Controlled Human Blood Stage Malaria Infection: Current Status and Potential Applications

Christopher J. A. Duncan Sir William Dunn School of Pathology, and Jenner Institute, University of Oxford, Oxford, United Kingdom

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Simon J. Draper Sir William Dunn School of Pathology, and Jenner Institute, University of Oxford, Oxford, United Kingdom

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Controlled human malaria infection by blood stage parasite (BSP) inoculation is an alternative to the well-established model of infection with Plasmodium falciparum sporozoites delivered by mosquito bites. The BSP model has been utilized less frequently, but its use is increasing. Advantages of BSP challenge include greater ease of administration, better standardization of the infecting dose per volunteer, and good inter-study reproducibility of in vivo parasite dynamics. Recently, a surprising reduction in clinical symptoms at microscopic patency in the BSP model has been identified, which has an undefined and intriguing pathophysiologic basis, but may make this approach more acceptable to volunteers. We summarize clinical, parasitologic, and immunologic data from all BSP challenges to date, explore differences between the BSP and sporozoite models, and propose future applications for BSP challenge.

Author Notes

*Address correspondence to Christopher J. A. Duncan, Sir William Dunn School of Pathology, University of Oxford, Oxford Molecular Pathology Institute Building, South Parks Road, Oxford OX1 3RE, United Kingdom. E-mails: chrisduncan@doctors.net.uk or christopher.duncan@path.ox.ac.uk

Financial support: Christopher J. A. Duncan is supported by a Wellcome Trust Research Training Fellowship (094449/Z/10/Z) and Simon J. Draper is supported by a United Kingdom Medical Research Council Career Development Fellowship (G1000527) and is a Jenner Investigator.

Disclosure: None of the authors has any conflicts of interest.

Authors' addresses: Christopher J. A. Duncan, Sir William Dunn School of Pathology, University of Oxford, Oxford Molecular Pathology Institute Building, Oxford, United Kingdom, E-mails: chrisduncan@doctors.net.uk or christopher.duncan@path.ox.ac.uk. Simon J. Draper, The Jenner Institute, University of Oxford, Old Road Campus Research Building, Headington, Oxford, United Kingdom, E-mail: simon.draper@ndm.ox.ac.uk.

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