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Malaria: progress, perils, and prospects for eradication
Brian M. Greenwood, … , Frank H. Collins, Patrick E. Duffy
Brian M. Greenwood, … , Frank H. Collins, Patrick E. Duffy
Published April 1, 2008
Citation Information: J Clin Invest. 2008;118(4):1266-1276. https://doi.org/10.1172/JCI33996.
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Review Series

Malaria: progress, perils, and prospects for eradication

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Abstract

There are still approximately 500 million cases of malaria and 1 million deaths from malaria each year. Yet recently, malaria incidence has been dramatically reduced in some parts of Africa by increasing deployment of anti-mosquito measures and new artemisinin-containing treatments, prompting renewed calls for global eradication. However, treatment and mosquito control currently depend on too few compounds and thus are vulnerable to the emergence of compound-resistant parasites and mosquitoes. As discussed in this Review, new drugs, vaccines, and insecticides, as well as improved surveillance methods, are research priorities. Insights into parasite biology, human immunity, and vector behavior will guide efforts to translate parasite and mosquito genome sequences into novel interventions.

Authors

Brian M. Greenwood, David A. Fidock, Dennis E. Kyle, Stefan H.I. Kappe, Pedro L. Alonso, Frank H. Collins, Patrick E. Duffy

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Figure 1

The life cycle of malaria-causing Plasmodium parasites.

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The life cycle of malaria-causing Plasmodium parasites.
               
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The Plasmodium life cycle comprises numerous transitions and stages, and any of these can be targeted by host immune responses. Upon inoculation by an Anopheles mosquito into the human dermis, elongated motile sporozoites must evade antibodies to (i) access blood vessels in the skin and then (ii) transit through liver macrophages and hepatocytes to initiate liver stage infection. Intrahepatocytic parasites (iii) are susceptible to CTLs. After approximately one week, infected hepatocytes rupture and release merozoites as aggregates called merosomes that might allow merozoites to (iv) evade antibodies and invade erythrocytes. Intraerythrocytic parasites (v) are susceptible to opsonizing antibodies and macrophages, and cytokine responses have been related to both protection and disease during this stage of infection. Antibodies that block (vi) binding of P. falciparum–infected erythrocytes to endothelium might prevent disease and control parasitemia. Human antibodies specific for (vii) sexual stage parasites are taken up by mosquitoes during the blood meal and can block transmission to mosquitoes, although these might require complement for parasite killing. Anopheles mosquito innate immune responses can also kill parasites during early (vii) or late (viii) sporogonic stages and lead to refractoriness to infection.

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