title: Lack of allele-specific efficacy of a bivalent AMA1 malaria vaccine.
abstract: BACKGROUND
  Extensive genetic diversity in vaccine antigens may contribute to the lack of efficacy of blood stage malaria vaccines. Apical membrane antigen-1 (AMA1) is a leading blood stage malaria vaccine candidate with extreme diversity, potentially limiting its efficacy against infection and disease caused by Plasmodium falciparum parasites with diverse forms of AMA1.
  
  
  METHODS
  Three hundred Malian children participated in a Phase 2 clinical trial of a bivalent malaria vaccine that found no protective efficacy. The vaccine consists of recombinant AMA1 based on the 3D7 and FVO strains of P. falciparum adjuvanted with aluminum hydroxide (AMA1-C1). The gene encoding AMA1 was sequenced from P. falciparum infections experienced before and after immunization with the study vaccine or a control vaccine. Sequences of ama1 from infections in the malaria vaccine and control groups were compared with regard to similarity to the vaccine antigens using several measures of genetic diversity. Time to infection with parasites carrying AMA1 haplotypes similar to the vaccine strains with respect to immunologically important polymorphisms and the risk of infection with vaccine strain haplotypes were compared.
  
  
  RESULTS
  Based on 62 polymorphic AMA1 residues, 186 unique ama1 haplotypes were identified among 315 ama1 sequences that were included in the analysis. Eight infections had ama1 sequences identical to 3D7 while none were identical to FVO. Several measures of genetic diversity showed that ama1 sequences in the malaria vaccine and control groups were comparable both at baseline and during follow up period. Pre- and post-immunization ama1 sequences in both groups all had a similar degree of genetic distance from FVO and 3D7 ama1. No differences were found in the time of first clinical episode or risk of infection with an AMA1 haplotype similar to 3D7 or FVO with respect to a limited set of immunologically important polymorphisms found in the cluster 1 loop of domain I of AMA1.
  
  
  CONCLUSIONS
  This Phase 2 trial of a bivalent AMA1 malaria vaccine found no evidence of vaccine selection or strain-specific efficacy, suggesting that the extreme genetic diversity of AMA1 did not account for failure of the vaccine to provide protection.
authors.affiliation: Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, Bamako, Mali.
authors.forename: Amed
authors.initials: A
authors.lastname: Ouattara
authors.forename: Jianbing
authors.initials: J
authors.lastname: Mu
authors.forename: Shannon
authors.initials: S
authors.lastname: Takala-Harrison
authors.forename: Renion
authors.initials: R
authors.lastname: Saye
authors.forename: Issaka
authors.initials: I
authors.lastname: Sagara
authors.forename: Alassane
authors.initials: A
authors.lastname: Dicko
authors.forename: Amadou
authors.initials: A
authors.lastname: Niangaly
authors.forename: Junhui
authors.initials: J
authors.lastname: Duan
authors.forename: Ruth D
authors.initials: RD
authors.lastname: Ellis
authors.forename: Louis H
authors.initials: LH
authors.lastname: Miller
authors.forename: Xin-zhuan
authors.initials: XZ
authors.lastname: Su
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Plowe
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D000483:Alleles; D000536:Aluminum Hydroxide; D000595:Amino Acid Sequence; D000953:Antigens, Protozoan / Q000235:genetics* / Q000276:immunology; D002648:Child; D004311:Double-Blind Method; D006239:Haplotypes / Q000276:immunology; D006801:Humans; D007114:Immunization; D017780:Malaria Vaccines / Q000009:adverse effects / Q000276:immunology*; D016778:Malaria, Falciparum / Q000469:parasitology / Q000517:prevention & control*; D008565:Membrane Proteins / Q000235:genetics* / Q000276:immunology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics* / Q000276:immunology; D016133:Polymerase Chain Reaction; D011110:Polymorphism, Genetic; D015800:Protozoan Proteins / Q000235:genetics* / Q000276:immunology
chemical_list: D000953:Antigens, Protozoan; D017780:Malaria Vaccines; D008565:Membrane Proteins; D015800:Protozoan Proteins; C090077:apical membrane antigen I, Plasmodium; D000536:Aluminum Hydroxide