Malaria research: host-parasite interactions and new developments in chemotherapy, immunology and vaccinology

Malaria remains the major parasitic disease, with 300-500 million new infec tions each year. This survey covers recent advances in the field of parasit e-host interactions, focusing on Plasmodium falciparum, the most virulent o f the human parasites. Rapid progress in genomic research is creating a bas is for the development of new drugs and vaccines. Identification of drug-re sistance mutations facilitates evaluation of improved drug policies, and at tempts are being made to develop new compounds that inhibit metabolic pathw ays that are specific to the parasite. Cytoadherence of parasitized erythro cytes to microvascular endothelium is responsible for the sequestration of parasites, causing pathology and severe disease. Newly identified molecular fine structures that mediate cytoadherence may provide new targets for spe cific therapies. Humoral and cell-mediated immunity induced by the parasite may be protective, but may also be harmful by generating imbalance in cyto kine responses. Efforts are made to determine the pathways that give rise t o protection, with vaccination being the principal goal for achieving malar ia control. Different vaccine constructs are being evaluated in preclinical and clinical trials, including modified viral vectors, synthetic peptides, DNA and new adjuvants. Curr Opin Infect Dis 13:431-443. (C) 2000 Lippincot t Williams & Wilkins.