Malaria: Molecular and Clinical Aspects PDF

PREFACE

The malaria parasite has been our follower and foe during the history of Homo sapiens. The prehistoric man was infected and we are still at risk, despite all efforts to eradicate the disease during the last 100 years. Indeed, malaria is more frequent today than ever and the death toll is on the increase in spite of the fact that certain areas of the world are less exposed. Nearly 500 million cases are reported each year with more than 2 million deaths and the number of children dying of malaria in Africa alone is estimated to be four every minute. Although frightening, these figures are only part of the story as they do not account for the severe social and economic consequences of the disease both for the affected individuals and for the mostly poor Third World countries where they reside. Yet, exciting technical developments are today at hand but research funding is much too scarce for a disease of such tremendous importance to global health.

During and after the second world war, many attempts were made world-wide to eliminate malaria by means of insecticides and anti-parasitic drugs. In many areas the attempts were successful at first Yet malaria has become more serious because of the growing resistance of the Anopheles mosquitoes to DDT and of the human malaria parasite, Plasmodium falciparum, to almost all available drugs. Against this background, it was decided by the World Health Organisation in the mid 1970s and later by other agencies such as the Rockefeller Foundation, inspired by the late Dr Ken Warren, to support research in malaria, aiming at the development of malaria vaccines together with other available measures as a means to control malaria. In view of the complexity of the parasite, and its intricate epidemiology, the construction of viable vaccines was considered a formidable if not impossible task. However, research elucidating various aspects of the immune response to the malaria parasite has been expanding rapidly and advances made in some areas are dramatic and astonishing. Among the causes accounting for this progress are the development of methods by Trager and Jensen in 1976 permitting in vitro cultures of the blood stages of P. falciparum, the availability of monoclonal antibodies as well as the development of the DNA technologies. The employment of these new techniques, together with recently generated knowledge in molecular immunology and microbial pathogenesis, have given malaria research a stable position in the forefront of investigation in infectious disease and vaccinology in general.

This volume gives a broad and up-to-date overview of every aspect of the disease; from the history of malaria to genome research. There are descriptions, tales and legends of the ups-and-downs in malaria research in the introductory chapter, a personal anecdote told by Bob Desowitz. In the subsequent chapters you will find the basic facts of the malaria-parasite (Chapters 2 and 3), and the disease it causes (Chapter 4). The genetics of the Anopheles mosquito and the probability of its genetic manipulation are described in Chapter 5. Chapters 6 to 8 are concerned with genes, antigens and genetic approaches that may be used to understand drug responses, pathogenesis and infectivity. Chapter 9 is a comprehensive and fascinating summary of some receptor-ligand interactions involving both the host and the malaria parasite. The pathogenesis of the disease, as a consequence of excessive binding of infected erythrocytes in the micro-vasculature is discussed in Chapter 10 followed by a description of the inflammatory processes also involved in the pathogenesis of malaria (Chapter 11). The mechanisms underlying inborn resistance to malaria are dissected in Chapter 12. The interdependency of Epstein-Barr virus and P. falciparum in the genesis of Burkitt's lymphoma is not known; facts and possibilities are discussed in Chapter 13. The last part of the book is dedicated to malaria immunology (mainly P. falciparum malaria: Chapter 14) and malaria vaccine strategies in the battle against this tremendous parasite (Chapters 15-17).

We therefore have provided you with summaries of current knowledge of all principal areas of malaria research and hope that the volume will form the basis for discussions among the readers and a platform for young scientists who wish to understand the fundamentals of malaria research Through this we hope that it will also help in the construction of a vaccine that abates disease and reduces death among the children of tomorrow.