D to F). These data show that exposure to P. yoelii resulted in an increase in Ab response to MSP119.
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FIG. 3. Ab responses specific to MSP119 (A to C) or P. yoelii antigens (D to F). PBS-primed (A and D) and MSP119-primed (B, C, E, and F) mice were boosted with one episode of infection/cure or 20 µg MSP119 as indicated. Sera were analyzed by ELISA. The data show the means ± standard errors for five mice. O.D., optical density.
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FIG. 4. Isotypes of Abs specific to MSP119. MSP119-primed mice were boosted by infection/cure or MSP119 vaccination. Pooled sera were diluted 1:5,000 before analysis by ELISA. O.D., optical density.
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FIG. 5. Parasitemia during challenge infection. Experimental treatments are indicated above each graph. Five weeks later all mice were challenged with 104 P. yoelii YM-parasitized RBC. The data show % parasitemia for five individual mice and represent one of five independent experiments with similar findings. Cross symbols indicate the days on which mice died.
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PBS-immunized mice that were subsequently given an infection/cure developed patent parasitemia (geometric mean peak parasitemia: 0.21%) but were able to control parasite growth (Fig. 5E). All five MSP119-vaccinated mice that were given an infection/cure also showed patent parasitemia during the challenge infection (geometric mean peak parasitemia: 1.65%) (Fig. 5F). One of five mice that had been vaccinated with two doses of MSP119 died by day 9 postchallenge (Fig. 5G); one had no detectable parasitemia, and three animals showed patent parasitemia.
Mice which received MSP119 vaccination prior to infection/cure (protocol 2) (Fig. 5F) developed a mean peak parasitemia significantly higher than that developed by mice that received infection/cure prior to MSP119 vaccination (protocol 1) (geometric mean peak parasitemia of 1.65% versus 0.04%; P < 0.05).
Prior vaccination with MSP119 impeded the ability of mice to produce Abs to other determinants on the parasite. We were concerned that prior exposure to MSP119-CFA or, to a lesser extent, PBS-CFA might alter the ability of parasite exposure to induce robust immunity. Since immunity induced by prior exposure to P. yoelii is believed to be mediated primarily by Abs (8), we asked whether prior vaccination with MSP119 impeded the ability of mice to generate an Ab response to other determinants on the parasite. Sera from MSP119-vaccinated P. yoelii-infected mice (from Fig. 5F) were tested in an inhibition ELISA in which free MSP119 was premixed with sera to absorb MSP119-specific Abs. The sera were then tested for their ability to recognize MSP119 and whole P yoelii parasites. The results (Fig. 6) demonstrate that free MSP119 can effectively block MSP119-specific Abs from recognizing MSP119 (Fig. 6B). However, there was also a significant reduction in the ability of the sera to respond to P. yoelii when the sera were blocked with free MSP119 (Fig. 6D). By comparison, MSP119-blocked sera from mice that had not been exposed to MSP119 but had been exposed to P. yoelii infection did not significantly affect Ab binding to P yoelii antigens at any of the serum dilutions tested (1/300 to 1/2,400) (Fig. 6C). These data are consistent with the reduced protection seen when P. yoelii-exposed mice were previously exposed to MSP119 (Fig. 5E versus F, geometric mean peak parasitemia of 0.21% versus 1.65% [P < 0.05]; Fig. 5F versus D, geometric mean peak parasitemia of 1.65% versus 0.04% [P < 0.05]), resulting in part from a reduced ability of MSP119-primed mice to generate an effective Ab response to P. yoelii antigens other than MSP119.
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FIG. 6. Ab specific to MSP119 and P. yoelii antigen in mouse sera detected by inhibition ELISA. Mice were primed with MSP119, followed by boost with infection/cure (C and D) or primed with infection/cure followed by boost with PBS (A and B). Anti-MSP119 Abs (A and C) and anti-P. yoelii Abs (B and D) were measured before and after blocking with excess free MSP119 antigen. O.D., optical density.
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FIG. 7. Parasitemia during challenge infection. Experimental treatments are indicated above each graph. Five weeks later all mice were challenged with 104 P. yoelii YM-parasitized RBC (a and c) or P. chabaudi (b). The data show % parasitemia for five individual mice and represent one of three independent experiments with similar findings. Cross symbols indicate the days on which mice died.
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The aims of this study were to investigate the immune responses that develop following MSP119 vaccination in malaria-preexposed animals and vice versa. Anti-MSP119 Abs could be detected in prevaccination sera from malaria-preexposed mice (Fig. 1 C and D), indicating that P. yoelii infection elicits a natural albeit limited Ab response to MSP119. MSP119 vaccination of these preexposed mice resulted in a boosting of the MSP119-specific Ab response (Fig. 1D), but this increase of anti-MSP119 Abs was not accompanied by an increase of anti-whole-parasite Abs (Fig. 1H). We have previously reported that malaria infection results in deletion of adoptively transferred MSP119-specific Th1 cells (18) and memory B cells (19). The increase in MSP119-specific antibodies seen in this study suggests that infection had not resulted in deletion of MSP119-specific helper cells to such an extent as to ablate helper activity. We also observed that infection of MSP119-primed mice with P. yoelii led to an increase of anti-MSP119 Abs (Fig. 3B). Boosting of P. yoelii-exposed mice with MSP119 or infection/cure of MSP119-primed mice boosted Ab responses to MSP119 in both groups to comparable levels (Fig. 1D versus 3B).
However, MSP119 boosting of malaria-preexposed mice (Fig. 5D) and infection/cure of MSP119-primed mice (Fig. 5F) induced different degrees of protective immunity against P. yoelii challenge. The levels of anti-MSP119 Abs in these groups were equivalent (Fig. 1D versus 3B). This suggested that immune responses other than MSP119-specific Abs were responsible for the differences in protection. This conclusion was confirmed from the study of the malaria-preexposed, PBS-vaccinated group. This group demonstrated the highest degree of protection (Fig. 5C), but they had low levels of anti-MSP119-specific Abs (Fig. 1C); although they had levels of whole-parasite-specific Abs comparable to those in the poorly protected malaria-preexposed, MSP119-boosted mice (Fig. 1G and 3E), the component of those Abs that were not directed against MSP119 was significantly greater in the malaria-preexposed, PBS-vaccinated group than in the malaria-preexposed, MSP119-boosted group, as shown by ELISA inhibition studies using free MSP119 (Fig. 6).
Significantly, in this study, we have shown that the impaired protective immunity in the MSP119-primed mice was at least in part induced by suboptimal vaccination with this antigen. The evidence comes from three separate sets of experiments. First, MSP119-nonresponding B10.S mice were used to test whether the MSP119 suboptimal vaccine affects immunity induced by homologous parasite infection/cure. We could demonstrate no such effect in MSP119-nonresponding mice, as the data showed that MSP119-primed B10.S mice that were boosted with an infection/cure had the same level of protection to parasite challenge (7a, D) as mice that were primed with infection/cure and boosted with MSP119 (7a, E). Second, we tested whether P. yoelii- derived-MSP119 priming affects immunity induced by a different species of parasite. As shown in Fig. 7b, D and E, the P. yoelii-derived-MSP119-primed BALB/c mice given an infection/cure with P. chabaudi parasites had the same level of protective immunity to P. chabaudi as mice that had been primed with infection/cure and boosted with P. yoelii-derived MSP119. Finally, a single P. yoelii-derived-MSP119 T-cell epitope was used to prime BALB/c mice. We showed that p24 priming had no ability to skew the immune response (Fig. 7c). Taken together, these experiments suggested that the impaired protective immunity that follows suboptimal vaccination was induced by the immune responses to P. yoelii-derived MSP119. These results have profound implications for a human vaccine program in a situation where the vaccine response may be suboptimal for a variety of reasons. Suboptimal vaccination may render the ultimate acquisition of immunity that follows parasite exposure more difficult.
This study shows that a single injection of MSP119 impedes the development of natural immunity that arises following parasite infection. The MSP119 vaccination regimen in this study was deliberately suboptimal in order to more clearly reflect the likely situation in humans, where some will respond well to vaccination but others less well. Exposure of MSP119-primed mice to P. yoelii resulted in an increase of anti-MSP119 Abs, suggesting that MSP119 is a dominant B-cell epitope and that malaria infection induces the boosting of a preexisting Ab response. However, the increase of anti-MSP119 Abs observed in these mice did not confer protection at the same level as that observed in mice exposed to malaria parasites before MSP119 vaccination. It is well known that in rodent systems a very high titer of anti-MSP119 antibodies is required for protection and that in these situations no mice demonstrate a patent parasitemia following challenge (8). However, when the immune response to vaccination is suboptimal, mice are not protected (8). This study now demonstrates that not only are mice not protected by a low-titer Ab response but also that they can be inhibited from developing an otherwise protective immune response to the parasite. This "original antigenic sin" phenomenon has also been observed in humans, in which malaria infection selectively induces existing Ab responses to immunodominant epitopes (5, 15, 17), but its contribution to protection remains to be investigated.
Similar to the findings in this study, a previous study has shown that immunization of preimmune Saimiri sciureus monkeys with recombinant proteins associated with the membranes of trophozoite- and schizont-infected erythrocytes results in an enhancement of Ab responses and better protective immunity (13). In another study (2), prior exposure of Aotus vociferans monkeys to P. falciparum primes the production of anti-native MSP119 Abs, which are further boosted by vaccination with recombinant MSP119. This monkey demonstrated better protection than a vaccinated malaria-naive monkey (2), analogous to the results of this study (Fig. 5). However, the effect of prior exposure to MSP119 on the ability to induce immunity following parasite exposure has been studied to only a very limited degree. In the study referred to above (2) six of six monkeys that were vaccinated with MSP119 and infected were protected against a second challenge infection. However, the MSP119 vaccine regimen was highly efficacious by itself in that seven of nine monkeys in total were protected from high parasitemia during their initial challenge. Our study was designed to assess the effect of suboptimal vaccination.
In conclusion, this study demonstrates that (i) prior exposure to malaria does not seem to have negative effect on the response to subunit vaccination and (ii) vaccination with a partially effective subunit vaccine may impair subsequent development of immunity following malaria infection. Potential differences in response to vaccines between naive and semi-immune or preexposed individuals should be taken into consideration when planning malaria vaccine trials, and the consequences of a less-than-optimal vaccination in naive individuals should be considered. The need for optimal vaccine-induced Ab responses should be considered with respect to the overall development of malaria immunity.
Research in the authors' laboratories is supported by the Australian National Health and Medical Research Council and the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR). H.X. is an Australian NHMRC RD Wright fellow, and his research is also supported by China MOST 973 CB513100 and NNSF30610103103.
Published ahead of print on 17 November 2008. ![]()
These authors contributed equally to this work. ![]()
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