The case for PfEMP1-based vaccines to protect pregnant women against Plasmodium falciparum malaria

Abstract

Vaccines are very cost-effective tools in combating infectious disease mortality and morbidity. Unfortunately, vaccines efficiently protecting against infection with malaria parasites are not available and are not likely to appear in the near future. An alternative strategy would be vaccines protecting against the disease and its consequences rather than against infection per se, by accelerating the development of the protective immunity that is normally acquired after years of exposure to malaria parasites in areas of stable transmission. This latter strategy is being energetically pursued to develop a vaccine protecting pregnant women and their offspring against mortality and morbidity caused by the accumulation of Plasmodium falciparum-infected erythrocytes in the placenta. It is based on a detailed understanding of the parasite antigen and the host receptor involved in this accumulation, as well as knowledge regarding the protective immune response that is acquired in response to placental P. falciparum infection. Nevertheless, it remains controversial in some quarters whether such a vaccine would have the desired impact, or indeed whether the strategy is meaningful. This article critically examines the relevance of several perceived obstacles to development of a vaccine against placental malaria.

Keywords::

• malaria
• PfEMP1
• placenta
• Plasmodium falciparum
• pregnancy
• vaccine
• VAR2CSA

Financial & competing interests disclosure

The author is listed as a co-inventor of patent P33116PC01-WO2004067559 A, (30 December 2003): ‘Compounds useful in the diagnosis and treatment of pregnancy-associated malaria’. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

CSA: Chondroitin sulfate A; IE: Infected erythrocytes.