RESUMO
BACKGROUND: Malaria in pregnancy has major impacts on mother and child health. To complement existing interventions, such as intermittent preventive treatment and use of impregnated bed nets, we developed a malaria vaccine candidate with the aim of reducing sequestration of asexual "blood-stage" parasites in the placenta, the major virulence mechanism. METHODS: The vaccine candidate PAMVAC is based on a recombinant fragment of VAR2CSA, the Plasmodium falciparum protein responsible for binding to the placenta via chondroitin sulfate A (CSA). Healthy, adult malaria-naive volunteers were immunized with 3 intramuscular injections of 20 µg (n = 9) or 50 µg (n = 27) PAMVAC, adjuvanted with Alhydrogel or glucopyranosyl lipid adjuvant in stable emulsion (GLA-SE) or in a liposomal formulation with QS21 (GLA-LSQ). Allocation was random and double blind. The vaccine was given every 4 weeks. Volunteers were observed for 6 months following last immunization. RESULTS: All PAMVAC formulations were safe and well tolerated. A total of 262 adverse events (AEs) occurred, 94 (10 grade 2 and 2 grade 3) at least possibly related to the vaccine. No serious AEs occurred. Distribution and severity of AEs were similar in all arms. PAMVAC was immunogenic in all participants. PAMVAC-specific antibody levels were highest with PAMVAC-GLA-SE. The antibodies inhibited binding of VAR2CSA expressing P. falciparum-infected erythrocytes to CSA in a standardized functional assay. CONCLUSIONS: PAMVAC formulated with Alhydrogel or GLA-based adjuvants was safe, well tolerated, and induced functionally active antibodies. Next, PAMVAC will be assessed in women before first pregnancies in an endemic area. CLINICAL TRIALS REGISTRATION: EudraCT 2015-001827-21; ClinicalTrials.gov NCT02647489.
Assuntos
Vacinas Antimaláricas/uso terapêutico , Adulto , Hidróxido de Alumínio/química , Sulfatos de Condroitina/metabolismo , Método Duplo-Cego , Feminino , Humanos , Injeções Intramusculares , Lipossomos/química , Vacinas Antimaláricas/administração & dosagem , Plasmodium falciparum/imunologia , Plasmodium falciparum/patogenicidade , Gravidez , Adulto JovemRESUMO
By application of Y-chromosomal STRs, DNA analysis of abortion material can be considerably facilitated since great excess of maternal DNA is tolerated without disturbing the Y-STR amplification. If paternity can't be excluded on the basis of the Y-STR haplotype, further examinations must follow, e.g. autosomal STR analysis. For this purpose, histological preparation of the abortion tissue might still be necessary. Different Y-chromosomal haplotypes of embryo and putative father usually lead to an exclusion from paternity. Based on four case examples, the feasibility of this method is discussed.