Background
Malaria is primarily confined to the poorest tropical areas of the world and constitutes one of the world’s greatest public health problems [
1]. Efforts to eliminate malaria transmission through use of insecticides and/or bed nets have resulted in only limited success [
2]. Vaccines hold the potential for effective control and elimination of the disease burden. However, despite decades of research there is still no clinically applicable vaccine available. With the renewed focus on malaria eradication, transmission blocking malaria vaccines (TBMV) which induce antibodies that target the sexual stages of the parasite have become a focus of malaria vaccine research. One of the leading candidates for a TBMV is
Pfs48/45, a protein expressed in gametocytes and on the surface of gametes and zygotes [
3‐
6].
Pfs48/45 is essential for male gamete fertility in
Plasmodium [
7] and anti-
Pfs48/45 antibodies have been found to prevent zygote development in the standard membrane feeding assay (SMFA) [
8]. The exact mechanism through which these antibodies interfere with fertility is unknown but steric hindrance is likely a possibility. Irrespective of the mechanism, it has been shown in ex vivo assays that there is a strong correlation between levels of
Pfs48/45-specific antibodies in sera from malaria-endemic areas and TB activity in the SMFA [
9‐
11].
Pfs48/45 is a relatively cysteine-rich protein with multiple disulfide bonds resulting in antibody epitopes that are dependent on tertiary structure rather than linear amino acid sequence. A panel of mAbs have been generated and characterized with respect to their TB-activity in SMFA [
12,
13]. Of these, mAb 85RF45.1 exhibits the strongest TB activity whereas mAbs 85RF45.2 and 85RF45.3 do not exhibit TB activity on their own but may act synergistically with 85RF45.1 [
12]. All three mAbs recognize conformational epitopes, of which epitope I, defined by mAb 85RF45.1, is located in the C-terminal portion of
Pfs48/45 (10C) [
14].
Pfs48/45 and fragments thereof has been produced on recombinant form in various expression systems [
5,
6,
15‐
18]; however, none of these products has reached clinical development phase. Recently, correctly folded fragments were produced of
Pfs48/45 (10C) containing all three epitopes and
Pfs48/45 (6C) containing only TB-epitope 1 fused in frame with the N-terminal part of the glutamate rich protein (GLURP) in the
Lactococcus lactis expression system [
19,
20]. This system has previously proved efficient for the production of GMZ2, an asexual blood-stage vaccine candidate [
21,
22], and GMZ2 adjuvanted in Al(OH)
3 has shown good safety and tolerability in phase 1 clinical trials [
21,
23‐
25].
With the aim of developing a TBMV, the effects of different adjuvant formulations were investigated in mice and rats on: (1) the production of antigen-specific IgG against recombinant and native proteins; and, (2) the biological activity of antibodies elicited by vaccination. The adjuvant vehicles used were either aluminium hydroxide (Alum), an oil-in-water stable emulsion (SE) or AbISCO
®-100, a saponin based adjuvant. Two of these formulations (Alum and SE) were supplemented with the Toll-like receptor synthetic TLR 4 agonist glucopyranosyl lipid A adjuvant (GLA) [
26]. GLA was used in the present study because it has been shown to enhance IgG responses against the GLURP.R0 component of GMZ2 in mice [
27], and GLA is safe for use in humans and non-human primates [
28].
Discussion
The development of a TBMV is an attractive goal because it holds the potential to accelerate elimination or even eradication of
P. falciparum malaria. The inclusion of a TBMV in these efforts would require a highly immunogenic vaccine formulation with the capacity to induce high levels of TB antibodies lasting for at least one transmission season. This is particularly important since several malaria antigens have proved to be poorly immunogenic in adjuvants for human use [
32,
33]. Recently, a new multi-stage vaccine candidate (R0.10C) was developed consisting of the N-terminal domain of GLURP (R0) fused in frame to a functional domain of
Pfs48/45 (10C) [
19]. The potential importance of increasing the overall immunogenicity of R0.10C and the
Pfs48/45 domain in particular, is suggested by the direct relationship between anti-R0.10C antibody titre and biological activity in the SMFA [
19]. In the present study, a series of adjuvant formulations in small rodents were investigated for their ability to enhance antibody responses against sexual blood stages. Antisera were also investigated for their ability to control parasite fertilization in the SMFA. It is evident that both Alum and SE/GLA formulations elicited strong TB immunity with five out of five animals showing >99 % TRA. In contrast, R0.10C formulated in Alum/GLA or in AbISCO was slightly less efficient with four out of five animals seroconverting to functional antibody titres. All mice and rat sera were tested at a 1/9 dilution. Testing rat sera from the Alum and Alum/GLA group at dilution of 1/27 still resulted in strong TB activity for the Alum group but not for the Alum/GLA group, showing that Alum alone is a better adjuvant for functional antibodies.
The analysis of specific antibody responses against the 10C domains of R0.10C suggests that the Alum formulation lead to the highest levels of 10C-specific antibodies compared to all other formulations (Fig.
2d). In contrast, an oil-in-water emulsion formulation of GLA led to relatively lower levels of 10C-specific IgG in mice, but not in rats (Fig.
2b). The discrepancy between the antibody titer measured in the R0.10C and MBP.10C ELISAs is due to antibodies against the R0 region of R0.10C. Since recombinant MBP.10C only share the
Pfs48/45-10C region with the R0.10C fusion protein, MBP.10C was used for the detection of 10C-specific antibodies. MBP.10C was included in the present study to allow comparison with previously published data [
6]. Re-testing in a larger group of animals and/or using the 10C part alone may help to clarify whether there is indeed a specific difference.
The identification and characterization of TB epitopes of
Pfs48/45 have been facilitated by the availability of mAbs with TB activity [
8,
12,
13]. In the process of developing a
Pfs48/45-based TBMV, a series of mAbs was used against conformation-dependent epitopes for the characterization of recombinant
Pfs48/45 [
6,
13]. Here, it has demonstrated that a R0.10C antigen preparation which is correctly folded with respect to epitope 1 of
Pfs48/45 elicits high levels of antibodies against this epitope in rats with the capacity to inhibit parasite growth in the mosquito when adjuvanted in Alum, Alum/GLA, SE/GLA, or AbISCO. Sera which inhibit a high level of TB activity (TRA) also has a low mosquito infection rate (Tables
1,
2,
3). Adjuvanted with Alum resulted in the highest TB activity (Table
3). Recently, Singh and others [
20] show that R0.6C (only epitope 1 of
Pfs48/45) did also give high TB activity. Further studies must be performed combining R0.10C and R0.6C for immunogenicity data.
The adjuvants tested here (Alum and SE with/without addition of GLA or AbISCO) are all applicable for human use [
28,
34]. Aluminium salts are the most commonly used adjuvants in clinical trials and they have the reputation of being safe and give high antibody titres and long-lasting antibody responses [
34]. Whether R0.10C/Alum is also a strong immunogen for induction of functional antibodies in humans remains to be determined.
In summary, the
Lactococcus lactis expression platform was used for production of correctly folded
Pfs48/45. Since Alum has been used in past malaria vaccine trials of GLURP-based vaccine candidates [
21,
35], a further vaccination study with the R0.10C antigen in combination with Alum alone can be pursued.
Authors’ contributions
WR, MT and RS contributed to the design and performance of the experiments and the writing of the manuscript. MvdVB produced the asexual and sexual stage parasites and GvG performed the SMFA. LS, SKS and SK expressed, purified and analysed the recombinant R0.10C protein. TA, GA and MC provided technical advice. All authors have read and approved the final manuscript.
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