A heterologous prime-boost strategy has been developed to potently induce T cell responses to pre-erythrocytic malaria antigens. Efficacy in the field is likely to depend on both peak immunogenicity and the durability of responses. To improve both immunogenicity and durability of responses, 54 adult males from a malaria endemic area were immunized with different vaccination regimens, systematically varying antigenic insert and the number and sequence of component vaccinations. The component vaccinations were recombinant attenuated viruses, either fowlpox (FP) 9 or modified vaccinia virus Ankara (MVA). These were recombinant for either of two preerythrocytic malaria antigens (multiple epitope-thrombospondin-related adhesion protein, ME-TRAP, or circumsporozoite antigen (CS). ELISPOT assays were used to measure the effector and resting memory T cell responses. Sequence, antigen insert and number of vaccinations influenced immunogenicity, but the novel alternating vector immunizations generated the largest resting memory T cell populations. Effector responses were maintained at 84% of the peak response after 270 days. This durability of response is unprecedented. Classical prime-boost vaccination responses were at 5% of the peak after 270 days. Vaccines administered by heterologous prime-boost regimes are being developed for diverse pathogens and cancer. These data suggest these vaccines should also be administered by alternating vector regimens in clinical development.
IntroductionOne million deaths per year are attributed to malaria [1]. A vaccine is urgently needed. Experimental studies on mice [2], field studies in humans [3] and irradiated sporozoite immunization [4] suggest that T cell responses are protective. A heterologous prime-boost strategy that induces T cells has been developed [5], using sequential immunization with different vectors delivering a common pre-erythrocytic malaria antigen. Two antigens have been used, multiple epitope-thrombospondin-related adhesion protein (ME-TRAP; multiple pre-erythrocytic stage epitopes joined with the whole pre-erythrocytic stage antigen TRAP) and CS (the circumsporozoite antigen with one additional Plasmodium falciparum epitope). Each antigen can be delivered by two different viral vectors, either the attenuated fowlpox strain FP9, or modified virus Ankara (MVA). In previous studies of ME-TRAP encoding vaccinations in non-immune volunteers, some individuals were fully protected and many immunized groups showed mean delays in time to parasitemia after controlled bites from P. falciparum-infected mosquitoes [6]. The direct, or ex vivo ELISPOT identifies T cells that produce IFN-c after overnight incubation with antigen. The cultured ELISPOT assay uses a 10-day pre-culture with first antigen then IL-2, to identify resting memory cells [7]. The cell populations identified by these two assays are different. A study of naturally acquired immunity to CS protein demonstrated no correlation between cultured ELISPOT and ex vivo ELISPOT results [8]. The cells identified by ...