Estudo fenotípico e funcional de populações de células B de memória durante a fase aguda e convalescença de malária vivax em pacientes expostos na Amazônia Brasileira

Abstract

Malaria is one of the greatest public health problems in the world, accounting for approximately half a million annual deaths. Therefore, due to the increasing resistance of the parasites to the usual antimalarials and an increase in the number of severe cases, especially those caused by P. vivax, great efforts have been dispensed with in the development of vaccines. To date, the only licensed vaccine has been shown to confer some degree of immunity against P. falciparum, but the inability to maintain a protective response over time has been a major challenge to be overcome. Individuals naturally exposed to the disease develop varying degrees of protection, which seems to be lost in the absence of re-stimulation. These observations point to failures in B cells-mediated immune memory. In Brazil, where about 85% of malaria episodes are attributed to P. vivax, studies on the development and maintenance of immune memory are scarce. Understanding of factors that can modulate immune responses during and after malaria are important in the development of vaccines. This study aimed to evaluate clinical and hematological aspects, to verify the generation and persistence of antibodies and memory B cells (MBCs) directed to synthetic peptides (PvAMA-1(S290-K307) and PvMSP-9(E795-A808)), as well as to the recombinant protein PvAMA-1DII and to investigate the occurrence of fluctuations in the B cell compartment in individuals during acute malaria and at 30, 60 and 180 days after the diagnosis (convalescence) of P. vivax. The results showed that hematological alterations occurred predominantly in the acute phase, especially thrombocytopenia, lymphopenia and leucopenia. In the acute phase of infection, individuals exhibited MBCs and antibodies specific for PvAMA-1(S290-K307) and PvMSP-9(E795-A808) as well as for PvAMA-1DII, which generally persisted > 180 days in the absence of reinfections/relapses. No positive associations between antibody responses and MBCs over time were observed for all antigens evaluated. In addition, this study corroborated the relationship between exposure/malarial infection and occurrence of fluctuations in the phenotypic profile of B-cell subpopulations in peripheral blood, with emphasis on immature and plasma expansion during the acute phase of the disease. Regarding atypical MBCs, regardless of the group evaluated (exposed controls, acute phase or convalescence), these cells were expanded in relation to that observed in individuals not exposed to malaria. The data from this study still suggest that the expansion of atypical B cells observed in individuals from the endemic area is influenced by the occurrence of previous episodes of the disease. Subsequent studies are of fundamental importance to determine the impact of such changes on immunization strategies aimed at combating vivax malaria in populations exposed in regions of low malaria transmission in the Brazilian Amazon.