Identifying the targets of protective immunity to malaria in pregnancy

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Malaria in pregnancy is a major cause of disease across many countries. Pregnant women have a high risk of malaria, and large numbers of malaria parasites accumulate in the placenta, which may lead to infant or maternal death. Malaria parasites infect the placenta by producing proteins that enable them to stick to the placenta. These malaria strains causing placental infection generally do not cause disease in non-pregnant individuals. Antibodies to the parasite proteins are produced in response to placental infection, which may help control the infection and protect against further malaria in pregnancy. However, placental malaria parasites are able to vary the proteins they produce to avoid immune responses. In this project, we will study the parasite strains that cause malaria in pregnancy and the development of antibodies that protect pregnant women against malaria and its complications. We aim to identify the genes and proteins that parasites use to stick to the placenta, and determine how much variation occurs in these proteins. We will also specifically examine the role of one particular candidate gene called var2csa, and its protein, as this has been recently been associated with pregnancy malaria. We will examine how antibodies develop that recognise different proteins and different forms of malaria parasites, and determine the type of antibodies that protect pregnant women taking part in a longitudinal study of malaria in pregnancy in Malawi, Africa. We will also examine how antimalarial drugs taken in pregnancy influence the development of protective antibodies. Through these studies we aim to understand how the immune system combats malaria in pregnancy. This will be important for developing new methods for preventing or treating malaria in pregnancy, and improving child and maternal health.