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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2017.00743</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Immunization with the Malaria Diversity-Covering Blood-Stage Vaccine Candidate <italic>Plasmodium falciparum</italic> Apical Membrane Antigen 1 DiCo in Complex with Its Natural Ligand <italic>Pf</italic>Ron2 Does Not Improve the <italic>In Vitro</italic> Efficacy</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Spiegel</surname> <given-names>Holger</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x0002A;</xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x02020;</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/302708"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Boes</surname> <given-names>Alexander</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>&#x02020;</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/281338"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Fendel</surname> <given-names>Rolf</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/426015"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Reimann</surname> <given-names>Andreas</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/452127"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Schillberg</surname> <given-names>Stefan</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/181821"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Fischer</surname> <given-names>Rainer</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/196861"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Fraunhofer Institute for Molecular Biology and Applied Ecology IME</institution>, <addr-line>Aachen</addr-line>, <country>Germany</country></aff>
<aff id="aff2"><sup>2</sup><institution>Institute for Phytopathology and Applied Zoology, Justus-Liebig University Giessen</institution>, <addr-line>Giessen</addr-line>, <country>Germany</country></aff>
<aff id="aff3"><sup>3</sup><institution>RWTH Aachen University, Institute for Molecular Biotechnology</institution>, <addr-line>Aachen</addr-line>, <country>Germany</country></aff>
<aff id="aff4"><sup>4</sup><institution>Indiana Biosciences Research Institute (IBRI)</institution>, <addr-line>Indianapolis, IN</addr-line>, <country>United States</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Xu Huji, Second Military Medical University, China</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Raffael Nachbagauer, Icahn School of Medicine at Mount Sinai, United States; Urszula Krzych, Walter Reed Army Institute of Research, United States</p></fn>
<corresp content-type="corresp" id="cor1">&#x0002A;Correspondence: Holger Spiegel, <email>holger.spiegel&#x00040;ime.fraunhofer.de</email></corresp>
<fn fn-type="other" id="fn001"><p><sup>&#x02020;</sup>These authors have contributed equally to this work.</p></fn>
<fn fn-type="other" id="fn002"><p>Specialty section: This article was submitted to Vaccines and Molecular Therapeutics, a section of the journal Frontiers in Immunology</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>27</day>
<month>06</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<volume>8</volume>
<elocation-id>743</elocation-id>
<history>
<date date-type="received">
<day>24</day>
<month>03</month>
<year>2017</year>
</date>
<date date-type="accepted">
<day>12</day>
<month>06</month>
<year>2017</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2017 Spiegel, Boes, Fendel, Reimann, Schillberg and Fischer.</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Spiegel, Boes, Fendel, Reimann, Schillberg and Fischer</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>The blood-stage malaria vaccine candidate <italic>Plasmodium falciparum</italic> apical membrane antigen 1 (<italic>Pf</italic>AMA1) can induce strong parasite growth-inhibitory antibody responses in animals but has not achieved the anticipated efficacy in clinical trials. Possible explanations in humans are the insufficient potency of the elicited antibody responses, as well as the high degree of sequence polymorphisms found in the field. Several strategies have been developed to improve the cross-strain coverage of <italic>Pf</italic>AMA1-based vaccines, whereas innovative concepts to increase the potency of <italic>Pf</italic>AMA1-specific IgG responses have received little attention even though this may be an essential requirement for protective efficacy. A previous study has demonstrated that immunization with a complex of <italic>Py</italic>AMA1 and <italic>Py</italic>RON2, a ligand with an essential functional role in erythrocyte invasion, leads to protection from lethal <italic>Plasmodium yoelli</italic> challenge in an animal model and suggested to extend this strategy toward improved strain coverage by using multiple <italic>Pf</italic>AMA1 alleles in combination with <italic>Pf</italic>Ron2L. As an alternative approach along this line, we decided to use <italic>Pf</italic>Ron2L in combination with three <italic>Pf</italic>AMA1 diversity covering variants (DiCo) to investigate the potential of this complex to induce more potent parasite growth inhibitory immune response in combination with better cross-strain-specific efficacy. Within the limits of the study design, the ability of the <italic>Pf</italic>AMA1 DiCo-Mix to induce cross-strain-specific antibodies was not affected in all immunization groups, but the DiCo&#x02013;<italic>Pf</italic>Ron2L complexes did not improve the potency of <italic>Pf</italic>AMA1-specific IgG responses.</p>
</abstract>
<kwd-group>
<kwd>agroinfiltration</kwd>
<kwd>growth inhibition assay</kwd>
<kwd>plant molecular farming</kwd>
<kwd><italic>Plasmodium falciparum</italic></kwd>
<kwd>strain-transcending immune responses</kwd>
<kwd>surface plasmon resonance spectroscopy</kwd>
<kwd>calibration-free concentration analysis</kwd>
</kwd-group>
<contract-sponsor id="cn01">Fraunhofer-Gesellschaft<named-content content-type="fundref-id">10.13039/501100003185</named-content></contract-sponsor>
<counts>
<fig-count count="5"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="52"/>
<page-count count="10"/>
<word-count count="7234"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="introduction">
<title>Introduction</title>
<p>Malaria remains a major global health problem affecting &#x0003E;200 million people and killing more than 500,000 per year (<xref ref-type="bibr" rid="B1">1</xref>). An effective malaria vaccine is regarded as an essential component of any eradication strategy. <italic>Plasmodium falciparum</italic> apical membrane antigen 1 (<italic>Pf</italic>AMA1), a <italic>Plasmodium</italic> protein functionally involved in human erythrocyte invasion, is one of the leading blood-stage vaccine candidates. Many studies indicate that <italic>Pf</italic>AMA1-specific antibodies contribute to naturally acquired semi-immunity, so the capacity of this protein to induce parasite growth-inhibitory responses has been investigated in animals (<xref ref-type="bibr" rid="B2">2</xref>&#x02013;<xref ref-type="bibr" rid="B6">6</xref>) and humans (<xref ref-type="bibr" rid="B7">7</xref>&#x02013;<xref ref-type="bibr" rid="B10">10</xref>).</p>
<p>Both <italic>in vitro</italic> and <italic>in vivo</italic> studies show that antibody responses induced by single <italic>Pf</italic>AMA1 alleles achieve significantly lower efficacy against heterologous strains (<xref ref-type="bibr" rid="B11">11</xref>). Several epidemiological studies in different countries have revealed large numbers of different <italic>Pf</italic>AMA1 haplotypes even in defined endemic areas (<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>). This high degree of polymorphism in the field is likely to be a parasite strategy to evade the immune system (<xref ref-type="bibr" rid="B11">11</xref>), thus presenting a serious challenge for the development of effective <italic>Pf</italic>AMA1-based vaccine candidates. The problem has been tackled by different groups using either mixtures of up to seven <italic>Pf</italic>AMA1 alleles (<xref ref-type="bibr" rid="B14">14</xref>&#x02013;<xref ref-type="bibr" rid="B18">18</xref>) or by the design of three so-called diversity covering (DiCo) variants (<xref ref-type="bibr" rid="B19">19</xref>). These artificial sequences were generated based on the analysis of over 300 different <italic>PfAMA1</italic> sequences from field isolates, and cover 97% of the observed amino acid variability affecting around 10% of the amino acid residues. Additionally, all potential N-glycosylation sites were removed using preferentially natural occurring mutations. Both strategies are successful in eliciting antibodies with a broader range of specificity by focusing the immune response toward conserved regions of the molecule. The outcome of several studies performed with <italic>Pf</italic>AMA1-based vaccines in animals and humans suggest that besides cross-strain efficacy, also the potency of the immune IgG needs to be improved to induce sufficient protection. Since variations in dose, adjuvant, formulation [protein in adjuvant, DNA, viral vectored as well as combinations thereof (<xref ref-type="bibr" rid="B20">20</xref>&#x02013;<xref ref-type="bibr" rid="B22">22</xref>)] have shown only moderate improvements, it is believed that alternative strategies are required to improve the potency of <italic>Pf</italic>AMA1-specific antibodies.</p>
<p><italic>Plasmodium falciparum</italic> apical membrane antigen 1 plays an important role in the erythrocyte invasion machinery and an essential step during invasion is the formation of a moving junction between the merozoite and the erythrocyte membrane. During this process, the connection between the two cells is maintained by the interaction between <italic>Pf</italic>AMA1 located on the surface of the parasite and <italic>Pf</italic>Ron2, another <italic>P. falciparum</italic> protein, which is translocated to the erythrocyte membrane early in the process (<xref ref-type="bibr" rid="B23">23</xref>&#x02013;<xref ref-type="bibr" rid="B25">25</xref>). Previous studies have shown that antibodies (<xref ref-type="bibr" rid="B26">26</xref>&#x02013;<xref ref-type="bibr" rid="B28">28</xref>), peptides (<xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B30">30</xref>), and drugs (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B32">32</xref>) that interfere with the AMA1&#x02013;Ron2 interaction in different plasmodium species inhibit the growth of the parasite. Additionally, structural analysis of the <italic>Pf</italic>AMA1&#x02013;<italic>Pf</italic>Ron2 complex has revealed extensive conformational changes in the <italic>Pf</italic>AMA1 variable loops surrounding the <italic>Pf</italic>Ron2-binding pocket compared to <italic>Pf</italic>AMA1 alone (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B33">33</xref>&#x02013;<xref ref-type="bibr" rid="B35">35</xref>) making those regions particularly interesting as targets for potent parasite growth-inhibitory antibodies. A complex of AMA1 and Ron2L (a synthetic peptide, representing the <italic>Pf</italic>AMA1-binding domain of <italic>Pf</italic>Ron2) as the immunogen achieved higher efficacy than AMA1 alone in an <italic>in vitro</italic> parasite growth inhibition assay (GIA) using <italic>P. falciparum</italic> and also protected mice against a lethal challenge with <italic>P. yoelii</italic> (<xref ref-type="bibr" rid="B35">35</xref>). Even though this strategy improves the potency of AMA1-based vaccines, it does not address the need for cross-strain protection, leading the authors of the abovementioned study to suggest the use of multiple <italic>Pf</italic>AMA1&#x02013;<italic>Pf</italic>Ron2 complexes representing different <italic>Pf</italic>AMA1 alleles (<xref ref-type="bibr" rid="B35">35</xref>). As an alternative, we chose to investigate a scenario involving the minimum number of different recombinant molecules by using the three DiCo <italic>Pf</italic>AMA1 variants (<xref ref-type="bibr" rid="B19">19</xref>) in a complex with <italic>Pf</italic>Ron2L.</p>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="S2-1">
<title>Bacteria, Plants, and Parasites</title>
<p><italic>Agrobacterium tumefaciens</italic> strain GV3101:pMP90RK (GmR, KmR, RifR) (<xref ref-type="bibr" rid="B36">36</xref>) was used for the production of recombinant proteins in <italic>Nicotiana benthamiana</italic> plants by agroinfiltration. Parasite strains <italic>P. falciparum</italic> 3D7, FCR3, and HB3 (MR4, Manassas, VA, USA) were used for the GIAs.</p>
</sec>
<sec id="S2-2">
<title>Construct Cloning and Transient Expression in <italic>N. benthamiana</italic></title>
<p>The DiCo1-3 sequences (Figure S1 in Supplementary Material) were amplified from their source constructs (<xref ref-type="bibr" rid="B37">37</xref>) and introduced into the plant expression vector pTRAkc-ERH (linearized with <italic>Nco</italic>I/<italic>Not</italic>I) in-frame with an upstream signal peptide sequence and a downstream His<sub>6</sub> tag and SEKDEL signal for retention in the endoplasmic reticulum (<xref ref-type="bibr" rid="B38">38</xref>). Additionally, six different alleles of <italic>Pf</italic>AMA1 (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1-RO33) were obtained as synthetic genes codon optimized for <italic>N. benthamiana</italic> from Geneart (Thermo Fisher Scientific, Waltham, MA, USA) and introduced into the plant expression vector pTRAkc-ERH using the cloning strategy mentioned above. All cloning steps were confirmed by DNA sequencing. The transformation and cultivation of <italic>A. tumefaciens</italic> as well as transient expression in <italic>N. benthamiana</italic> plants was carried out as previously described (<xref ref-type="bibr" rid="B38">38</xref>).</p>
</sec>
<sec id="S2-3">
<title>Purification of Recombinant Proteins</title>
<p>The three DiCo variants and six <italic>Pf</italic>AMA1 alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1-RO33) were purified by immobilized metal affinity chromatography (IMAC) followed by size exclusion chromatography (SEC) on a Superdex 75 column (GE Healthcare Life Sciences, Little Chalfont, UK) as previously described (<xref ref-type="bibr" rid="B39">39</xref>).</p>
</sec>
<sec id="S2-4">
<title>Analysis of DiCo&#x02013;<italic>Pf</italic>Ron2L Complex Formation</title>
<p>The concentration of <italic>Pf</italic>Ron2L (DITQQAKDIGAGPVASCFTTRMSPPQQICLNSVVNTALS), purchased in the oxidized form from Pepscan (Lelystad, The Netherlands) required for equilibrium saturation of the three purified DiCo molecules was determined by surface plasmon resonance (SPR)-based competition analysis using a Biacore T200 instrument (Biacore, Uppsala, Sweden). We mixed 796&#x02009;nM of each purified DiCo variant with serial 1:3 dilutions of <italic>Pf</italic>Ron2L starting at 12.5&#x02009;&#x000B5;M and descending to a minimum of 5.7&#x02009;nM. The residual binding of the remaining free DiCo molecules was quantified using an S-series streptavidin chip coated with biotinylated <italic>Pf</italic>Ron2L.</p>
</sec>
<sec id="S2-5">
<title>Formulation of Antigens</title>
<p>Immunization with DiCo-Mix (group D), DiCo-Mix, and <italic>Pf</italic>Ron2L at different injection sites (group D&#x02009;&#x0002B;&#x02009;R) or the Dico-Mix&#x02013;<italic>Pf</italic>Ron2L complex (group C) was achieved using different vaccine dose formulations. The purified DiCo variants and the <italic>Pf</italic>Ron2L peptide were lyophilized (PBS, pH 7.4) in single-dose scale glass vials and stored at &#x02212;20&#x000B0;C. For immunization, the lyophilized proteins were reconstituted in sterile water. To facilitate complex formation, the DiCo&#x02013;<italic>Pf</italic>Ron2L mixture was incubated for 30&#x02009;min at room temperature prior to final formulation with the adjuvant.</p>
</sec>
<sec id="S2-6">
<title>SDS-PAGE and Immunoblot Analysis</title>
<p>Proteins were separated on 4&#x02013;12% (w/v) NuPage polyacrylamide gradient gels (Thermo Fisher Scientific, Waltham, MA, USA) and either stained with Coomassie Brilliant Blue or transferred onto a nitrocellulose membrane (Whatmann, Dassel, Germany) for immunoblot analysis as previously described (<xref ref-type="bibr" rid="B39">39</xref>).</p>
</sec>
<sec id="S2-7">
<title>Rabbit Immunization and IgG Purification</title>
<p>Rabbits were housed, immunized, and sampled by Biogenes GmbH (Berlin, Germany) according to national animal welfare regulations. Four rabbits were immunized with either DiCo-Mix (D, 50&#x02009;&#x000B5;g), or DiCo-Mix (50&#x02009;&#x000B5;g) and <italic>Pf</italic>Ron2L (50&#x02009;&#x000B5;g) at different injection sites (D&#x02009;&#x0002B;&#x02009;R), or the Dico-Mix&#x02013;<italic>Pf</italic>Ron2L complex (C, prepared by mixing 50&#x02009;&#x000B5;g of DiCo-Mix with 50&#x02009;&#x000B5;g <italic>Pf</italic>Ron2L), each formulated with the Biogenes proprietary adjuvant, on days 0, 28, and 56. Serum samples were collected on day 70. IgG purification and quantification was carried out as previously described (<xref ref-type="bibr" rid="B39">39</xref>).</p>
</sec>
<sec id="S2-8">
<title>Analysis of Immune Sera</title>
<p>Antibody titers against the different <italic>Pf</italic>AMA1 variants were determined by direct-coating enzyme-linked immunosorbent assay (ELISA) as previously described (<xref ref-type="bibr" rid="B39">39</xref>), using DiCo-Mix, single DiCo variants, and six different <italic>Pf</italic>AMA1 alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1-RO33). To measure the avidity of the immune sera for the DiCo-Mix, we used the NaSCN displacement ELISA, an adapted protocol called Avidity ELISA (<xref ref-type="bibr" rid="B40">40</xref>). Based on previous titer determinations, all serum samples were diluted to OD<sub>405&#x02009;nm</sub>&#x02009;&#x0003D;&#x02009;0.6&#x02013;0.8. The avidity index is the molar NaSCN concentration at which 50% of the bound serum antibodies can be eluted.</p>
</sec>
<sec id="S2-9">
<title>Calibration-Free Concentration Analysis (CFCA) of Purified Rabbit Immune IgG</title>
<p>Antigen-specific antibody concentrations were measured in the purified rabbit antibody preparations by CFCA (<xref ref-type="bibr" rid="B41">41</xref>) using a Biacore T200 instrument. The antigens (DiCo-Mix, <italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, and <italic>Pf</italic>AMA1-HB3) were separately covalently coupled to CM5 S-Series sensor chips using standard EDC&#x02013;NHS chemistry as previously described (<xref ref-type="bibr" rid="B39">39</xref>).</p>
</sec>
<sec id="S2-10">
<title>SPR-Based Competition Analysis</title>
<p>To confirm the CFCA results, a competition assay was carried out using the Biacore T200 instrument and the DiCo-Mix surface. To determine the quantity of DiCo and allele-specific antibodies, the purified IgG preparations were mixed either with running buffer, or a molar excess of DiCo-Mix, single DiCo (1-3), <italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, or <italic>Pf</italic>AMA1-HB3, as well as a mixture of three alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3) and a mixture of six alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1-RO33). The 90-s injections were conducted under mass transport limitation, and the DiCo-Mix surface was regenerated between injections using 20-s pulses with 30&#x02009;mM HCl. The binding signal resulting from competition mixtures was normalized against the end-point values for the corresponding buffer controls, which were set to 100%.</p>
</sec>
<sec id="S2-11">
<title>Parasite Culture and GIA</title>
<p><italic>P. falciparum</italic> strains 3D7A, HB3, and FCR3 were cultured under routine culture conditions and synchronized as described before (<xref ref-type="bibr" rid="B42">42</xref>). The ability of purified polyclonal rabbit IgGs to inhibit the growth of <italic>P. falciparum</italic> strains 3D7A, FCR3, and HB3 was determined by conducting GIAs as previously described (<xref ref-type="bibr" rid="B43">43</xref>, <xref ref-type="bibr" rid="B44">44</xref>). Highly synchronous parasites were treated with eight serial dilutions of the rabbit IgG (1:2, starting at a final concentration of 6&#x02009;mg/ml) at schizont stage. The parasites cultures were harvested at 42&#x02013;44&#x02009;h of coculture. As controls, BG98 (positive control, kindly provided by Ed Remarque, BPRC, Rijswijk, Netherlands) (<xref ref-type="bibr" rid="B45">45</xref>) and purified IgG from non-immunized rabbits (negative control) were used at a concentration of 6&#x02009;mg/ml. Parasite growth was estimated using the pLDH-assay (<xref ref-type="bibr" rid="B42">42</xref>).</p>
</sec>
<sec id="S2-12">
<title>Statistical Analysis</title>
<p>Titers, avidities, allele-specific antibody concentrations, competition data, and GIA IC<sub>50</sub> values derived from the three different immunization groups (D, D&#x02009;&#x0002B;&#x02009;R, and C) were compared by one-way analysis of variance (ANOVA) using Origin data analysis software (OriginLab, Northampton, MA, USA). GIAs were analyzed using GraphPad Prism software package v7.02. For the determination of IC<sub>50</sub>-values, the growth curves were fitted using a 4-parameter logistic curve fit and the IC<sub>50</sub>-value estimated using the Hill equation. The level of statistical significance for all analyses was set at 0.05.</p>
</sec>
</sec>
<sec id="S3">
<title>Results</title>
<sec id="S3-1">
<title>Transient Expression and Purification of <italic>Pf</italic>AMA1 Variants</title>
<p>After generating the expression constructs and the corresponding recombinant <italic>A. tumefaciens</italic> cultures, small-scale transient expression was carried out in <italic>N. benthamiana</italic> allowing the provision of recombinant proteins within a few days (<xref ref-type="bibr" rid="B38">38</xref>). All three DiCo proteins (DiCo1-3), as well as the six alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1-RO33) accumulated to high levels and were successfully purified from leaf tissue by IMAC and SEC.</p>
</sec>
<sec id="S3-2">
<title>Analysis of DiCo&#x02013;<italic>Pf</italic>Ron2L Complex Formation</title>
<p>The full equilibrium saturation of each purified DiCo variant as well as the DiCo-Mix was achieved at 12.5&#x02009;&#x000B5;M (50&#x02009;&#x000B5;g/ml) <italic>Pf</italic>Ron2L as illustrated by the complete reduction of the binding signal in SPR measurements (Figure <xref ref-type="fig" rid="F1">1</xref>). Although almost full saturation was achieved at a concentration &#x0003E;1,000&#x02009;nM for DiCo1, DiCo2, and DiCo-Mix, a higher concentration was required for the equilibrium saturation of DiCo3 (&#x0003E;10,000&#x02009;nM), probably reflecting the lower <italic>Pf</italic>Ron2L-binding affinity of this variant. The DiCo concentration (796&#x02009;nM or 50&#x02009;&#x000B5;g/ml) used for equilibrium saturation analysis was identical to the conditions used for the constitution of the immunization complex (50&#x02009;&#x000B5;g DiCo-Mix plus 50&#x02009;&#x000B5;g <italic>Pf</italic>Ron2L).</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p>Analysis of DiCo&#x02013;<italic>Pf</italic>Ron2L complex formation. To determine the equilibrium saturation of the DiCo&#x02013;<italic>Pf</italic>Ron2L complex, surface plasmon resonance-based competition experiments were conducted using a biotinylated <italic>Pf</italic>Ron2L peptide immobilized on a Series S sensor chip streptavidin. Equivalent concentrations of purified DiCo1, DiCo2, DiCo3 as well as a balanced DiCo-Mix were mixed 1:1 with buffer (reference) or decreasing concentrations of the <italic>Pf</italic>Ron2L peptide. The final concentration in the competition assays was 50&#x02009;&#x000B5;g/ml for the DiCo proteins with a molecular weight of approximately 62.5&#x02009;kDa (796&#x02009;nM) and 50&#x02009;&#x000B5;g/ml (12,500&#x02009;nM)&#x02014;0.022&#x02009;&#x000B5;g/ml (5.7&#x02009;nM) for the <italic>Pf</italic>Ron2L peptide. The competition samples were incubated for 4&#x02009;h at room temperature and the residual binding to the immobilized <italic>Pf</italic>Ron2L was analyzed. The buffer control (reference) was set to 100%, and residual binding was expressed as a percentage compared to the control.</p></caption>
<graphic xlink:href="fimmu-08-00743-g001.tif"/>
</fig>
</sec>
<sec id="S3-3">
<title>Rabbit Immunizations and Characterization of Immune Sera</title>
<p>Serum samples collected after the immunization of rabbit groups were analyzed by ELISA to determine specific IgG titers for DiCo-Mix, the three individual DiCo variants, and the different <italic>Pf</italic>AMA1 alleles (Figure <xref ref-type="fig" rid="F2">2</xref>). No significant differences in IgG titer were observed among the three groups (D, D&#x02009;&#x0002B;&#x02009;R, and C). Geometric mean titers against DiCo-Mix and the individual DiCo variants were approximately 2.5&#x02009;&#x000D7;&#x02009;10<sup>5</sup> (Figure <xref ref-type="fig" rid="F2">2</xref>). Immune sera were also compared by avidity ELISA, revealing no significant differences among the immunization groups (Figure <xref ref-type="fig" rid="F3">3</xref>).</p>
<fig id="F2" position="float">
<label>Figure 2</label>
<caption><p>Determination of antibody titers in the serum samples. Four rabbits (R1&#x02013;R4) in each group were immunized using a one prime (day 0) and two boost (day 28 and day 56) immunization schedule and the serum samples were collected on day 70. The antibody titers were assessed by direct-coating enzyme-linked immunosorbent assay using the DiCo-Mix and single DiCo variants as well as six different <italic>Plasmodium falciparum</italic> apical membrane antigen 1 alleles as coating antigens (indicated above each lane). D: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix; D&#x02009;&#x0002B;&#x02009;R: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L peptide at different injection sites; C: group of rabbits that were immunized with the DiCo&#x02013;<italic>Pf</italic>Ron2L complex formed by mixing 50&#x02009;&#x000B5;g of DiCo-Mix with 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L. To facilitate complex formation, the DiCo&#x02013;<italic>Pf</italic>Ron2L mixture was incubated for 30&#x02009;min at room temperature before formulation with the adjuvant and immunization. The end-point titers were defined as the highest dilution that gave double the value of the background (pre-immune serum).</p></caption>
<graphic xlink:href="fimmu-08-00743-g002.tif"/>
</fig>
<fig id="F3" position="float">
<label>Figure 3</label>
<caption><p>Determination of antibody avidity in the serum samples. The antibody avidity for the DiCo-Mix was assessed using the NaSCN-displacement enzyme-linked immunosorbent assay protocol and is defined as the NaSCN concentration (molar) required to reduce the OD<sub>405&#x02009;nm</sub> by 50% compared to the reference sample incubated without NaSCN. D: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix; D&#x02009;&#x0002B;&#x02009;R: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L peptide at different injection sites; C: group of rabbits that were immunized with the DiCo&#x02013;<italic>Pf</italic>Ron2L complex formed by mixing 50&#x02009;&#x000B5;g of DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L. To facilitate the complex formation, the DiCo&#x02013;<italic>Pf</italic>Ron2L mixture was incubated for 30&#x02009;min at room temperature before formulation with the adjuvant and immunization.</p></caption>
<graphic xlink:href="fimmu-08-00743-g003.tif"/>
</fig>
</sec>
<sec id="S3-4">
<title>Quantification and Analysis of Purified Immune IgG</title>
<p>Analytical SEC was used to determine the total quantity of IgG in the rabbit immune IgG purified by Protein A affinity chromatography. Sensor chips functionalized with DiCo-Mix, <italic>Pf</italic>AMA1<italic>-</italic>3D7, <italic>Pf</italic>AMA1<italic>-</italic>FCR3, or <italic>Pf</italic>AMA1<italic>-</italic>HB3 were used to determine the concentrations of antigen-specific antibodies in all preparations by CFCA. Table <xref ref-type="table" rid="T1">1</xref> shows the concentration of total IgG (milligrams per milliliter) and the quantity of antigen-specific antibodies indicated both by the concentration (milligrams per milliliter) and the proportion relative to total IgG (%). The quantity of allele-specific IgG is also shown relative to the quantity of DiCo-Mix-specific IgG (%). As already observed for the avidity index (Figure <xref ref-type="fig" rid="F3">3</xref>), there were no significant differences in immunogenicity among the three immunization groups (Figure <xref ref-type="fig" rid="F4">4</xref>A). Using the combination of <italic>Pf</italic>AMA1 and <italic>Pf</italic>Ron2L either as complex (C) or at separate injections sites (D&#x02009;&#x0002B;&#x02009;R) also had no quantitative effect on the strain specificity of the induced immune responses, which ranged from 60 to 70% (<italic>Pf</italic>AMA1-3D7 and <italic>Pf</italic>AMA1-HB3) up to 80% (<italic>Pf</italic>AMA1-FCR3) allele-specific IgG relative to the DiCo-Mix-specific immune IgG (Figure <xref ref-type="fig" rid="F4">4</xref>B). This result was also confirmed by SPR-based competition assays (Figure <xref ref-type="fig" rid="F4">4</xref>C). In the SPR-based competition assay using the DiCo-Mix surface, we also tested mixtures of three and six alleles to investigate the reactivity profile of the DiCo-Mix-specific antibody preparations. As also shown in Figure <xref ref-type="fig" rid="F4">4</xref>C, the use of DiCo-Mix as a competitor led to the complete abolition of binding, whereas three alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3) neutralized 80% of the binding signal and six alleles (<italic>Pf</italic>AMA1-3D7, <italic>Pf</italic>AMA1-FCR3, <italic>Pf</italic>AMA1-HB3, <italic>Pf</italic>AMA1-Dd2, <italic>Pf</italic>AMA1-7G8, and <italic>Pf</italic>AMA1&#x02013;RO33) neutralized 90% of the binding signal.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Summary of total and antigen-specific antibody concentrations in the purified immune IgG preparations.</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left">Antigen</th>
<th valign="top" align="center">ID</th>
<th valign="top" align="center">Total IgG (mg/ml)</th>
<th valign="top" align="center">DiCo-specific IgG (mg/ml)</th>
<th valign="top" align="center">DiCo-specific/total (%)</th>
<th valign="top" align="center">3D7-specific IgG (mg/ml)</th>
<th valign="top" align="center">3D7-specific/total (%)</th>
<th valign="top" align="center">3D7-specific/DiCo-specific (%)</th>
<th valign="top" align="center">FCR3-specific IgG (mg/ml)</th>
<th valign="top" align="center">FCR3-specific/total (%)</th>
<th valign="top" align="center">FCR3-specific/DiCo-specific (%)</th>
<th valign="top" align="center">HB3-specific IgG (mg/ml)</th>
<th valign="top" align="center">HB3-specific/Total (%)</th>
<th valign="top" align="center">HB3-specific/DiCo-specific (%)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">DiCo-Mix</td>
<td align="center" valign="top">R1</td>
<td align="center" valign="top">13.35</td>
<td align="center" valign="top">0.34</td>
<td align="center" valign="top">2.55</td>
<td align="center" valign="top">0.21</td>
<td align="center" valign="top">1.57</td>
<td align="center" valign="top">61.76</td>
<td align="center" valign="top">0.24</td>
<td align="center" valign="top">1.80</td>
<td align="center" valign="top">70.59</td>
<td align="center" valign="top">0.20</td>
<td align="center" valign="top">1.50</td>
<td align="center" valign="top">58.82</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix</td>
<td align="center" valign="top">R2</td>
<td align="center" valign="top">17.69</td>
<td align="center" valign="top">0.50</td>
<td align="center" valign="top">2.83</td>
<td align="center" valign="top">0.32</td>
<td align="center" valign="top">1.81</td>
<td align="center" valign="top">64.00</td>
<td align="center" valign="top">0.39</td>
<td align="center" valign="top">2.20</td>
<td align="center" valign="top">78.00</td>
<td align="center" valign="top">0.31</td>
<td align="center" valign="top">1.75</td>
<td align="center" valign="top">62.00</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix</td>
<td align="center" valign="top">R3</td>
<td align="center" valign="top">15.44</td>
<td align="center" valign="top">0.78</td>
<td align="center" valign="top">5.05</td>
<td align="center" valign="top">0.52</td>
<td align="center" valign="top">3.37</td>
<td align="center" valign="top">66.67</td>
<td align="center" valign="top">0.62</td>
<td align="center" valign="top">4.02</td>
<td align="center" valign="top">79.49</td>
<td align="center" valign="top">0.52</td>
<td align="center" valign="top">3.37</td>
<td align="center" valign="top">66.67</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix</td>
<td align="center" valign="top">R4</td>
<td align="center" valign="top">13.63</td>
<td align="center" valign="top">0.63</td>
<td align="center" valign="top">4.62</td>
<td align="center" valign="top">0.46</td>
<td align="center" valign="top">3.37</td>
<td align="center" valign="top">73.02</td>
<td align="center" valign="top">0.51</td>
<td align="center" valign="top">3.74</td>
<td align="center" valign="top">80.95</td>
<td align="center" valign="top">0.49</td>
<td align="center" valign="top">3.59</td>
<td align="center" valign="top">77.78</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02009;&#x0002B;&#x02009;Ron2L</td>
<td align="center" valign="top">R1</td>
<td align="center" valign="top">14.01</td>
<td align="center" valign="top">0.50</td>
<td align="center" valign="top">3.57</td>
<td align="center" valign="top">0.33</td>
<td align="center" valign="top">2.36</td>
<td align="center" valign="top">66.00</td>
<td align="center" valign="top">0.36</td>
<td align="center" valign="top">2.57</td>
<td align="center" valign="top">72.00</td>
<td align="center" valign="top">0.29</td>
<td align="center" valign="top">2.07</td>
<td align="center" valign="top">58.00</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02009;&#x0002B;&#x02009;Ron2L</td>
<td align="center" valign="top">R2</td>
<td align="center" valign="top">15.50</td>
<td align="center" valign="top">0.58</td>
<td align="center" valign="top">3.74</td>
<td align="center" valign="top">0.31</td>
<td align="center" valign="top">2.00</td>
<td align="center" valign="top">53.45</td>
<td align="center" valign="top">0.45</td>
<td align="center" valign="top">2.90</td>
<td align="center" valign="top">77.59</td>
<td align="center" valign="top">0.34</td>
<td align="center" valign="top">2.19</td>
<td align="center" valign="top">58.62</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02009;&#x0002B;&#x02009;Ron2L</td>
<td align="center" valign="top">R3</td>
<td align="center" valign="top">15.25</td>
<td align="center" valign="top">0.53</td>
<td align="center" valign="top">3.48</td>
<td align="center" valign="top">0.37</td>
<td align="center" valign="top">2.43</td>
<td align="center" valign="top">69.81</td>
<td align="center" valign="top">0.44</td>
<td align="center" valign="top">2.89</td>
<td align="center" valign="top">83.02</td>
<td align="center" valign="top">0.39</td>
<td align="center" valign="top">2.56</td>
<td align="center" valign="top">73.58</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02009;&#x0002B;&#x02009;Ron2L</td>
<td align="center" valign="top">R4</td>
<td align="center" valign="top">13.79</td>
<td align="center" valign="top">0.38</td>
<td align="center" valign="top">2.76</td>
<td align="center" valign="top">0.22</td>
<td align="center" valign="top">1.60</td>
<td align="center" valign="top">57.89</td>
<td align="center" valign="top">0.34</td>
<td align="center" valign="top">2.47</td>
<td align="center" valign="top">89.47</td>
<td align="center" valign="top">0.24</td>
<td align="center" valign="top">1.74</td>
<td align="center" valign="top">63.16</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02013;Ron2L complex</td>
<td align="center" valign="top">R1</td>
<td align="center" valign="top">16.86</td>
<td align="center" valign="top">0.89</td>
<td align="center" valign="top">5.28</td>
<td align="center" valign="top">0.76</td>
<td align="center" valign="top">4.51</td>
<td align="center" valign="top">85.39</td>
<td align="center" valign="top">0.77</td>
<td align="center" valign="top">4.57</td>
<td align="center" valign="top">86.52</td>
<td align="center" valign="top">0.64</td>
<td align="center" valign="top">3.79</td>
<td align="center" valign="top">71.91</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02013;Ron2L complex</td>
<td align="center" valign="top">R2</td>
<td align="center" valign="top">18.01</td>
<td align="center" valign="top">0.54</td>
<td align="center" valign="top">3.00</td>
<td align="center" valign="top">0.37</td>
<td align="center" valign="top">2.05</td>
<td align="center" valign="top">68.52</td>
<td align="center" valign="top">0.41</td>
<td align="center" valign="top">2.28</td>
<td align="center" valign="top">75.93</td>
<td align="center" valign="top">0.34</td>
<td align="center" valign="top">1.89</td>
<td align="center" valign="top">62.96</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02013;Ron2L complex</td>
<td align="center" valign="top">R3</td>
<td align="center" valign="top">17.15</td>
<td align="center" valign="top">0.62</td>
<td align="center" valign="top">3.62</td>
<td align="center" valign="top">0.38</td>
<td align="center" valign="top">2.22</td>
<td align="center" valign="top">61.29</td>
<td align="center" valign="top">0.47</td>
<td align="center" valign="top">2.74</td>
<td align="center" valign="top">75.81</td>
<td align="center" valign="top">0.40</td>
<td align="center" valign="top">2.33</td>
<td align="center" valign="top">64.52</td>
</tr>
<tr>
<td align="left" valign="top">DiCo-Mix&#x02013;Ron2L complex</td>
<td align="center" valign="top">R4</td>
<td align="center" valign="top">14.17</td>
<td align="center" valign="top">0.58</td>
<td align="center" valign="top">4.09</td>
<td align="center" valign="top">0.34</td>
<td align="center" valign="top">2.40</td>
<td align="center" valign="top">58.62</td>
<td align="center" valign="top">0.38</td>
<td align="center" valign="top">2.68</td>
<td align="center" valign="top">65.52</td>
<td align="center" valign="top">0.38</td>
<td align="center" valign="top">2.68</td>
<td align="center" valign="top">65.52</td>
</tr>
</tbody>
</table>
</table-wrap>
<fig id="F4" position="float">
<label>Figure 4</label>
<caption><p>Quantification and analysis of purified immune IgG. The total IgG concentration in the purified IgG preparation was determined by analytical size exclusion chromatography. The antigen-specific IgG concentration for the immunization antigen (DiCo-Mix) as well as for three <italic>Plasmodium falciparum</italic> apical membrane antigen 1 (<italic>Pf</italic>AMA1) alleles (3D7, FCR3, and HB3) was quantified by surface plasmon resonance (SPR) spectroscopy (Biacore T200) using the calibration-free concentration analysis (CFCA) module. The DiCo-specific IgG concentration is expressed as a percentage of total IgG <bold>(A)</bold> and as an indication for balanced <italic>Pf</italic>AMA1 allele coverage as a percentage <italic>Pf</italic>AMA1 allele-specific response per DiCo-Mix-induced IgG response <bold>(B)</bold>. <bold>(C)</bold> SPR-based competition experiments were performed to confirm the CFCA results and to further characterize the purified IgG preparation after immunization with the different DiCo formulations (D: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix; D&#x02009;&#x0002B;&#x02009;R: group of rabbits that received 50&#x02009;&#x000B5;g DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L peptide at different injection sites; C: group of rabbits that were immunized with the DiCo&#x02013;<italic>Pf</italic>Ron2L complex formed by mixing 50&#x02009;&#x000B5;g of DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L). The DiCo-Mix was immobilized by EDC&#x02013;NHS chemistry to a CM5 sensor chip. Purified IgG preparations were diluted 1:100 and mixed 1:1 with 30&#x02009;&#x000B5;g/ml of each competitor antigen (indicated above each lane). For the DiCo-Mix and the three-allele mixture (3D7, FCR3, and HB3), the concentration of each antigen was 10&#x02009;&#x000B5;g/ml, whereas in the six-allele mixture (3D7, FCR3, HB3, Dd2, 7G8, and RO33), the concentration of each individual <italic>Pf</italic>AMA1 allele was 5&#x02009;&#x000B5;g/ml. Competition samples were incubated for 1&#x02009;h at room temperature and residual binding to the DiCo-mix surface was determined. The reference (IgG sample mixed with buffer) was set to 100% and residual binding is expressed as a percentage compared to the reference.</p></caption>
<graphic xlink:href="fimmu-08-00743-g004.tif"/>
</fig>
</sec>
<sec id="S3-5">
<title>Growth Inhibition Assays</title>
<p>Growth inhibition assays were used to compare the ability of the immune IgG preparations derived from the three different rabbit groups (D, D&#x02009;&#x0002B;&#x02009;R, and C) to inhibit parasite growth. The data were used to calculate IC<sub>50</sub> values for three different <italic>P. falciparum</italic> strains (3D7A, FCR3, and HB3) that have previously been used to characterize <italic>Pf</italic>AMA1 strain-specific antibodies. Figure <xref ref-type="fig" rid="F5">5</xref> shows the IC<sub>50</sub> values as normalized to the DiCo-specific IgG (Figure <xref ref-type="fig" rid="F5">5</xref>A) as well as to allele-specific IgG (Figure <xref ref-type="fig" rid="F5">5</xref>B). The results clearly show that for both, DiCo-specific IgG, as well as strain-specific IgG, there is no significant difference between the different groups regarding the IC<sub>50</sub> values observed for each of the three different strains. It is also obvious that the mean IC<sub>50</sub> values (between 120 and 180&#x02009;&#x000B5;g/ml) observed for the DiCo-specific IgG are in the expected range and do not differ significantly for the three strains, which proves the induction of a cross-strain-specific immune response. The differences between DiCo and single allele-specific IC<sub>50</sub> values are proportional to the fraction of allele-specific IgG within the DiCo-specific antibody response (Figure <xref ref-type="fig" rid="F4">4</xref>B).</p>
<fig id="F5" position="float">
<label>Figure 5</label>
<caption><p>Growth inhibition assay. The parasite growth-inhibitory activity of the immune IgG preparations from the three different rabbit groups (see below) were assessed using three <italic>P. falciparum</italic> strains (3D7A, FCR3, and HB3). A serial dilution of purified IgG preparations starting at 6&#x02009;mg/ml total IgG were used to determine IC<sub>50</sub> values for the three <italic>P. falciparum</italic> strains. Based on the antigen-specific antibody concentrations (Table <xref ref-type="table" rid="T1">1</xref>), IC<sub>50</sub> values are expressed in micrograms per milliliter DiCo-specific IgG <bold>(A)</bold> and micrograms per milliliter allele-specific IgG <bold>(B)</bold>. D: group of rabbits that were vaccinated using 50&#x02009;&#x000B5;g DiCo-Mix; D&#x02009;&#x0002B;&#x02009;R: group of rabbits that were vaccinated using 50&#x02009;&#x000B5;g DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L peptide at different injection sites; C: group of rabbits that were immunized with the DiCo&#x02013;<italic>Pf</italic>Ron2L complex formed by mixing 50&#x02009;&#x000B5;g of DiCo-Mix and 50&#x02009;&#x000B5;g of <italic>Pf</italic>Ron2L. To facilitate the complex formation, the DiCo&#x02013;<italic>Pf</italic>Ron2L mixture was incubated for 30&#x02009;min at room temperature before formulation with the adjuvant and immunization.</p></caption>
<graphic xlink:href="fimmu-08-00743-g005.tif"/>
</fig>
</sec>
</sec>
<sec id="S4" sec-type="discussion">
<title>Discussion</title>
<p>A preparation consisting of recombinant <italic>Pf</italic>AMA1 and its peptide ligand <italic>Pf</italic>Ron2L was recently shown to achieve greater efficacy than <italic>Pf</italic>AMA1 alone in an <italic>in vitro</italic> parasite GIA using <italic>P. falciparum</italic> and to protect mice from a lethal challenge with <italic>P. yoelii</italic> (<xref ref-type="bibr" rid="B35">35</xref>). We, therefore, tested the same strategy to determine whether it could enhance the potency of antibody responses when combining recombinant DiCo variants of <italic>Pf</italic>AMA1 with <italic>Pf</italic>Ron2L. The available epidemiological (<xref ref-type="bibr" rid="B46">46</xref>), preclinical (<xref ref-type="bibr" rid="B14">14</xref>), and clinical data (<xref ref-type="bibr" rid="B47">47</xref>, <xref ref-type="bibr" rid="B48">48</xref>) clearly show that both greater potency (by increasing specificity or immunogenicity) and improved cross-strain coverage are required to develop an efficient <italic>Pf</italic>AMA1-based blood-stage vaccine (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B49">49</xref>). We immunized three groups of four rabbits with a balanced mixture of the three DiCo variants (D), or DiCo-Mix and <italic>Pf</italic>Ron2L at different injection sites (D&#x02009;&#x0002B;&#x02009;R), or the DiCo-Mix in complex with <italic>Pf</italic>Ron2L (C), and conducted a detailed quantitative and qualitative analysis of the resulting immune IgG, using different ELISA formats, SPR-based binding assays and parasite GIAs.</p>
<p>In agreement with our earlier DiCo-based studies (<xref ref-type="bibr" rid="B37">37</xref>, <xref ref-type="bibr" rid="B44">44</xref>) and those reported by other groups (<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B45">45</xref>), we observed balanced IC<sub>50</sub> values (&#x0007E;150&#x02009;&#x003BC;g/ml) against different strains. This is in contrast to using single alleles for immunization, where the IC<sub>50</sub> values in GIA are significantly higher (greater than twofold) for heterologous compared to homologous (vaccine-like) strains (<xref ref-type="bibr" rid="B18">18</xref>).</p>
<p>On one hand, comparison among the three immunization groups (D, D&#x02009;&#x0002B;&#x02009;R, and C) showed that co-immunization with <italic>Pf</italic>Ron2L [either at a different injection site (D&#x02009;&#x0002B;&#x02009;R) or in a complex (C)] does not reduce the ability of the DiCo-Mix to induce cross-strain parasite inhibitory responses. On the other hand, there was no significant difference in IC<sub>50</sub> values between the DiCo&#x02013;<italic>Pf</italic>Ron2L complex group and the other two groups, as reported for homologous GIAs using <italic>P. falciparum</italic> and a lethal challenge using <italic>P. yoelii</italic> following the immunization of mice with single-allele AMA1&#x02013;Ron2L complexes (<xref ref-type="bibr" rid="B35">35</xref>).</p>
<p>Even though these results appear contradictory, there may be a common explanation. The authors of the abovementioned study provided evidence that the improved efficacy of the AMA1&#x02013;Ron2L complex relies on antibody responses, and that antibodies against certain variable loops surrounding the Ron2-binding pocket play an important role in this scenario (<xref ref-type="bibr" rid="B35">35</xref>). Parasite growth-inhibitory antibodies interfering with the AMA1&#x02013;Ron2L interaction by recognizing these variable (or even hypervariable) loops are most probably strain specific and, therefore, less favorable when aiming for cross-strain efficacy. This is further illustrated by the monoclonal antibody 1F9 (<xref ref-type="bibr" rid="B50">50</xref>), a murine antibody raised by immunization with <italic>Pf</italic>AMA1-3D7, which interferes with the <italic>Pf</italic>AMA1&#x02013;<italic>Pf</italic>Ron2 interaction by binding to a reduction-sensitive epitope including the most polymorphic residue of the antigen. Point mutations at this residue, such as those found in alleles <italic>Pf</italic>AMA1-HB3 and <italic>Pf</italic>AMA1-W2<sub>mef</sub>, prevent 1F9 binding to the corresponding alleles and eliminate growth inhibitory activity against these strains (<xref ref-type="bibr" rid="B28">28</xref>). Immunization with multiple <italic>Pf</italic>AMA1 alleles improved cross-strain efficacy by increasing the proportion of conserved face-specific antibodies that recognize epitopes shared by the majority or even all known <italic>P. falciparum</italic> strains (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>). Taken together, these experiments suggest that at least four (<xref ref-type="bibr" rid="B18">18</xref>) or five (<xref ref-type="bibr" rid="B17">17</xref>) different alleles must be combined to induce cross-strain-specific responses covering diverse naturally occurring strains.</p>
<p>Each additional allele provided as a recombinant protein in the context of a vaccine formulation adds to the costs and complexity of process development, manufacturing, and regulatory approval, so, three DiCo variants have been designed to cover the allelic diversity of <italic>Pf</italic>AMA1 comprehensively using the smallest number of recombinant proteins (<xref ref-type="bibr" rid="B19">19</xref>). As discussed above for the conventional multi-allele approach (<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>), the DiCo approach successfully increases the induction of conserved region-specific antibodies by dilution of the strain-specific variable epitopes (<xref ref-type="bibr" rid="B51">51</xref>). Alternative approaches that drive the immune response toward conserved <italic>Pf</italic>AMA1 epitopes include the immunodampening of the hypervariable loop Id (<xref ref-type="bibr" rid="B52">52</xref>) as well as glycan masking of the variable regions (Boes et al., in preparation). If the improved potency of the AMA1&#x02013;Ron2L complex results from the induction of antibodies targeting variable loops near the Ron2-binding pocket that undergo conformational changes when Ron2 binds (<xref ref-type="bibr" rid="B35">35</xref>), then a strategy favoring cross-strain specific epitopes by overrepresentation of the conserved regions may reduce the induction of such antibodies below effective concentrations, which is probably why the IC<sub>50</sub>-values we observed could not be improved by the combination of DiCo-Mix with <italic>Pf</italic>Ron2L. Alternatively, the artificial mixed allele design approach of the <italic>Pf</italic>AMA1 DiCo variants could affect the conformational changes normally induced by <italic>Pf</italic>Ron2-binding in the variable loop region of natural <italic>Pf</italic>AMA1 alleles and thus fail to induce efficacious antibodies. Although these explanations are speculative and require conformational studies, they highlights the complexity associated with <italic>Pf</italic>AMA1 as a vaccine target.</p>
<p>In our setting, co-formulation with the <italic>Pf</italic>Ron2L peptide did not improve the <italic>in vitro</italic> efficacy of the DiCo-Mix, a vaccine that aims for cross-strain coverage by eliciting higher levels of constant region-specific antibodies. However, our results provide additional insight into DiCo-specific antibody responses. The competition experiment revealed that single <italic>Pf</italic>AMA1 alleles neutralize between 65% (<italic>Pf</italic>AMA1-3D7) and 75% (<italic>Pf</italic>AMA1-FCR3) of DiCo-specific immune IgG. Whereas conserved region-specific immune IgG will be neutralized by all alleles, antibodies against polymorphic, strain-specific regions will only be neutralized by alleles that present the corresponding epitopes. The observed trend toward different degrees of competition of the three alleles (<italic>Pf</italic>3D7, <italic>Pf</italic>FCR3, and <italic>Pf</italic>HB3), although not statistically significant, most probably reflects the ability of the DiCo-Mix to induce corresponding strain-specific IgG in addition to commonly neutralizing cross-strain-specific antibodies, given that constant region-specific antibodies will be neutralized equally by all <italic>Pf</italic>AMA1 alleles and DiCo variants. The trend indicates that DiCo-specific immune IgG may contain a lower proportion of strain-specific IgG directed toward <italic>Pf</italic>AMA1<italic>-</italic>3D7 than <italic>Pf</italic>AMA1<italic>-</italic>FCR3 or <italic>Pf</italic>AMA1<italic>-</italic>HB3. The comparison of GIA IC<sub>50</sub> values (&#x0007E;125&#x02009;&#x003BC;g/ml) for <italic>Pf</italic>AMA1-3D7-specific antibodies in immune IgG preparations derived from the three immunization groups (D, D&#x02009;&#x0002B;&#x02009;R, and C) and the corresponding IC<sub>50</sub> values for <italic>Pf</italic>AMA1-3D7-specific antibodies (&#x0007E;40&#x02009;&#x003BC;g/ml) generated by single-allele immunization with <italic>Pf</italic>AMA1-3D7 (<xref ref-type="bibr" rid="B38">38</xref>) suggests that DiCo-derived <italic>Pf</italic>AMA1-3D7-specific antibodies have a lower <italic>in vitro</italic> efficacy. This contrasts with the results of a <italic>Pf</italic>AMA1 multi-allele study in which identical IC<sub>50</sub> values were observed for affinity-purified <italic>Pf</italic>AMA1<italic>-</italic>3D7-specific antibodies derived from rabbits immunized with either single-allele <italic>Pf</italic>AMA1<italic>-</italic>3D7 or with a mixture (Quadvax) of the four different <italic>Pf</italic>AMA1 alleles 3D7, FVO, HB3, and W2<sub>mef</sub> (<xref ref-type="bibr" rid="B18">18</xref>). Even though Quadvax seems to induce predominantly conserved region-specific antibodies, it is possible that the presence of <italic>Pf</italic>AMA1-3D7 within the vaccine formulation leads to the induction of potent, allele-specific growth inhibitory antibodies, which account for this difference. Looking at an alignment of sequences featuring the three DiCo variants, as well as the three alleles <italic>Pf</italic>AMA1<italic>-</italic>3D7, <italic>Pf</italic>AMA1<italic>-</italic>FCR3, and <italic>Pf</italic>AMA1<italic>-</italic>HB3 (Figure S1 in Supplementary Material), we find a glutamic acid residue (E197) in the hypervariable loop Id (<xref ref-type="bibr" rid="B33">33</xref>), which is not present in any of the three DiCo variants or strains <italic>Pf</italic>AMA1<italic>-</italic>3D7, <italic>Pf</italic>AMA1<italic>-</italic>FCR3, and <italic>Pf</italic>AMA1<italic>-</italic>HB3. E197, the most polymorphic residue in <italic>Pf</italic>AMA1, is a key residue within an epitope targeted by the <italic>Pf</italic>3D7 growth-inhibitory monoclonal antibody 1F9 (<xref ref-type="bibr" rid="B28">28</xref>). Replacing this residue with random amino acids or those found in other allelic variants of <italic>Pf</italic>AMA1 abolishes 1F9 binding and consequently growth-inhibitory activity. Another hint that antibodies directed to the Id loop may play an essential role was shown by replacing all polymorphic residues within the Id loop with alanine, aiming to reduce Id-specific reactivity and generate improved cross-strain-specific responses targeting the conserved region (<xref ref-type="bibr" rid="B52">52</xref>). The improved cross-strain efficacy was achieved at the cost of reduced overall growth-inhibitory activity for the homologous strain, which is analogous to our observations. All these results and conclusions together suggest that it would be more promising to work on the induction of highly potent or maximally cross-strain-specific antibodies by investing resources into concepts that target these goals separately, and, if reasonable, combine them once both approaches show promising improvements beyond the current state of the art.</p>
</sec>
<sec id="S5">
<title>Ethics Statement</title>
<p>Rabbits were housed, immunized, and sampled by Biogenes GmbH (Berlin, Germany) according to national animal welfare regulations. The animal facilities and protocols were reviewed and approved by: Landesamt f&#x000FC;r Landwirtschaft, Lebensmittelsicherheit, und Fischerei MecklenburgVorpommern (LALLF M-V) (Approval No: 7221.3-2-030-13).</p>
</sec>
<sec id="S6" sec-type="author-contributor">
<title>Author Contributions</title>
<p>AB and HS conceived the study, performed the experiments, analyzed the data, and wrote the manuscript. RF performed and analyzed the GIA experiments and contributed to data analysis and writing the manuscript. AR, SS, and RFi conceived the overall study design and contributed to writing the manuscript. All authors read and approved the final manuscript.</p>
</sec>
<sec id="S7">
<title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<ack>
<p>We thank Dr. Richard M. Twyman for manuscript editing. We are grateful for the BG98 standard, which was kindly provided by BPRC (Rijswijk, the Netherlands). <italic>Plasmodium falciparum</italic> 3D7A, MRA-151, deposited by D. Walliker; <italic>Plasmodium falciparum</italic> HB3, MRA-155, deposited by T. E. Wellems; and <italic>Plasmodium falciparum</italic> FCR-3/Gambia Subline F-86, MRA-731, deposited by W. Trager, were obtained through the MR4 as part of the BEI Resources Repository, NIAID, NIH. We also would like to thank Anh-Tuan Pham for technical help performing the culture of <italic>Plasmodium falciparum</italic> parasites and the growth inhibitions assays. This work was supported by the &#x0201C;Fraunhofer-Zukunftsstiftung.&#x0201D;</p>
</ack>
<sec id="S8" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at <uri xlink:href="http://journal.frontiersin.org/article/10.3389/fimmu.2017.00743/full&#x00023;supplementary-material">http://journal.frontiersin.org/article/10.3389/fimmu.2017.00743/full&#x00023;supplementary-material</uri>.</p>
<supplementary-material xlink:href="data_sheet_1.docx" id="SM1" mimetype="applicationn/docx" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1"><label>1</label><citation citation-type="book"><collab>World Health Organization</collab>. <source>World Malaria Report 2016</source>. <publisher-loc>Geneva</publisher-loc>: <publisher-name>WHO</publisher-name> (<year>2016</year>).</citation></ref>
<ref id="B2"><label>2</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Anders</surname> <given-names>RFR</given-names></name> <name><surname>Crewther</surname> <given-names>PEP</given-names></name> <name><surname>Edwards</surname> <given-names>SS</given-names></name> <name><surname>Margetts</surname> <given-names>MM</given-names></name> <name><surname>Matthew</surname> <given-names>MLM</given-names></name> <name><surname>Pollock</surname> <given-names>BB</given-names></name> <etal/></person-group> <article-title>Immunisation with recombinant AMA-1 protects mice against infection with <italic>Plasmodium chabaudi</italic></article-title>. <source>Vaccine</source> (<year>1997</year>) <volume>16</volume>:<fpage>240</fpage>&#x02013;<lpage>7</lpage>.<pub-id pub-id-type="doi">10.1016/S0264-410X(97)88331-4</pub-id></citation></ref>
<ref id="B3"><label>3</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Collins</surname> <given-names>WE</given-names></name> <name><surname>Pye</surname> <given-names>D</given-names></name> <name><surname>Crewther</surname> <given-names>PE</given-names></name> <name><surname>Vandenberg</surname> <given-names>KL</given-names></name> <name><surname>Galland</surname> <given-names>GG</given-names></name> <name><surname>Sulzer</surname> <given-names>AJ</given-names></name> <etal/></person-group> <article-title>Protective immunity induced in squirrel monkeys with recombinant apical membrane antigen-1 of <italic>Plasmodium fragile</italic></article-title>. <source>Am J Trop Med Hyg</source> (<year>1994</year>) <volume>51</volume>:<fpage>711</fpage>&#x02013;<lpage>9</lpage>.<pub-id pub-id-type="doi">10.4269/ajtmh.1994.51.711</pub-id><pub-id pub-id-type="pmid">7810803</pub-id></citation></ref>
<ref id="B4"><label>4</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Deans</surname> <given-names>JA</given-names></name> <name><surname>Knight</surname> <given-names>AM</given-names></name> <name><surname>Jean</surname> <given-names>WC</given-names></name> <name><surname>Waters</surname> <given-names>AP</given-names></name> <name><surname>Cohen</surname> <given-names>S</given-names></name> <name><surname>Mitchell</surname> <given-names>GH</given-names></name></person-group>. <article-title>Vaccination trials in rhesus monkeys with a minor, invariant, <italic>Plasmodium knowlesi</italic> 66 kD merozoite antigen</article-title>. <source>Parasite Immunol</source> (<year>1988</year>) <volume>10</volume>:<fpage>535</fpage>&#x02013;<lpage>52</lpage>.<pub-id pub-id-type="doi">10.1111/j.1365-3024.1988.tb00241.x</pub-id><pub-id pub-id-type="pmid">3194149</pub-id></citation></ref>
<ref id="B5"><label>5</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Narum</surname> <given-names>DL</given-names></name> <name><surname>Ogun</surname> <given-names>SA</given-names></name> <name><surname>Thomas</surname> <given-names>AW</given-names></name> <name><surname>Holder</surname> <given-names>AA</given-names></name></person-group>. <article-title>Immunization with parasite-derived apical membrane antigen 1 or passive immunization with a specific monoclonal antibody protects BALB/c mice against lethal <italic>Plasmodium yoelii yoelii</italic> YM blood-stage infection</article-title>. <source>Infect Immun</source> (<year>2000</year>) <volume>68</volume>:<fpage>2899</fpage>&#x02013;<lpage>906</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.68.5.2899-2906.2000</pub-id><pub-id pub-id-type="pmid">10768987</pub-id></citation></ref>
<ref id="B6"><label>6</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Remarque</surname> <given-names>EJE</given-names></name> <name><surname>Faber</surname> <given-names>BWB</given-names></name> <name><surname>Kocken</surname> <given-names>CHMC</given-names></name> <name><surname>Thomas</surname> <given-names>AWA</given-names></name></person-group>. <article-title>Apical membrane antigen 1: a malaria vaccine candidate in review</article-title>. <source>Trends Parasitol</source> (<year>2008</year>) <volume>24</volume>:<fpage>11</fpage>&#x02013;<lpage>11</lpage>.<pub-id pub-id-type="doi">10.1016/j.pt.2007.12.002</pub-id><pub-id pub-id-type="pmid">18226584</pub-id></citation></ref>
<ref id="B7"><label>7</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Thera</surname> <given-names>MA</given-names></name> <name><surname>Doumbo</surname> <given-names>OK</given-names></name> <name><surname>Coulibaly</surname> <given-names>D</given-names></name> <name><surname>Diallo</surname> <given-names>DA</given-names></name> <name><surname>Kone</surname> <given-names>AK</given-names></name> <name><surname>Guindo</surname> <given-names>AB</given-names></name> <etal/></person-group> <article-title>Safety and immunogenicity of an AMA-1 malaria vaccine in Malian adults: results of a phase 1 randomized controlled trial</article-title>. <source>PLoS One</source> (<year>2008</year>) <volume>3</volume>:<fpage>e1465</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0001465</pub-id><pub-id pub-id-type="pmid">18213374</pub-id></citation></ref>
<ref id="B8"><label>8</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pierce</surname> <given-names>MA</given-names></name> <name><surname>Ellis</surname> <given-names>RD</given-names></name> <name><surname>Martin</surname> <given-names>LB</given-names></name> <name><surname>Malkin</surname> <given-names>E</given-names></name> <name><surname>Tierney</surname> <given-names>E</given-names></name> <name><surname>Miura</surname> <given-names>K</given-names></name> <etal/></person-group> <article-title>Phase 1 safety and immunogenicity trial of the <italic>Plasmodium falciparum</italic> blood-stage malaria vaccine AMA1-C1/ISA 720 in Australian adults</article-title>. <source>Vaccine</source> (<year>2010</year>) <volume>28</volume>:<fpage>2236</fpage>&#x02013;<lpage>42</lpage>.<pub-id pub-id-type="doi">10.1016/j.vaccine.2009.12.049</pub-id><pub-id pub-id-type="pmid">20051276</pub-id></citation></ref>
<ref id="B9"><label>9</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ellis</surname> <given-names>RD</given-names></name> <name><surname>Wu</surname> <given-names>Y</given-names></name> <name><surname>Martin</surname> <given-names>LB</given-names></name> <name><surname>Shaffer</surname> <given-names>D</given-names></name> <name><surname>Miura</surname> <given-names>K</given-names></name> <name><surname>Aebig</surname> <given-names>J</given-names></name> <etal/></person-group> <article-title>Phase 1 study in malaria na&#x000EF;ve adults of BSAM2/Alhydrogel<sup>&#x000AE;</sup>&#x0002B;CPG 7909, a blood stage vaccine against <italic>P. falciparum</italic> malaria</article-title>. <source>PLoS One</source> (<year>2012</year>) <volume>7</volume>:<fpage>e46094</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0046094</pub-id><pub-id pub-id-type="pmid">23056238</pub-id></citation></ref>
<ref id="B10"><label>10</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dicko</surname> <given-names>A</given-names></name> <name><surname>Sagara</surname> <given-names>I</given-names></name> <name><surname>Ellis</surname> <given-names>RD</given-names></name> <name><surname>Miura</surname> <given-names>K</given-names></name> <name><surname>Guindo</surname> <given-names>O</given-names></name> <name><surname>Kamate</surname> <given-names>B</given-names></name> <etal/></person-group> <article-title>Phase 1 study of a combination AMA1 blood stage malaria vaccine in Malian children</article-title>. <source>PLoS One</source> (<year>2008</year>) <volume>3</volume>:<fpage>e1563</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0001563</pub-id><pub-id pub-id-type="pmid">18270560</pub-id></citation></ref>
<ref id="B11"><label>11</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Healer</surname> <given-names>J</given-names></name> <name><surname>Murphy</surname> <given-names>V</given-names></name> <name><surname>Hodder</surname> <given-names>AN</given-names></name> <name><surname>Masciantonio</surname> <given-names>R</given-names></name> <name><surname>Gemmill</surname> <given-names>AW</given-names></name> <name><surname>Anders</surname> <given-names>RF</given-names></name> <etal/></person-group> <article-title>Allelic polymorphisms in apical membrane antigen-1 are responsible for evasion of antibody-mediated inhibition in <italic>Plasmodium falciparum</italic></article-title>. <source>Mol Microbiol</source> (<year>2004</year>) <volume>52</volume>:<fpage>159</fpage>&#x02013;<lpage>68</lpage>.<pub-id pub-id-type="doi">10.1111/j.1365-2958.2003.03974.x</pub-id><pub-id pub-id-type="pmid">15049818</pub-id></citation></ref>
<ref id="B12"><label>12</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Polley</surname> <given-names>SD</given-names></name> <name><surname>Chokejindachai</surname> <given-names>W</given-names></name> <name><surname>Conway</surname> <given-names>DJ</given-names></name></person-group>. <article-title>Allele frequency-based analyses robustly map sequence sites under balancing selection in a malaria vaccine candidate antigen</article-title>. <source>Genetics</source> (<year>2003</year>) <volume>165</volume>(<issue>2</issue>):<fpage>555</fpage>&#x02013;<lpage>61</lpage>.<pub-id pub-id-type="pmid">14573469</pub-id></citation></ref>
<ref id="B13"><label>13</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Polley</surname> <given-names>SD</given-names></name> <name><surname>Conway</surname> <given-names>DJ</given-names></name></person-group>. <article-title>Strong diversifying selection on domains of the <italic>Plasmodium falciparum</italic> apical membrane antigen 1 gene</article-title>. <source>Genetics</source> (<year>2001</year>) <volume>158</volume>(<issue>4</issue>):<fpage>1505</fpage>&#x02013;<lpage>12</lpage>.<pub-id pub-id-type="pmid">11514442</pub-id></citation></ref>
<ref id="B14"><label>14</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kusi</surname> <given-names>KA</given-names></name> <name><surname>Faber</surname> <given-names>BW</given-names></name> <name><surname>Riasat</surname> <given-names>V</given-names></name> <name><surname>Thomas</surname> <given-names>AW</given-names></name> <name><surname>Kocken</surname> <given-names>CHM</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name></person-group>. <article-title>Generation of humoral immune responses to multi-allele PfAMA1 vaccines; effect of adjuvant and number of component alleles on the breadth of response</article-title>. <source>PLoS One</source> (<year>2010</year>) <volume>5</volume>:<fpage>e15391</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0015391</pub-id><pub-id pub-id-type="pmid">21082025</pub-id></citation></ref>
<ref id="B15"><label>15</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kusi</surname> <given-names>KA</given-names></name> <name><surname>Faber</surname> <given-names>BW</given-names></name> <name><surname>Thomas</surname> <given-names>AW</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name></person-group>. <article-title>Humoral immune response to mixed PfAMA1 alleles; multivalent PfAMA1 vaccines induce broad specificity</article-title>. <source>PLoS One</source> (<year>2009</year>) <volume>4</volume>:<fpage>e8110</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0008110</pub-id><pub-id pub-id-type="pmid">19956619</pub-id></citation></ref>
<ref id="B16"><label>16</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kusi</surname> <given-names>KA</given-names></name> <name><surname>Faber</surname> <given-names>BW</given-names></name> <name><surname>van der Eijk</surname> <given-names>M</given-names></name> <name><surname>Thomas</surname> <given-names>AW</given-names></name> <name><surname>Kocken</surname> <given-names>CHM</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name></person-group>. <article-title>Immunization with different PfAMA1 alleles in sequence induces clonal imprint humoral responses that are similar to responses induced by the same alleles as a vaccine cocktail in rabbits</article-title>. <source>Malar J</source> (<year>2011</year>) <volume>10</volume>:<fpage>40</fpage>.<pub-id pub-id-type="doi">10.1186/1475-2875-10-40</pub-id><pub-id pub-id-type="pmid">21320299</pub-id></citation></ref>
<ref id="B17"><label>17</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Miura</surname> <given-names>K</given-names></name> <name><surname>Herrera</surname> <given-names>R</given-names></name> <name><surname>Diouf</surname> <given-names>A</given-names></name> <name><surname>Zhou</surname> <given-names>H</given-names></name> <name><surname>Mu</surname> <given-names>J</given-names></name> <name><surname>Hu</surname> <given-names>Z</given-names></name> <etal/></person-group> <article-title>Overcoming allelic specificity by immunization with five allelic forms of <italic>Plasmodium falciparum</italic> apical membrane antigen 1</article-title>. <source>Infect Immun</source> (<year>2013</year>) <volume>81</volume>:<fpage>1491</fpage>&#x02013;<lpage>501</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.01414-12</pub-id><pub-id pub-id-type="pmid">23429537</pub-id></citation></ref>
<ref id="B18"><label>18</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dutta</surname> <given-names>S</given-names></name> <name><surname>Dlugosz</surname> <given-names>LS</given-names></name> <name><surname>Drew</surname> <given-names>DR</given-names></name> <name><surname>Ge</surname> <given-names>X</given-names></name> <name><surname>Ge</surname> <given-names>X</given-names></name> <name><surname>Ababacar</surname> <given-names>D</given-names></name> <etal/></person-group> <article-title>Overcoming antigenic diversity by enhancing the immunogenicity of conserved epitopes on the malaria vaccine candidate apical membrane antigen-1</article-title>. <source>PLoS Pathog</source> (<year>2013</year>) <volume>9</volume>:<fpage>e1003840</fpage>.<pub-id pub-id-type="doi">10.1371/journal.ppat.1003840</pub-id><pub-id pub-id-type="pmid">24385910</pub-id></citation></ref>
<ref id="B19"><label>19</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Remarque</surname> <given-names>EJE</given-names></name> <name><surname>Faber</surname> <given-names>BWB</given-names></name> <name><surname>Kocken</surname> <given-names>CHMC</given-names></name> <name><surname>Thomas</surname> <given-names>AWA</given-names></name></person-group>. <article-title>A diversity-covering approach to immunization with <italic>Plasmodium falciparum</italic> apical membrane antigen 1 induces broader allelic recognition and growth inhibition responses in rabbits</article-title>. <source>Infect Immun</source> (<year>2008</year>) <volume>76</volume>:<fpage>2660</fpage>&#x02013;<lpage>70</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.00170-08</pub-id><pub-id pub-id-type="pmid">18378635</pub-id></citation></ref>
<ref id="B20"><label>20</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Sedegah</surname> <given-names>M</given-names></name> <name><surname>Hollingdale</surname> <given-names>MR</given-names></name> <name><surname>Farooq</surname> <given-names>F</given-names></name> <name><surname>Ganeshan</surname> <given-names>H</given-names></name> <name><surname>Belmonte</surname> <given-names>M</given-names></name> <name><surname>Kim</surname> <given-names>Y</given-names></name> <etal/></person-group> <article-title>Sterile immunity to malaria after DNA prime/adenovirus boost immunization is associated with effector memory CD8&#x0002B; T cells targeting AMA1 class I epitopes</article-title>. <source>PLoS One</source> (<year>2014</year>) <volume>9</volume>:<fpage>e106241</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0106241</pub-id><pub-id pub-id-type="pmid">25211344</pub-id></citation></ref>
<ref id="B21"><label>21</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hodgson</surname> <given-names>SH</given-names></name> <name><surname>Choudhary</surname> <given-names>P</given-names></name> <name><surname>Elias</surname> <given-names>SC</given-names></name> <name><surname>Milne</surname> <given-names>KH</given-names></name> <name><surname>Rampling</surname> <given-names>TW</given-names></name> <name><surname>Biswas</surname> <given-names>S</given-names></name> <etal/></person-group> <article-title>Combining viral vectored and protein-in-adjuvant vaccines against the blood-stage malaria antigen AMA1: report on a phase 1a clinical trial</article-title>. <source>Mol Ther</source> (<year>2014</year>) <volume>22</volume>:<fpage>2142</fpage>&#x02013;<lpage>54</lpage>.<pub-id pub-id-type="doi">10.1038/mt.2014.157</pub-id><pub-id pub-id-type="pmid">25156127</pub-id></citation></ref>
<ref id="B22"><label>22</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Biswas</surname> <given-names>S</given-names></name> <name><surname>Dicks</surname> <given-names>MDJ</given-names></name> <name><surname>Long</surname> <given-names>CA</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name> <name><surname>Siani</surname> <given-names>L</given-names></name> <name><surname>Colloca</surname> <given-names>S</given-names></name> <etal/></person-group> <article-title>Transgene optimization, immunogenicity and in vitro efficacy of viral vectored vaccines expressing two alleles of <italic>Plasmodium falciparum</italic> AMA1</article-title>. <source>PLoS One</source> (<year>2011</year>) <volume>6</volume>:<fpage>e20977</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0020977</pub-id><pub-id pub-id-type="pmid">21698193</pub-id></citation></ref>
<ref id="B23"><label>23</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lamarque</surname> <given-names>M</given-names></name> <name><surname>Besteiro</surname> <given-names>S</given-names></name> <name><surname>Papoin</surname> <given-names>J</given-names></name> <name><surname>Roques</surname> <given-names>M</given-names></name> <name><surname>Vulliez-Le Normand</surname> <given-names>B</given-names></name> <name><surname>Morlon-Guyot</surname> <given-names>J</given-names></name> <etal/></person-group> <article-title>The RON2-AMA1 interaction is a critical step in moving junction-dependent invasion by apicomplexan parasites</article-title>. <source>PLoS Pathog</source> (<year>2011</year>) <volume>7</volume>:<fpage>e1001276</fpage>.<pub-id pub-id-type="doi">10.1371/journal.ppat.1001276</pub-id><pub-id pub-id-type="pmid">21347343</pub-id></citation></ref>
<ref id="B24"><label>24</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Srinivasan</surname> <given-names>P</given-names></name> <name><surname>Beatty</surname> <given-names>WL</given-names></name> <name><surname>Diouf</surname> <given-names>A</given-names></name> <name><surname>Herrera</surname> <given-names>R</given-names></name> <name><surname>Ambroggio</surname> <given-names>X</given-names></name> <name><surname>Moch</surname> <given-names>JK</given-names></name> <etal/></person-group> <article-title>Binding of <italic>Plasmodium merozoite</italic> proteins RON2 and AMA1 triggers commitment to invasion</article-title>. <source>Proc Natl Acad Sci U S A</source> (<year>2011</year>) <volume>108</volume>:<fpage>13275</fpage>&#x02013;<lpage>80</lpage>.<pub-id pub-id-type="doi">10.1073/pnas.1110303108</pub-id><pub-id pub-id-type="pmid">21788485</pub-id></citation></ref>
<ref id="B25"><label>25</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vulliez-Le Normand</surname> <given-names>B</given-names></name> <name><surname>Tonkin</surname> <given-names>ML</given-names></name> <name><surname>Lamarque</surname> <given-names>MH</given-names></name> <name><surname>Langer</surname> <given-names>S</given-names></name> <name><surname>Hoos</surname> <given-names>S</given-names></name> <name><surname>Roques</surname> <given-names>M</given-names></name> <etal/></person-group> <article-title>Structural and functional insights into the malaria parasite moving junction complex</article-title>. <source>PLoS Pathog</source> (<year>2012</year>) <volume>8</volume>:<fpage>e1002755</fpage>.<pub-id pub-id-type="doi">10.1371/journal.ppat.1002755</pub-id><pub-id pub-id-type="pmid">22737069</pub-id></citation></ref>
<ref id="B26"><label>26</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vulliez-Le Normand</surname> <given-names>B</given-names></name> <name><surname>Faber</surname> <given-names>BW</given-names></name> <name><surname>Saul</surname> <given-names>FA</given-names></name> <name><surname>van der Eijk</surname> <given-names>M</given-names></name> <name><surname>Thomas</surname> <given-names>AW</given-names></name> <name><surname>Singh</surname> <given-names>B</given-names></name> <etal/></person-group> <article-title>Crystal structure of <italic>Plasmodium knowlesi</italic> apical membrane antigen 1 and its complex with an invasion-inhibitory monoclonal antibody</article-title>. <source>PLoS One</source> (<year>2015</year>) <volume>10</volume>:<fpage>e0123567</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0123567</pub-id><pub-id pub-id-type="pmid">25886591</pub-id></citation></ref>
<ref id="B27"><label>27</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Maskus</surname> <given-names>DJ</given-names></name> <name><surname>Kr&#x000F3;lik</surname> <given-names>M</given-names></name> <name><surname>Bethke</surname> <given-names>S</given-names></name> <name><surname>Spiegel</surname> <given-names>H</given-names></name> <name><surname>Kapelski</surname> <given-names>S</given-names></name> <name><surname>Seidel</surname> <given-names>M</given-names></name> <etal/></person-group> <article-title>Characterization of a novel inhibitory human monoclonal antibody directed against <italic>Plasmodium falciparum</italic> apical membrane antigen 1</article-title>. <source>Sci Rep</source> (<year>2016</year>) <volume>6</volume>:<fpage>39462</fpage>.<pub-id pub-id-type="doi">10.1038/srep39462</pub-id><pub-id pub-id-type="pmid">28000709</pub-id></citation></ref>
<ref id="B28"><label>28</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Coley</surname> <given-names>AM</given-names></name> <name><surname>Parisi</surname> <given-names>K</given-names></name> <name><surname>Masciantonio</surname> <given-names>R</given-names></name> <name><surname>Hoeck</surname> <given-names>J</given-names></name> <name><surname>Casey</surname> <given-names>JL</given-names></name> <name><surname>Murphy</surname> <given-names>VJ</given-names></name> <etal/></person-group> <article-title>The most polymorphic residue on <italic>Plasmodium falciparum</italic> apical membrane antigen 1 determines binding of an invasion-inhibitory antibody</article-title>. <source>Infect Immun</source> (<year>2006</year>) <volume>74</volume>:<fpage>2628</fpage>&#x02013;<lpage>36</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.74.5.2628-2636.2006</pub-id><pub-id pub-id-type="pmid">16622199</pub-id></citation></ref>
<ref id="B29"><label>29</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>G</given-names></name> <name><surname>Drinkwater</surname> <given-names>N</given-names></name> <name><surname>Drew</surname> <given-names>DR</given-names></name> <name><surname>MacRaild</surname> <given-names>CA</given-names></name> <name><surname>Chalmers</surname> <given-names>DK</given-names></name> <name><surname>Mohanty</surname> <given-names>B</given-names></name> <etal/></person-group> <article-title>Structure-activity studies of &#x003B2;-Hairpin peptide inhibitors of the <italic>Plasmodium falciparum</italic> AMA1-RON2 interaction</article-title>. <source>J Mol Biol</source> (<year>2016</year>) <volume>428</volume>:<fpage>3986</fpage>&#x02013;<lpage>98</lpage>.<pub-id pub-id-type="doi">10.1016/j.jmb.2016.07.001</pub-id><pub-id pub-id-type="pmid">27422009</pub-id></citation></ref>
<ref id="B30"><label>30</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>G</given-names></name> <name><surname>MacRaild</surname> <given-names>CA</given-names></name> <name><surname>Mohanty</surname> <given-names>B</given-names></name> <name><surname>Mobli</surname> <given-names>M</given-names></name> <name><surname>Cowieson</surname> <given-names>NP</given-names></name> <name><surname>Anders</surname> <given-names>RF</given-names></name> <etal/></person-group> <article-title>Molecular insights into the interaction between <italic>Plasmodium falciparum</italic> apical membrane antigen 1 and an invasion-inhibitory peptide</article-title>. <source>PLoS One</source> (<year>2014</year>) <volume>9</volume>:<fpage>e109674</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0109674</pub-id><pub-id pub-id-type="pmid">25343578</pub-id></citation></ref>
<ref id="B31"><label>31</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Srinivasan</surname> <given-names>P</given-names></name> <name><surname>Yasgar</surname> <given-names>A</given-names></name> <name><surname>Luci</surname> <given-names>DK</given-names></name> <name><surname>Beatty</surname> <given-names>WL</given-names></name> <name><surname>Hu</surname> <given-names>X</given-names></name> <name><surname>Andersen</surname> <given-names>J</given-names></name> <etal/></person-group> <article-title>Disrupting malaria parasite AMA1-RON2 interaction with a small molecule prevents erythrocyte invasion</article-title>. <source>Nat Commun</source> (<year>2013</year>) <volume>4</volume>:<fpage>2261</fpage>.<pub-id pub-id-type="doi">10.1038/ncomms3261</pub-id><pub-id pub-id-type="pmid">23907321</pub-id></citation></ref>
<ref id="B32"><label>32</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pihan</surname> <given-names>E</given-names></name> <name><surname>Delgadillo</surname> <given-names>RF</given-names></name> <name><surname>Tonkin</surname> <given-names>ML</given-names></name> <name><surname>Pugni&#x000E8;re</surname> <given-names>M</given-names></name> <name><surname>Lebrun</surname> <given-names>M</given-names></name> <name><surname>Boulanger</surname> <given-names>MJ</given-names></name> <etal/></person-group> <article-title>Computational and biophysical approaches to protein-protein interaction inhibition of <italic>Plasmodium falciparum</italic> AMA1/RON2 complex</article-title>. <source>J Comput Aided Mol Des</source> (<year>2015</year>) <volume>29</volume>:<fpage>525</fpage>&#x02013;<lpage>39</lpage>.<pub-id pub-id-type="doi">10.1007/s10822-015-9842-7</pub-id><pub-id pub-id-type="pmid">25822046</pub-id></citation></ref>
<ref id="B33"><label>33</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bai</surname> <given-names>T</given-names></name> <name><surname>Becker</surname> <given-names>M</given-names></name> <name><surname>Gupta</surname> <given-names>A</given-names></name> <name><surname>Strike</surname> <given-names>P</given-names></name> <name><surname>Murphy</surname> <given-names>VJ</given-names></name> <name><surname>Anders</surname> <given-names>RF</given-names></name> <etal/></person-group> <article-title>Structure of AMA1 from <italic>Plasmodium falciparum</italic> reveals a clustering of polymorphisms that surround a conserved hydrophobic pocket</article-title>. <source>Proc Natl Acad Sci U S A</source> (<year>2005</year>) <volume>102</volume>:<fpage>12736</fpage>&#x02013;<lpage>41</lpage>.<pub-id pub-id-type="doi">10.1073/pnas.0501808102</pub-id><pub-id pub-id-type="pmid">16129835</pub-id></citation></ref>
<ref id="B34"><label>34</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Lim</surname> <given-names>SS</given-names></name> <name><surname>Yang</surname> <given-names>W</given-names></name> <name><surname>Krishnarjuna</surname> <given-names>B</given-names></name> <name><surname>Kannan Sivaraman</surname> <given-names>K</given-names></name> <name><surname>Chandrashekaran</surname> <given-names>IR</given-names></name> <name><surname>Kass</surname> <given-names>I</given-names></name> <etal/></person-group> <article-title>Structure and dynamics of apical membrane antigen 1 from <italic>Plasmodium falciparum</italic> FVO</article-title>. <source>Biochemistry</source> (<year>2014</year>) <volume>53</volume>:<fpage>7310</fpage>&#x02013;<lpage>20</lpage>.<pub-id pub-id-type="doi">10.1021/bi5012089</pub-id><pub-id pub-id-type="pmid">25360546</pub-id></citation></ref>
<ref id="B35"><label>35</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Srinivasan</surname> <given-names>P</given-names></name> <name><surname>Ekanem</surname> <given-names>E</given-names></name> <name><surname>Diouf</surname> <given-names>A</given-names></name> <name><surname>Tonkin</surname> <given-names>ML</given-names></name> <name><surname>Miura</surname> <given-names>K</given-names></name> <name><surname>Boulanger</surname> <given-names>MJ</given-names></name> <etal/></person-group> <article-title>Immunization with a functional protein complex required for erythrocyte invasion protects against lethal malaria</article-title>. <source>Proc Natl Acad Sci U S A</source> (<year>2014</year>) <volume>111</volume>:<fpage>10311</fpage>&#x02013;<lpage>6</lpage>.<pub-id pub-id-type="doi">10.1073/pnas.1409928111</pub-id><pub-id pub-id-type="pmid">24958881</pub-id></citation></ref>
<ref id="B36"><label>36</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Koncz</surname> <given-names>C</given-names></name> <name><surname>Schell</surname> <given-names>J</given-names></name></person-group>. <article-title>The promoter of TL-DNA gene 5 controls the tissue-specific expression of chimaeric genes carried by a novel type of <italic>Agrobacterium</italic> binary vector</article-title>. <source>Mol Gen Genet</source> (<year>1986</year>) <volume>204</volume>:<fpage>383</fpage>&#x02013;<lpage>96</lpage>.<pub-id pub-id-type="doi">10.1007/BF00331014</pub-id></citation></ref>
<ref id="B37"><label>37</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Spiegel</surname> <given-names>H</given-names></name> <name><surname>Boes</surname> <given-names>A</given-names></name> <name><surname>Kastilan</surname> <given-names>R</given-names></name> <name><surname>Kapelski</surname> <given-names>S</given-names></name> <name><surname>Edgue</surname> <given-names>G</given-names></name> <name><surname>Beiss</surname> <given-names>V</given-names></name> <etal/></person-group> <article-title>The stage-specific in vitro efficacy of a malaria antigen cocktail provides valuable insights into the development of effective multi-stage vaccines</article-title>. <source>Biotechnol J</source> (<year>2015</year>) <volume>10</volume>(<issue>10</issue>):<fpage>1651</fpage>&#x02013;<lpage>9</lpage>.<pub-id pub-id-type="doi">10.1002/biot.201500055</pub-id><pub-id pub-id-type="pmid">25913888</pub-id></citation></ref>
<ref id="B38"><label>38</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Boes</surname> <given-names>A</given-names></name> <name><surname>Reimann</surname> <given-names>A</given-names></name> <name><surname>Twyman</surname> <given-names>RM</given-names></name> <name><surname>Fischer</surname> <given-names>R</given-names></name> <name><surname>Schillberg</surname> <given-names>S</given-names></name> <name><surname>Spiegel</surname> <given-names>H</given-names></name></person-group>. <article-title>A plant-based transient expression system for the rapid production of malaria vaccine candidates</article-title>. <source>Methods Mol Biol</source> (<year>2016</year>) <volume>1404</volume>:<fpage>597</fpage>&#x02013;<lpage>619</lpage>.<pub-id pub-id-type="doi">10.1007/978-1-4939-3389-1_39</pub-id><pub-id pub-id-type="pmid">27076325</pub-id></citation></ref>
<ref id="B39"><label>39</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Boes</surname> <given-names>A</given-names></name> <name><surname>Spiegel</surname> <given-names>H</given-names></name> <name><surname>Edgue</surname> <given-names>G</given-names></name> <name><surname>Kapelski</surname> <given-names>S</given-names></name> <name><surname>Scheuermayer</surname> <given-names>M</given-names></name> <name><surname>Fendel</surname> <given-names>R</given-names></name> <etal/></person-group> <article-title>Detailed functional characterization of glycosylated and nonglycosylated variants of malaria vaccine candidate PfAMA1 produced in <italic>Nicotiana benthamiana</italic> and analysis of growth inhibitory responses in rabbits</article-title>. <source>Plant Biotechnol J</source> (<year>2014</year>) <volume>13</volume>(<issue>2</issue>):<fpage>222</fpage>&#x02013;<lpage>34</lpage>.<pub-id pub-id-type="doi">10.1111/pbi.12255</pub-id></citation></ref>
<ref id="B40"><label>40</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Remarque</surname> <given-names>EJ</given-names></name> <name><surname>Roestenberg</surname> <given-names>M</given-names></name> <name><surname>Younis</surname> <given-names>S</given-names></name> <name><surname>Walraven</surname> <given-names>V</given-names></name> <name><surname>van der Werff</surname> <given-names>N</given-names></name> <name><surname>Faber</surname> <given-names>BW</given-names></name> <etal/></person-group> <article-title>Humoral immune responses to a single allele PfAMA1 vaccine in healthy malaria-na&#x000EF;ve adults</article-title>. <source>PLoS One</source> (<year>2012</year>) <volume>7</volume>:<fpage>e38898</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0038898</pub-id><pub-id pub-id-type="pmid">22768052</pub-id></citation></ref>
<ref id="B41"><label>41</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pol</surname> <given-names>E</given-names></name> <name><surname>Karlsson</surname> <given-names>R</given-names></name> <name><surname>Roos</surname> <given-names>H</given-names></name> <name><surname>Jansson</surname> <given-names>A</given-names></name> <name><surname>Xu</surname> <given-names>B</given-names></name> <name><surname>Larsson</surname> <given-names>A</given-names></name> <etal/></person-group> <article-title>Biosensor-based characterization of serum antibodies during development of an anti-IgE immunotherapeutic against allergy and asthma</article-title>. <source>J Mol Recognit</source> (<year>2007</year>) <volume>20</volume>:<fpage>22</fpage>&#x02013;<lpage>31</lpage>.<pub-id pub-id-type="doi">10.1002/jmr.804</pub-id><pub-id pub-id-type="pmid">17036306</pub-id></citation></ref>
<ref id="B42"><label>42</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Maskus</surname> <given-names>DJ</given-names></name> <name><surname>Bethke</surname> <given-names>S</given-names></name> <name><surname>Seidel</surname> <given-names>M</given-names></name> <name><surname>Kapelski</surname> <given-names>S</given-names></name> <name><surname>Addai-Mensah</surname> <given-names>O</given-names></name> <name><surname>Boes</surname> <given-names>A</given-names></name> <etal/></person-group> <article-title>Isolation, production and characterization of fully human monoclonal antibodies directed to <italic>Plasmodium falciparum</italic> MSP10</article-title>. <source>Malar J</source> (<year>2015</year>) <volume>14</volume>:<fpage>276</fpage>.<pub-id pub-id-type="doi">10.1186/s12936-015-0797-X</pub-id><pub-id pub-id-type="pmid">26174014</pub-id></citation></ref>
<ref id="B43"><label>43</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Boes</surname> <given-names>A</given-names></name> <name><surname>Spiegel</surname> <given-names>H</given-names></name> <name><surname>Voepel</surname> <given-names>N</given-names></name> <name><surname>Edgue</surname> <given-names>G</given-names></name> <name><surname>Beiss</surname> <given-names>V</given-names></name> <name><surname>Kapelski</surname> <given-names>S</given-names></name> <etal/></person-group> <article-title>Analysis of a multi-component multi-stage malaria vaccine candidate-tackling the cocktail challenge</article-title>. <source>PLoS One</source> (<year>2015</year>) <volume>10</volume>:<fpage>e0131456</fpage>.<pub-id pub-id-type="doi">10.1371/journal.pone.0131456</pub-id></citation></ref>
<ref id="B44"><label>44</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Boes</surname> <given-names>A</given-names></name> <name><surname>Spiegel</surname> <given-names>H</given-names></name> <name><surname>Kastilan</surname> <given-names>R</given-names></name> <name><surname>Bethke</surname> <given-names>S</given-names></name> <name><surname>Voepel</surname> <given-names>N</given-names></name> <name><surname>Chudobov&#x000E1;</surname> <given-names>I</given-names></name> <etal/></person-group> <article-title>Analysis of the dose-dependent stage-specific in vitro efficacy of a multi-stage malaria vaccine candidate cocktail</article-title>. <source>Malar J</source> (<year>2016</year>) <volume>15</volume>:<fpage>279</fpage>.<pub-id pub-id-type="doi">10.1186/s12936-016-1328-0</pub-id><pub-id pub-id-type="pmid">27188716</pub-id></citation></ref>
<ref id="B45"><label>45</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Faber</surname> <given-names>BW</given-names></name> <name><surname>Younis</surname> <given-names>S</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name> <name><surname>Garcia</surname> <given-names>RR</given-names></name> <name><surname>Riasat</surname> <given-names>V</given-names></name> <name><surname>Walraven</surname> <given-names>V</given-names></name> <etal/></person-group> <article-title>Diversity covering AMA1-MSP119 fusion proteins as malaria vaccines</article-title>. <source>Infect Immun</source> (<year>2013</year>) <volume>81</volume>(<issue>5</issue>):<fpage>1479</fpage>&#x02013;<lpage>90</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.01267-12</pub-id><pub-id pub-id-type="pmid">23429538</pub-id></citation></ref>
<ref id="B46"><label>46</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Osier</surname> <given-names>FHA</given-names></name> <name><surname>Weedall</surname> <given-names>GD</given-names></name> <name><surname>Verra</surname> <given-names>F</given-names></name> <name><surname>Murungi</surname> <given-names>L</given-names></name> <name><surname>Tetteh</surname> <given-names>KKA</given-names></name> <name><surname>Bull</surname> <given-names>P</given-names></name> <etal/></person-group> <article-title>Allelic diversity and naturally acquired allele-specific antibody responses to <italic>Plasmodium falciparum</italic> apical membrane antigen 1 in Kenya</article-title>. <source>Infect Immun</source> (<year>2010</year>) <volume>78</volume>:<fpage>4625</fpage>&#x02013;<lpage>33</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.00576-10</pub-id><pub-id pub-id-type="pmid">20732997</pub-id></citation></ref>
<ref id="B47"><label>47</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ouattara</surname> <given-names>A</given-names></name> <name><surname>Mu</surname> <given-names>J</given-names></name> <name><surname>Takala-Harrison</surname> <given-names>S</given-names></name> <name><surname>Saye</surname> <given-names>R</given-names></name> <name><surname>Sagara</surname> <given-names>I</given-names></name> <name><surname>Dicko</surname> <given-names>A</given-names></name> <etal/></person-group> <article-title>Lack of allele-specific efficacy of a bivalent AMA1 malaria vaccine</article-title>. <source>Malar J</source> (<year>2010</year>) <volume>9</volume>:<fpage>175</fpage>.<pub-id pub-id-type="doi">10.1186/1475-2875-9-175</pub-id><pub-id pub-id-type="pmid">20565971</pub-id></citation></ref>
<ref id="B48"><label>48</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Payne</surname> <given-names>RO</given-names></name> <name><surname>Milne</surname> <given-names>KH</given-names></name> <name><surname>Elias</surname> <given-names>SC</given-names></name> <name><surname>Edwards</surname> <given-names>NJ</given-names></name> <name><surname>Douglas</surname> <given-names>AD</given-names></name> <name><surname>Brown</surname> <given-names>RE</given-names></name> <etal/></person-group> <article-title>Demonstration of the blood-stage <italic>Plasmodium falciparum</italic> controlled human malaria infection model to assess efficacy of the <italic>P. falciparum</italic> apical membrane antigen 1 vaccine, FMP2.1/AS01</article-title>. <source>J Infect Dis</source> (<year>2016</year>) <volume>213</volume>:<fpage>1743</fpage>&#x02013;<lpage>51</lpage>.<pub-id pub-id-type="doi">10.1093/infdis/jiw039</pub-id><pub-id pub-id-type="pmid">26908756</pub-id></citation></ref>
<ref id="B49"><label>49</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Barry</surname> <given-names>AE</given-names></name> <name><surname>Arnott</surname> <given-names>A</given-names></name></person-group>. <article-title>Strategies for designing and monitoring malaria vaccines targeting diverse antigens</article-title>. <source>Front Immunol</source> (<year>2014</year>) <volume>5</volume>:<fpage>359</fpage>.<pub-id pub-id-type="doi">10.3389/fimmu.2014.00359</pub-id><pub-id pub-id-type="pmid">25120545</pub-id></citation></ref>
<ref id="B50"><label>50</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Coley</surname> <given-names>AM</given-names></name> <name><surname>Campanale</surname> <given-names>NV</given-names></name> <name><surname>Casey</surname> <given-names>JL</given-names></name> <name><surname>Hodder</surname> <given-names>AN</given-names></name> <name><surname>Crewther</surname> <given-names>PE</given-names></name> <name><surname>Anders</surname> <given-names>RF</given-names></name> <etal/></person-group> <article-title>Rapid and precise epitope mapping of monoclonal antibodies against <italic>Plasmodium falciparum</italic> AMA1 by combined phage display of fragments and random peptides</article-title>. <source>Protein Eng</source> (<year>2001</year>) <volume>14</volume>(<issue>9</issue>):<fpage>691</fpage>&#x02013;<lpage>8</lpage>.</citation></ref>
<ref id="B51"><label>51</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ouattara</surname> <given-names>A</given-names></name> <name><surname>Barry</surname> <given-names>AE</given-names></name> <name><surname>Dutta</surname> <given-names>S</given-names></name> <name><surname>Remarque</surname> <given-names>EJ</given-names></name> <name><surname>Beeson</surname> <given-names>JG</given-names></name> <name><surname>Plowe</surname> <given-names>CV</given-names></name></person-group>. <article-title>Designing malaria vaccines to circumvent antigen variability</article-title>. <source>Vaccine</source> (<year>2015</year>) <volume>33</volume>:<fpage>7506</fpage>&#x02013;<lpage>12</lpage>.<pub-id pub-id-type="doi">10.1016/j.vaccine.2015.09.110</pub-id><pub-id pub-id-type="pmid">26475447</pub-id></citation></ref>
<ref id="B52"><label>52</label><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Harris</surname> <given-names>KS</given-names></name> <name><surname>Adda</surname> <given-names>CG</given-names></name> <name><surname>Khore</surname> <given-names>M</given-names></name> <name><surname>Drew</surname> <given-names>DR</given-names></name> <name><surname>Valentini-Gatt</surname> <given-names>A</given-names></name> <name><surname>Fowkes</surname> <given-names>FJI</given-names></name> <etal/></person-group> <article-title>Use of immunodampening to overcome diversity in the malarial vaccine candidate apical membrane antigen 1</article-title>. <source>Infect Immun</source> (<year>2014</year>) <volume>82</volume>:<fpage>4707</fpage>&#x02013;<lpage>17</lpage>.<pub-id pub-id-type="doi">10.1128/IAI.02061-14</pub-id><pub-id pub-id-type="pmid">25156737</pub-id></citation></ref>
</ref-list>
</back>
</article>