Background
In 2017, an estimated 219 million cases of malaria occurred worldwide leading to nearly half a million deaths, which makes malaria the most deadly parasitic disease worldwide (according to the World Health Organization, World Malaria Report 2018). Infection with malaria is initiated when
Plasmodium parasites are injected into the skin by a probing
Anopheles mosquito in the highly motile sporozoite (spz) stage [
1]. Motility enables spz to exit the skin site, enter the bloodstream and reach and infect the liver, which makes spz motility a target for anti-malarial drugs and vaccines [
2]. In addition, the potency of malaria vaccine candidates based on live attenuated spz depends on their potential to migrate in the human host, infect hepatocytes and induce an immune response, which cannot be replicated by dead sporozoites [
3]. Nevertheless, the regulation of this migratory behaviour is still an unknown process.
After intradermal deposition, spz rely on their own adhesion capacity and actin/myosin-based motility machinery to migrate. Their adhesion capacity relies on proteins, e.g. the circumsporozoite protein (CSP) and the thrombospondin-related adhesive protein (TRAP), which can form adhesion sites [
4,
5]. The establishment of new adhesion sites and the release of the old, enabled by the actin/myosin motor, provides the forward locomotion at a speed linked to the turnover rate [
6]. The subsequent direction of this movement is related to the geometrical properties (the crescent shape and the presence of polar rings) of the spz which induce chirality [
7,
8]. Spz motility is required to move out of the dermal tissue and to reach the bloodstream. At that point the blood flow will transport spz to the liver where they can invade hepatocytes [
9,
10]. As a result, the migration process of spz and possibly thereby also their infectivity is directly influenced by their motility [
11,
12]. Although the presence and importance of the elements of the spz motility machinery are confirmed, the regulation of e.g. adhesive protein secretion, actin/myosin motor activity and spz chirality is still poorly understood [
9,
13,
14]. Given the importance of spz motility, a better understanding of stimuli that promote and inhibit spz motility is needed [
11,
12].
To shed light on spz motility, transgenic spz e.g.
Plasmodium berghei and
Plasmodium yoelii expressing fluorescent proteins (e.g. green fluorescent protein; GFP) [
15] have been generated for intravital studies [
16,
17]. These studies showed that spz display complex motility in their natural environment [
18‐
20], possibly due to tissue morphology and the availability of nutrients in the extracellular matrix. In order to dissect the role of these factors separately, more simplified in vitro models are needed [
13,
21]. Studies using 3D in vitro environments revealed that physical confinement plays an important role in regulating the direction and velocity of spz movement [
22,
23]. However, when physical confinement is taken out of the equation, the availability of chemical stimuli is revealed as a crucial regulator of spz motility. So far, reports on in vitro spz motility have shown that albumin and calcium act as essential stimuli of spz motility [
24‐
26]. More research is needed to characterize other stimuli of spz motility.
Classically, gliding assays are used as the gold standard for assessing spz motility in vitro [
27,
28], but this assay is not ideal for exploring spz motility regulation, because it only provides indirect analysis of spz motility performed through post hoc assessment of spz trails [
5,
29]. What is lacking to date, is a quantitative in vitro analysis tool that allows real time detailed spz motility characterization.
In vitro microscopic imaging studies with Plasmodium berghei-mCherry when augmented with a quantitative analysis tool have the potential to provide a means to assess the regulation of P. berghei adhesion and locomotion by formulation composition. To illustrate the potential of this concept, the custom image analysis software called SMOOTIn vitro (Sporozoite Motility Orienting and Organizing Tool) has been developed and used to study the effect of a systematic variation in formulations: PBS, HBSS and RPMI, enriched with either albumin or whole serum.
Discussion
The availability of a dedicated analysis tool (SMOOTIn vitro) enabled a quantitative analysis of spz motility by describing their (1) attachment rate, (2) movement pattern distribution and (3) velocity distribution. Because SMOOTIn vitro enabled to tease apart spz motility in tracks, segments and frames, the different motility parameters could be individually dissected and subtle differences could be quantified. In this way has been confirmed that albumin is essential to induce spz attachment and movement. Glucose, salts, amino acids and vitamins, components in RPMI, further increased the attachment rate and the percentage of moving spz, whereas the supplements present in whole serum regulated the velocity of the spz movement. Combined, these findings indicate that the regulation of spz motility is a complex interplay of spz with different macromolecules and salts.
The three in vitro movement patterns, floating, stationary (fully attached and waving) and circling (> 95% CCW), which were observed for
P. berghei are in line with previous reports [
8,
28,
32]. These same reports have also shown that spz could only sustain CW circling for a short period of time. In this study, SMOOT
In vitro facilitated the analysis of the circular movement patterns at a level of detail beyond what has previously been performed [
25,
33]. Particularly, the image processing tool enabled the assessment of unique but subtle alterations in spz velocity along the tracks, which might reflect the turnover rate of spz adhesion sites [
6]. The remarkable differences in velocity distribution between the formulations suggested that this level of detail is needed to do justice to the complex interplay between the available (macro)molecules and the spz motility machinery. Since SMOOT
In vitro allowed for detailed analysis of spz motility at frame level, the tool can be used to further study the action of (novel) motility inhibiting drugs at different concentrations. Potentially, motility analysis with SMOOT
In vitro could be performed as an additional assay to previously described high-throughput screening methods [
2].
Spz attachment and movement are two distinguishable, but likely related steps in spz motility. Both appear to be initiated by external stimuli transferred by internal signalling cascades. Hegge et al. have described spz adherence and movement as a four step procedure [
34]: step 1 is the initial adhesion with one tip, step 2 the formation of secondary adhesion site, step 3 full body attachment, step 4 the initiation of gliding. According to literature, step 2–4 of this adhesion model should be dependent on the secretion of adhesive proteins triggered by albumin and the turnover of these adhesion sites by the actin/myosin-based molecular motor [
6,
24,
35]. The latter requires a considerable sustained internal energy production. In accordance with the proposed model, without the presence of albumin and glucose only a few spz (7%) could achieve full body attachment (step 3) and none of the spz started gliding (step 4). Albumin strongly promoted full body attachment and glucose further increased it (step 3), however in these conditions also gliding was initiated (step 4). In conclusion, our data supports the notion that spz attachment and movement are related steps in spz motility.
Interestingly, albumin and glucose do not seem to be the sole supplements regulating spz motility. In addition, supplements present in RPMI (which, besides salts and glucose also contains amino acids and vitamins) act as stimuli for spz attachment and subsequent moving. As spz can also use glutamate or glutamine to enter the Krebs cycle to produce energy and the availability of these compounds influences spz motility [
10,
33], this could explain why depletion of the amino acid content of RPMI decreased the percentage of attached and moving spz compared to PBS and HBSS.
The available (macro)molecules did not only regulate the occurrence of spz adherence and moving, but also the velocity of their forward locomotion. Besides attachment to the surface via adhesive proteins, also detachment by the turnover of the adhesion sites is essential to allow the spz to move forwards at a certain speed [
6,
36]. This attachment–detachment process could have caused the fluctuating velocity we measured at frame level. Strikingly, whole serum induced a distribution shift to higher velocities of spz compared to albumin without changing the maximum reached velocity. It is still unclear which of the > 30 components that whole serum consists of is responsible for this shift. Nevertheless, the change in velocity distribution induced by whole serum reveals that besides the attachment rate and the initiation of movement, the velocity of spz movement is clearly also regulated by the formulation composition.
The comparison between the attachment rate, movement pattern distribution and velocity distribution induced by the different formulations suggested two different trends: (1) whole serum both increased the attachment rate, the percentage of circling spz and their velocity compared to albumin and (2) RPMI increased the attachment rate and the percentage of circling spz, but decreased their velocity compared to PBS and HBSS. Combined these trends indicate that spz motility is dependent on regulators inducing the right balance between strong attachment and fast detachment. The SMOOT
In vitro analysis of the effect of different potential stimuli and inhibitors has the potential to provide insight in the biological mechanisms behind spz motility. A recently developed fluorescent labelling approach for non-fluorescent parasites provides the opportunity to study the motility of spz in vaccine preparations or isolated in the field [
37]. Potentially, SMOOT
In vitro can be adapted to study the motility of malaria parasites in other developmental stages (e.g. ookinetes) if the segmentation and stitching parameters would be adjusted and validated to select the parasite.
Despite the regulating role of the different supplements on spz motility, PfSPZ vaccines currently are formulated in PBS with albumin only [
38]. It is not yet clear to what extent the observed in vitro formulation effects can impact the in vivo situation where proteins, glucose, salts and amino acids are in supply from the surrounding blood/tissue. However, this should be the subject of further research, as the addition of glucose, salts and amino acids will potentially improve spz motility after deposition in the human skin and thereby may enhance the potency of whole-parasite malaria vaccines.
Authors’ contributions
Study concept and design: CK, LL, AV, FL, MR. Acquisition of data: CK, LL. Analyses and interpretation of data: CK, LL, FL, MR. Drafting the manuscript: CK, FL, MR and all authors reviewed the manuscript. Critical revision of the manuscript for important intellectual content: LL, MO, BW, AV, BF. Technical or material support: MO, EB, SC, BF. Study supervision: AV, FL, MR. All authors read and approved the final manuscript.