Progress and Insights Toward an Effective Placental Malaria Vaccine

Benoît Gamain, Arnaud Chêne, Nicola K Viebig, Nicaise Tuikue Ndam, Morten A Nielsen, Benoît Gamain, Arnaud Chêne, Nicola K Viebig, Nicaise Tuikue Ndam, Morten A Nielsen

Abstract

In areas where Plasmodium falciparum transmission is endemic, clinical immunity against malaria is progressively acquired during childhood and adults are usually protected against the severe clinical consequences of the disease. Nevertheless, pregnant women, notably during their first pregnancies, are susceptible to placental malaria and the associated serious clinical outcomes. Placental malaria is characterized by the massive accumulation of P. falciparum infected erythrocytes and monocytes in the placental intervillous spaces leading to maternal anaemia, hypertension, stillbirth and low birth weight due to premature delivery, and foetal growth retardation. Remarkably, the prevalence of placental malaria sharply decreases with successive pregnancies. This protection is associated with the development of antibodies directed towards the surface of P. falciparum-infected erythrocytes from placental origin. Placental sequestration is mediated by the interaction between VAR2CSA, a member of the P. falciparum erythrocyte membrane protein 1 family expressed on the infected erythrocytes surface, and the placental receptor chondroitin sulfate A. VAR2CSA stands today as the leading candidate for a placental malaria vaccine. We recently reported the safety and immunogenicity of two VAR2CSA-derived placental malaria vaccines (PRIMVAC and PAMVAC), spanning the chondroitin sulfate A-binding region of VAR2CSA, in both malaria-naïve and P. falciparum-exposed non-pregnant women in two distinct Phase I clinical trials (ClinicalTrials.gov, NCT02658253 and NCT02647489). This review discusses recent advances in placental malaria vaccine development, with a focus on the recent clinical data, and discusses the next clinical steps to undertake in order to better comprehend vaccine-induced immunity and accelerate vaccine development.

Keywords: PfEMP1; Plasmodium falciparum; VAR2CSA; placental malaria; pregnancy; vaccine.

Conflict of interest statement

MN appears on a patent issued on virus like particle vaccines (US10086056B2). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past collaboration with the author NTN.

Copyright © 2021 Gamain, Chêne, Viebig, Tuikue Ndam and Nielsen.

Figures

Figure 1
Figure 1
Schematic representation of VAR2CSA and vaccines tested in clinical trials. VAR2CSA is a 350-kDa transmembrane protein composed of an N-terminal segment (NTS) followed by six Duffy-binding like (DBL) domains interspaced by 4 inter-domains (ID), a transmembrane region and a cytoplasmic Acidic C terminus sequence (ATS). PRIMVAC and PAMVAC schematic representation with sequences boundaries, predicted molecular weight, expression systems, and adjuvants used for the Phase I clinical trials. ClinicalTrials identifier for both Phase I are indicated.

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