1
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Gardner RA, Ceppi F, Rivers J, Annesley C, Summers C, Taraseviciute A, Gust J, Leger KJ, Tarlock K, Cooper TM, Finney OC, Brakke H, Li DH, Park JR, Jensen MC. Preemptive mitigation of CD19 CAR T-cell cytokine release syndrome without attenuation of antileukemic efficacy. Blood 2019; 134:2149-2158. [PMID: 31697826 PMCID: PMC6908832 DOI: 10.1182/blood.2019001463] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022] Open
Abstract
Immunotherapy with the adoptive transfer of T cells redirected with CD19-specific chimeric antigen receptors (CARs) for B-lineage acute lymphoblastic leukemia (ALL) can salvage >80% of patients having relapsed/refractory disease. The therapeutic index of this emerging modality is attenuated by the occurrence of immunologic toxicity syndromes that occur upon CAR T-cell engraftment. Here, we report on the low incidence of severe cytokine release syndrome (CRS) in a subject treated with a CAR T-cell product composed of a defined ratio CD4:CD8 T-cell composition with a 4-1BB:zeta CAR targeting CD19 who also recieved early intervention treatment. We report that early intervention with tocilizumab and/or corticosteroids may reduce the frequency at which subjects transition from mild CRS to severe CRS. Although early intervention doubled the numbers of subjects dosed with tocilizumab and/or corticosteroids, there was no apparent detrimental effect on minimal residual disease-negative complete remission rates or subsequent persistence of functional CAR T cells compared with subjects who did not receive intervention. Moreover, early intervention therapy did not increase the proportion of subjects who experience neurotoxicity or place subjects at risk for infectious sequelae. These data support the contention that early intervention with tocilizumab and/or corticosteroids in subjects with early signs of CRS is without negative impact on the antitumor potency of CD19 CAR T cells. This intervention serves to enhance the therapeutic index in relapsed/refractory patients and provides the rationale to apply CAR T-cell therapy more broadly in ALL therapy. This trial was registered at www.clinicaltrials.gov as #NCT020284.
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MESH Headings
- Adolescent
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/pharmacology
- Adult
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/pharmacology
- Antigens, CD19/immunology
- Antigens, CD19/metabolism
- Child
- Child, Preschool
- Cytokine Release Syndrome/etiology
- Cytokine Release Syndrome/metabolism
- Cytokines/blood
- Cytokines/metabolism
- Dose-Response Relationship, Drug
- Female
- Humans
- Immunotherapy, Adoptive/adverse effects
- Immunotherapy, Adoptive/methods
- Incidence
- Infant
- Male
- Neoplasm Grading
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Receptors, Antigen, T-Cell/metabolism
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- T-Lymphocyte Subsets/pathology
- Young Adult
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Affiliation(s)
- Rebecca A Gardner
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | | | - Julie Rivers
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Colleen Annesley
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Corinne Summers
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Agne Taraseviciute
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Juliane Gust
- Seattle Children's Research Institute, Seattle, WA
- Department of Neurology, University of Washington, Seattle, WA; and
| | - Kasey J Leger
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Katherine Tarlock
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Todd M Cooper
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | | | | | - Daniel H Li
- Clinical Statistics Group, Juno Therapeutics, Inc., Seattle, WA
| | - Julie R Park
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
| | - Michael C Jensen
- Seattle Children's Research Institute, Seattle, WA
- Department of Pediatrics and
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2
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Healy SA, Murphy SC, Hume JCC, Shelton L, Kuntz S, Van Voorhis WC, Moodie Z, Metch B, Wang R, Silver-Brace T, Fishbaugher M, Kennedy M, Finney OC, Chaturvedi R, Marcsisin SR, Hobbs CV, Warner-Lubin M, Talley AK, Wong-Madden S, Stuart K, Wald A, Kappe SH, Kublin JG, Duffy PE. Chemoprophylaxis Vaccination: Phase I Study to Explore Stage-specific Immunity to Plasmodium falciparum in US Adults. Clin Infect Dis 2019; 71:1481-1490. [PMID: 31621832 PMCID: PMC7486848 DOI: 10.1093/cid/ciz1010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Chemoprophylaxis vaccination with sporozoites (CVac) with chloroquine induces protection against a homologous Plasmodium falciparum sporozoite (PfSPZ) challenge, but whether blood-stage parasite exposure is required for protection remains unclear. Chloroquine suppresses and clears blood-stage parasitemia, while other antimalarial drugs, such as primaquine, act against liver-stage parasites. Here, we evaluated CVac regimens using primaquine and/or chloroquine as the partner drug to discern whether blood-stage parasite exposure impacts protection against homologous controlled human malaria infection. METHODS In a Phase I, randomized, partial double-blind, placebo-controlled study of 36 malaria-naive adults, all CVac subjects received chloroquine prophylaxis and bites from 12-15 P. falciparum-infected mosquitoes (CVac-chloroquine arm) at 3 monthly iterations, and some received postexposure primaquine (CVac-primaquine/chloroquine arm). Drug control subjects received primaquine, chloroquine, and uninfected mosquito bites. After a chloroquine washout, subjects, including treatment-naive infectivity controls, underwent homologous, PfSPZ controlled human malaria infection and were monitored for parasitemia for 21 days. RESULTS No serious adverse events occurred. During CVac, all but 1 subject in the study remained blood-smear negative, while only 1 subject (primaquine/chloroquine arm) remained polymerase chain reaction-negative. Upon challenge, compared to infectivity controls, 3/3 chloroquine arm subjects displayed delayed patent parasitemia (P = .01) but not sterile protection, while 3/11 primaquine/chloroquine subjects remained blood-smear negative. CONCLUSIONS CVac-primaquine/chloroquine is safe and induces sterile immunity to P. falciparum in some recipients, but a single 45 mg dose of primaquine postexposure does not completely prevent blood-stage parasitemia. Unlike previous studies, CVac-chloroquine did not produce sterile immunity. CLINICAL TRIALS REGISTRATION NCT01500980.
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Affiliation(s)
- Sara A Healy
- Center for Infectious Disease Research, Seattle, Washington, USA,Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA,Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sean C Murphy
- Center for Infectious Disease Research, Seattle, Washington, USA,Department of Laboratory Medicine and Microbiology, University of Washington, Seattle, Washington, USA,Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jen C C Hume
- Center for Infectious Disease Research, Seattle, Washington, USA,Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Shelton
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Steve Kuntz
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Wesley C Van Voorhis
- Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA,Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Zoe Moodie
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Barbara Metch
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ruobing Wang
- Center for Infectious Disease Research, Seattle, Washington, USA
| | | | | | - Mark Kennedy
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Olivia C Finney
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Richa Chaturvedi
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Sean R Marcsisin
- Military Malaria Research Program, Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Charlotte V Hobbs
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Margaret Warner-Lubin
- Center for Infectious Disease Research, Seattle, Washington, USA,C3 Research Associates, Seattle, Washington, USA
| | - Angela K Talley
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Sharon Wong-Madden
- Center for Infectious Disease Research, Seattle, Washington, USA,Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ken Stuart
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - Anna Wald
- Department of Laboratory Medicine and Microbiology, University of Washington, Seattle, Washington, USA,Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Epidemiology, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Stefan H Kappe
- Center for Infectious Disease Research, Seattle, Washington, USA
| | - James G Kublin
- Center for Infectious Disease Research, Seattle, Washington, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Patrick E Duffy
- Center for Infectious Disease Research, Seattle, Washington, USA,Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA,Correspondence: P. E. Duffy, 29 Lincoln Drive, Building 29B, Bethesda, MD, 20892 ()
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3
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Gust J, Finney OC, Li D, Brakke HM, Hicks RM, Futrell RB, Gamble DN, Rawlings-Rhea SD, Khalatbari HK, Ishak GE, Duncan VE, Hevner RF, Jensen MC, Park JR, Gardner RA. Glial injury in neurotoxicity after pediatric CD19-directed chimeric antigen receptor T cell therapy. Ann Neurol 2019; 86:42-54. [PMID: 31074527 DOI: 10.1002/ana.25502] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test whether systemic cytokine release is associated with central nervous system inflammatory responses and glial injury in immune effector cell-associated neurotoxicity syndrome (ICANS) after chimeric antigen receptor (CAR)-T cell therapy in children and young adults. METHODS We performed a prospective cohort study of clinical manifestations as well as imaging, pathology, CSF, and blood biomarkers on 43 subjects ages 1 to 25 who received CD19-directed CAR/T cells for acute lymphoblastic leukemia (ALL). RESULTS Neurotoxicity occurred in 19 of 43 (44%) subjects. Nine subjects (21%) had CTCAE grade 3 or 4 neurological symptoms, with no neurotoxicity-related deaths. Reversible delirium, headache, decreased level of consciousness, tremor, and seizures were most commonly observed. Cornell Assessment of Pediatric Delirium (CAPD) scores ≥9 had 94% sensitivity and 33% specificity for grade ≥3 neurotoxicity, and 91% sensitivity and 72% specificity for grade ≥2 neurotoxicity. Neurotoxicity correlated with severity of cytokine release syndrome, abnormal past brain magnetic resonance imaging (MRI), and higher peak CAR-T cell numbers in blood, but not cerebrospinal fluid (CSF). CSF levels of S100 calcium-binding protein B and glial fibrillary acidic protein increased during neurotoxicity, indicating astrocyte injury. There were concomitant increases in CSF white blood cells, protein, interferon-γ (IFNγ), interleukin (IL)-6, IL-10, and granzyme B (GzB), with concurrent elevation of serum IFNγ IL-10, GzB, granulocyte macrophage colony-stimulating factor, macrophage inflammatory protein 1 alpha, and tumor necrosis factor alpha, but not IL-6. We did not find direct evidence of endothelial activation. INTERPRETATION Our data are most consistent with ICANS as a syndrome of systemic inflammation, which affects the brain through compromise of the neurovascular unit and astrocyte injury. ANN NEUROL 2019.
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Affiliation(s)
- Juliane Gust
- Seattle Children's Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, WA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Olivia C Finney
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | | | - Hannah M Brakke
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Roxana M Hicks
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Robert B Futrell
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Danielle N Gamble
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Stephanie D Rawlings-Rhea
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | | | | | | | - Robert F Hevner
- Department of Pathology, University of California San Diego, San Diego, CA
| | - Michael C Jensen
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA.,Seattle Children's Division of Hematology-Oncology, Seattle, WA
| | - Julie R Park
- Seattle Children's Division of Hematology-Oncology, Seattle, WA
| | - Rebecca A Gardner
- Seattle Children's Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA.,Seattle Children's Division of Hematology-Oncology, Seattle, WA
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4
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Finney OC, Brakke H, Rawlings-Rhea S, Hicks R, Doolittle D, Lopez M, Futrell B, Orentas RJ, Li D, Gardner R, Jensen MC. CD19 CAR T cell product and disease attributes predict leukemia remission durability. J Clin Invest 2019; 129:2123-2132. [PMID: 30860496 PMCID: PMC6486329 DOI: 10.1172/jci125423] [Citation(s) in RCA: 221] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chimeric antigen receptor (CAR) T cells can induce remission in highly refractory leukemia and lymphoma subjects, yet the parameters for achieving sustained relapse-free survival are not fully delineated. METHODS We analyzed 43 pediatric and young adult subjects participating in a Phase I trial of defined composition CD19CAR T cells (NCT02028455). CAR T cell phenotype, function and expansion, as well as starting material T cell repertoire, were analyzed in relation to therapeutic outcome (defined as achieving complete remission within 63 days) and duration of leukemia free survival and B cell aplasia. RESULTS These analyses reveal that initial therapeutic failures (n = 5) were associated with attenuated CAR T cell expansion and/or rapid attrition of functional CAR effector cells following adoptive transfer. The CAR T products were similar in phenotype and function when compared to products resulting in sustained remissions. However, the initial apheresed peripheral blood T cells could be distinguished by an increased frequency of LAG-3+/TNF-αlow CD8 T cells and, following adoptive transfer, the rapid expression of exhaustion markers. For the 38 subjects who achieved an initial sustained MRD-neg remission, remission durability correlated with therapeutic products having increased frequencies of TNF-α-secreting CAR CD8+ T cells, and was dependent on a sufficiently high CD19+ antigen load at time of infusion to trigger CAR T cell proliferation. CONCLUSION These parameters have the potential to prospectively identify patients at risk for therapeutic failure and support the development of approaches to boost CAR T cell activation and proliferation in patients with low levels of CD19 antigen. TRIAL REGISTRATION ClinicalTrials.gov NCT02028455. FUNDING Partial funding for this study was provided by Stand Up to Cancer & St. Baldrick's Pediatric Dream Team Translational Research Grant (SU2C-AACR-DT1113), RO1 CA136551-05, Alex Lemonade Stand Phase I/II Infrastructure Grant, Conquer Cancer Foundation Career Development Award, Washington State Life Sciences Discovery Fund, Ben Towne Foundation, William Lawrence & Blanche Hughes Foundation, and Juno Therapeutics, Inc., a Celgene Company.
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Affiliation(s)
- Olivia C. Finney
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Hannah Brakke
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Stephanie Rawlings-Rhea
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Roxana Hicks
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Danielle Doolittle
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Marisa Lopez
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Ben Futrell
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Rimas J. Orentas
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Daniel Li
- Clinical Statistics Group, Juno Therapeutics, Inc., Seattle, Washington, USA
| | - Rebecca Gardner
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Michael C. Jensen
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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5
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Talley AK, Healy SA, Finney OC, Murphy SC, Kublin J, Salas CJ, Lundebjerg S, Gilbert P, Van Voorhis WC, Whisler J, Wang R, Ockenhouse CF, Heppner DG, Kappe SH, Duffy PE. Safety and comparability of controlled human Plasmodium falciparum infection by mosquito bite in malaria-naïve subjects at a new facility for sporozoite challenge. PLoS One 2014; 9:e109654. [PMID: 25405724 PMCID: PMC4236046 DOI: 10.1371/journal.pone.0109654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/30/2014] [Indexed: 12/18/2022] Open
Abstract
Background Controlled human malaria infection (CHMI) studies which recapitulate mosquito-borne infection are a critical tool to identify protective vaccine and drug candidates for advancement to field trials. In partnership with the Walter Reed Army Institute of Research, the CHMI model was established at the Seattle Biomedical Research Institute's Malaria Clinical Trials Center (MCTC). Activities and reagents at both centers were aligned to ensure comparability and continued safety of the model. To demonstrate successful implementation, CHMI was performed in six healthy malaria-naïve volunteers. Methods All volunteers received NF54 strain Plasmodium falciparum by the bite of five infected Anopheles stephensi mosquitoes under controlled conditions and were monitored for signs and symptoms of malaria and for parasitemia by peripheral blood smear. Subjects were treated upon diagnosis with chloroquine by directly observed therapy. Immunological (T cell and antibody) and molecular diagnostic (real-time quantitative reverse transcriptase polymerase chain reaction [qRT-PCR]) assessments were also performed. Results All six volunteers developed patent parasitemia and clinical malaria. No serious adverse events occurred during the study period or for six months post-infection. The mean prepatent period was 11.2 days (range 9–14 days), and geometric mean parasitemia upon diagnosis was 10.8 parasites/µL (range 2–69) by microscopy. qRT-PCR detected parasites an average of 3.7 days (range 2–4 days) earlier than blood smears. All volunteers developed antibodies to the blood-stage antigen merozoite surface protein 1 (MSP-1), which persisted up to six months. Humoral and cellular responses to pre-erythrocytic antigens circumsporozoite protein (CSP) and liver-stage antigen 1 (LSA-1) were limited. Conclusion The CHMI model was safe, well tolerated and characterized by consistent prepatent periods, pre-symptomatic diagnosis in 3/6 subjects and adverse event profiles as reported at established centers. The MCTC can now evaluate candidates in the increasingly diverse vaccine and drug pipeline using the CHMI model. Trial Registration ClinicalTrials.gov NCT01058226
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Affiliation(s)
- Angela K. Talley
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Sara A. Healy
- Laboratory for Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Olivia C. Finney
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Sean C. Murphy
- Department of Laboratory Medicine, University of Washington Medical Center, Seattle, Washington, United States of America
| | - James Kublin
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Carola J. Salas
- United States Naval Medical Research Unit Number 6, Lima, Peru
| | - Susan Lundebjerg
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Peter Gilbert
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Wesley C. Van Voorhis
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, United States of America
| | - John Whisler
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Ruobing Wang
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Chris F. Ockenhouse
- United States Military Malaria Vaccine Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - D. Gray Heppner
- United States Military Malaria Vaccine Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Stefan H. Kappe
- Malaria Clinical Trials Center, Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Patrick E. Duffy
- Laboratory for Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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6
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Finney OC, Danziger SA, Molina DM, Vignali M, Takagi A, Ji M, Stanisic DI, Siba PM, Liang X, Aitchison JD, Mueller I, Gardner MJ, Wang R. Predicting antidisease immunity using proteome arrays and sera from children naturally exposed to malaria. Mol Cell Proteomics 2014; 13:2646-60. [PMID: 25023128 DOI: 10.1074/mcp.m113.036632] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malaria remains one of the most prevalent and lethal human infectious diseases worldwide. A comprehensive characterization of antibody responses to blood stage malaria is essential to support the development of future vaccines, sero-diagnostic tests, and sero-surveillance methods. We constructed a proteome array containing 4441 recombinant proteins expressed by the blood stages of the two most common human malaria parasites, P. falciparum (Pf) and P. vivax (Pv), and used this array to screen sera of Papua New Guinea children infected with Pf, Pv, or both (Pf/Pv) that were either symptomatic (febrile), or asymptomatic but had parasitemia detectable via microscopy or PCR. We hypothesized that asymptomatic children would develop antigen-specific antibody profiles associated with antidisease immunity, as compared with symptomatic children. The sera from these children recognized hundreds of the arrayed recombinant Pf and Pv proteins. In general, responses in asymptomatic children were highest in those with high parasitemia, suggesting that antibody levels are associated with parasite burden. In contrast, symptomatic children carried fewer antibodies than asymptomatic children with infections detectable by microscopy, particularly in Pv and Pf/Pv groups, suggesting that antibody production may be impaired during symptomatic infections. We used machine-learning algorithms to investigate the relationship between antibody responses and symptoms, and we identified antibody responses to sets of Plasmodium proteins that could predict clinical status of the donors. Several of these antibody responses were identified by multiple comparisons, including those against members of the serine enriched repeat antigen family and merozoite protein 4. Interestingly, both P. falciparum serine enriched repeat antigen-5 and merozoite protein 4 have been previously investigated for use in vaccines. This machine learning approach, never previously applied to proteome arrays, can be used to generate a list of potential seroprotective and/or diagnostic antigens candidates that can be further evaluated in longitudinal studies.
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Affiliation(s)
- Olivia C Finney
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA
| | - Samuel A Danziger
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA; §Institute for Systems Biology, 401 Terry Ave N, Seattle, WA 98109 USA
| | - Douglas M Molina
- ¶Antigen Discovery Inc. (ADi), 1 Technology Dr E, Irvine, CA 92618 USA
| | - Marissa Vignali
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA
| | - Aki Takagi
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA
| | - Ming Ji
- ‖Division of Epidemiology/Biostatistics, Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Drive, San Diego, CA 92182
| | - Danielle I Stanisic
- **Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea; ‡‡Walter & Eliza Hall Institute, 1G Royal Parade, Parkville Victoria 3052, Australia
| | - Peter M Siba
- **Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Xiawu Liang
- ¶Antigen Discovery Inc. (ADi), 1 Technology Dr E, Irvine, CA 92618 USA
| | - John D Aitchison
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA; §Institute for Systems Biology, 401 Terry Ave N, Seattle, WA 98109 USA
| | - Ivo Mueller
- **Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea; ‡‡Walter & Eliza Hall Institute, 1G Royal Parade, Parkville Victoria 3052, Australia; §§Barcelona Centre for International Health Research, Carrer Roselló 132, 08036 Barcelona, Spain
| | - Malcolm J Gardner
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA
| | - Ruobing Wang
- From the ‡Seattle Biomedical Research Institute, 307 Westlake Ave N., Suite 500, Seattle, WA 98109 USA;
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7
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Finney OC, Keitany GJ, Smithers H, Kaushansky A, Kappe S, Wang R. Immunization with genetically attenuated P. falciparum parasites induces long-lived antibodies that efficiently block hepatocyte invasion by sporozoites. Vaccine 2014; 32:2135-8. [PMID: 24582635 DOI: 10.1016/j.vaccine.2014.02.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Abstract
Whole-parasite malaria vaccines have shown promise in clinical trials. We recently reported the first human trial of a malaria vaccine based on Plasmodium falciparum genetically attenuated parasites (PfGAP). Herein we report for the first time that PfGAP induces prolonged functional humoral responses in humans. Six volunteers were exposed to 5 bites of PfGAP-infected mosquitoes followed by approximately 200 bites. Plasma collected from all volunteers 3 months after the last exposure efficiently inhibits invasion of hepatocytes by P. falciparum sporozoites. The level of inhibition observed is comparable to that attained using plasma collected after 4-5 intravenously administrations of high numbers of irradiated sporozoites, validating the potential of PfGAP malaria vaccines. Our data highlight the role of antibody responses in pre-erythrocytic stages of human malaria, and suggests that to be protective, malaria vaccines might need to elicit long-lasting functional antibodies in addition to cellular responses.
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Affiliation(s)
- Olivia C Finney
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA
| | - Gladys J Keitany
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA
| | - Hannah Smithers
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA
| | - Alexis Kaushansky
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA
| | - Stefan Kappe
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA
| | - Ruobing Wang
- Seattle Biomedical Research Institute, 307 Westlake Avenue North, Suite 500, Seattle, WA, 98109, USA.
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Finney OC, Lawrence E, Gray AP, Njie M, Riley EM, Walther M. Freeze-thaw lysates of Plasmodium falciparum-infected red blood cells induce differentiation of functionally competent regulatory T cells from memory T cells. Eur J Immunol 2012; 42:1767-77. [PMID: 22585585 PMCID: PMC3549566 DOI: 10.1002/eji.201142164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In addition to naturally occurring regulatory T (nTreg) cells derived from the thymus, functionally competent Treg cells can be induced in vitro from peripheral blood lymphocytes in response to TCR stimulation with cytokine costimulation. Using these artificial stimulation conditions, both naïve as well as memory CD4+ T cells can be converted into induced Treg (iTreg) cells, but the cellular origin of such iTreg cells in vivo or in response to more physiologic stimulation with pathogen-derived antigens is less clear. Here, we demonstrate that a freeze/thaw lysate of Plasmodium falciparum schizont extract (PfSE) can induce functionally competent Treg cells from peripheral lymphocytes in a time- and dose-dependent manner without the addition of exogenous costimulatory factors. The PfSE-mediated induction of Treg cells required the presence of nTreg cells in the starting culture. Further experiments mixing either memory or naïve T cells with antigen presenting cells and CFSE-labeled Treg cells identified CD4+CD45RO+CD25− memory T cells rather than Treg cells as the primary source of PfSE-induced Treg cells. Taken together, these data suggest that in the presence of nTreg cells, PfSE induces memory T cells to convert into iTreg cells that subsequently expand alongside PfSE-induced effector T cells.
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Affiliation(s)
- Olivia C Finney
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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9
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Molina DM, Finney OC, Arevalo-Herrera M, Herrera S, Felgner PL, Gardner MJ, Liang X, Wang R. Plasmodium vivax pre-erythrocytic-stage antigen discovery: exploiting naturally acquired humoral responses. Am J Trop Med Hyg 2012; 87:460-9. [PMID: 22826492 DOI: 10.4269/ajtmh.2012.12-0222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The development of pre-erythrocytic Plasmodium vivax vaccines is hindered by the lack of in vitro culture systems or experimental rodent models. To help bypass these roadblocks, we exploited the fact that naturally exposed Fy- individuals who lack the Duffy blood antigen (Fy) receptor are less likely to develop blood-stage infections; therefore, they preferentially develop immune responses to pre-erythrocytic-stage parasites, whereas Fy+ individuals experience both liver- and blood-stage infections and develop immune responses to both pre-erythrocytic and erythrocytic parasites. We screened 60 endemic sera from P. vivax-exposed Fy+ or Fy- donors against a protein microarray containing 91 P. vivax proteins with P. falciparum orthologs that were up-regulated in sporozoites. Antibodies against 10 P. vivax antigens were identified in sera from P. vivax-exposed individuals but not unexposed controls. This technology has promising implications in the discovery of potential vaccine candidates against P. vivax malaria.
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10
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Orlov M, Vaida F, Finney OC, Smith DM, Talley AK, Wang R, Kappe SH, Deng Q, Schooley RT, Duffy PE. P. falciparum enhances HIV replication in an experimental malaria challenge system. PLoS One 2012; 7:e39000. [PMID: 22745697 PMCID: PMC3383717 DOI: 10.1371/journal.pone.0039000] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/15/2012] [Indexed: 01/09/2023] Open
Abstract
Co-infection with HIV and P. falciparum worsens the prognosis of both infections; however, the mechanisms driving this adverse interaction are not fully delineated. To evaluate this, we studied HIV-1 and P. falciparum interactions in vitro using peripheral blood mononuclear cells (PBMCs) from human malaria naïve volunteers experimentally infected with P. falciparum in a malaria challenge trial.PBMCs collected before the malaria challenge and at several time points post-infection were infected with HIV-1 and co-cultured with either P. falciparum infected (iRBCs) or uninfected (uRBCs) red blood cells. HIV p24Ag and TNF-α, IFN-γ, IL-4, IL-6, IL-10, IL-17, and MIP-1α were quantified in the co-culture supernatants. In general, iRBCs stimulated more HIV p24Ag production by PBMCs than did uRBCs. HIV p24Ag production by PBMCs in the presence of iRBCs (but not uRBCs) further increased during convalescence (days 35, 56, and 90 post-challenge). In parallel, iRBCs induced higher secretion of pro-inflammatory cytokines (TNF-α, IFN-γ, and MIP-1α) than uRBCs, and production increased further during convalescence. Because the increase in p24Ag production occurred after parasitemia and generalized immune activation had resolved, our results suggest that enhanced HIV production is related to the development of anti-malaria immunity and may be mediated by pro-inflammatory cytokines.
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Affiliation(s)
- Marika Orlov
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Florin Vaida
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Olivia C. Finney
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - David M. Smith
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Angela K. Talley
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Ruobing Wang
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Stefan H. Kappe
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
| | - Qianqian Deng
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Robert T. Schooley
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Patrick E. Duffy
- Seattle Biomedical Research Institute, Seattle, Washington, United States of America
- Laboratory of Malaria Immunology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland, United States of America
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11
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do Rosario APF, Langhorne J, Duffy PE, Finney OC. Recent advances in malaria research: new tools to understand an old enemy. Expert Rev Anti Infect Ther 2010. [DOI: 10.1586/eri.10.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Finney OC, Riley EM, Walther M. Regulatory T cells in malaria – friend or foe? Trends Immunol 2010; 31:63-70. [DOI: 10.1016/j.it.2009.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 12/06/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
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Finney OC, Riley EM, Walther M. Phenotypic analysis of human peripheral blood regulatory T cells (CD4+FOXP3+CD127lo/-) ex vivo and after in vitro restimulation with malaria antigens. Eur J Immunol 2009; 40:47-60. [DOI: 10.1002/eji.200939708] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Finney OC, Nwakanma D, Conway DJ, Walther M, Riley EM. Homeostatic regulation of T effector to Treg ratios in an area of seasonal malaria transmission. Eur J Immunol 2009; 39:1288-300. [PMID: 19338000 DOI: 10.1002/eji.200839112] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
An important aspect of clinical immunity to malaria is the ability to down-regulate inflammatory responses, once parasitaemia is under control, in order to avoid immune-mediated pathology. The role of classical (CD4(+)CD25(+)CD127(lo/-)FOXP3(+)) Treg in this process, however, remains controversial. Thus, we have characterized the frequency, phenotype and function of Treg populations, over time, in healthy individuals in The Gambia. We observed that both the percentage and the absolute number of CD4(+)FOXP3(+)CD127(lo/-) T cells were higher among individuals living in a rural village with highly seasonal malaria transmission than among individuals living in an urban area where malaria rarely occurs. These CD4(+)FOXP3(+)CD127(lo/-) T cells exhibited an effector memory and apoptosis-prone phenotype and suppressed cytokine production in response to malaria antigen. Cells from individuals exposed to malaria expressed significantly higher levels of mRNA for forkhead box P3 and T-box 21 (T-BET) at the end of the malaria transmission season than at the end of the non-transmission season. Importantly, the ratio of T-BET to forkhead box P3 was remarkably consistent between populations and over time, indicating that in healthy individuals, a transient increase in Th1 responses during the malaria transmission season is balanced by a commensurate Treg response, ensuring that immune homeostasis is maintained.
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Affiliation(s)
- Olivia C Finney
- Malaria Programme, MRC Laboratories, Fajara, Banjul, The Gambia
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Walther M, Jeffries D, Finney OC, Njie M, Ebonyi A, Deininger S, Lawrence E, Ngwa-Amambua A, Jayasooriya S, Cheeseman IH, Gomez-Escobar N, Okebe J, Conway DJ, Riley EM. Distinct roles for FOXP3 and FOXP3 CD4 T cells in regulating cellular immunity to uncomplicated and severe Plasmodium falciparum malaria. PLoS Pathog 2009; 5:e1000364. [PMID: 19343213 PMCID: PMC2658808 DOI: 10.1371/journal.ppat.1000364] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/03/2009] [Indexed: 02/04/2023] Open
Abstract
Failure to establish an appropriate balance between pro- and anti-inflammatory immune responses is believed to contribute to pathogenesis of severe malaria. To determine whether this balance is maintained by classical regulatory T cells (CD4(+) FOXP3(+) CD127(-/low); Tregs) we compared cellular responses between Gambian children (n = 124) with severe Plasmodium falciparum malaria or uncomplicated malaria infections. Although no significant differences in Treg numbers or function were observed between the groups, Treg activity during acute disease was inversely correlated with malaria-specific memory responses detectable 28 days later. Thus, while Tregs may not regulate acute malarial inflammation, they may limit memory responses to levels that subsequently facilitate parasite clearance without causing immunopathology. Importantly, we identified a population of FOXP3(-), CD45RO(+) CD4(+) T cells which coproduce IL-10 and IFN-gamma. These cells are more prevalent in children with uncomplicated malaria than in those with severe disease, suggesting that they may be the regulators of acute malarial inflammation.
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Affiliation(s)
- Michael Walther
- Medical Research Council Laboratories, Fajara, Banjul, The Gambia.
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Korbel DS, Finney OC, Riley EM. Natural killer cells and innate immunity to protozoan pathogens. Int J Parasitol 2004; 34:1517-28. [PMID: 15582528 DOI: 10.1016/j.ijpara.2004.10.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 09/16/2004] [Accepted: 10/06/2004] [Indexed: 10/26/2022]
Abstract
Natural killer (NK) cells are lymphoid cells that mediate significant cytotoxic activity and produce high levels of pro-inflammatory cytokines in response to infection. During viral infection, NK cell cytotoxicity and cytokine production is induced principally by monocyte-macrophage- and dendritic cell-derived cytokines but virally encoded ligands for NK cells are also beginning to be described. NK derived interferon-gamma (IFN-gamma) production is also essential for control of several protozoal infections including toxoplasmosis, trypanosomiasis, leishmaniasis and malaria. The activation of NK cells by protozoan pathogens is also believed to be cytokine-mediated although some recent studies suggest that direct recognition of parasites by NK cells also occurs. Both indirect signalling via accessory cell-derived cytokines and direct signalling, presumably through NK receptors, are needed in order for human malaria parasites (Plasmodium falciparum) to optimally stimulate NK activity.
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Affiliation(s)
- Daniel S Korbel
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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