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<jats:p>Severe malaria (SM) is a life-threatening complication of infection with<jats:named-content content-type="genus-species">Plasmodium falciparum</jats:named-content>. Epidemiological observations have long indicated that immunity against SM is acquired relatively rapidly, but prospective studies to investigate its immunological basis are logistically challenging and have rarely been undertaken. We investigated the merozoite targets and antibody-mediated mechanisms associated with protection against SM in Kenyan children aged 0 to 2 years. We designed a unique prospective matched case-control study of well-characterized SM clinical phenotypes nested within a longitudinal birth cohort of children (<jats:italic>n</jats:italic>= 5,949) monitored over the first 2 years of life. We quantified immunological parameters in sera collected before the SM event in cases and their individually matched controls to evaluate the prospective odds of developing SM in the first 2 years of life. Anti-AMA1 antibodies were associated with a significant reduction in the odds of developing SM (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15 to 0.90;<jats:italic>P</jats:italic>= 0.029) after adjustment for responses to all other merozoite antigens tested, while those against MSP-2, MSP-3,<jats:named-content content-type="genus-species">Plasmodium falciparum</jats:named-content>Rh2 [<jats:italic>Pf</jats:italic>Rh2], MSP-1<jats:sub>19</jats:sub>, and the infected red blood cell surface antigens were not. The combined ability of total IgG to inhibit parasite growth and mediate the release of reactive oxygen species from neutrophils was associated with a marked reduction in the odds of developing SM (OR = 0.07; 95% CI = 0.006 to 0.82;<jats:italic>P</jats:italic>= 0.03). Assays of these two functional mechanisms were poorly correlated (Spearman rank correlation coefficient [<jats:italic>r<jats:sub>s</jats:sub></jats:italic>] = 0.12;<jats:italic>P</jats:italic>= 0.07). Our data provide epidemiological evidence that multiple antibody-dependent mechanisms contribute to protective immunity via distinct targets whose identification could accelerate the development of vaccines to protect against SM.</jats:p>

Original publication

DOI

10.1128/iai.01120-15

Type

Journal article

Journal

Infection and Immunity

Publisher

American Society for Microbiology

Publication Date

04/2016

Volume

84

Pages

950 - 963