Our results show that
P. berghei CAS are completely arrested at the liver stage, fail to produce blood stage parasites in mice, and induce sterile protection in BALB/c and C57BL/6 mice following vaccination. A previous study attempted a chemical attenuation strategy by treating
P. berghei NK65 sporozoites with high doses (0.8 mg/ml) of chloroquine (
33). It was found that using five immunizing doses of 2.5 × 10
4 sporozoites treated with 0.8 mg/ml of chloroquine for 60 min produced 78.6% protection in mice, although the viability of the sporozoites was not reported. This malaria vaccine strategy, as well as the RAS vaccine approach, was then abandoned in favor of the subunit vaccine approach (
22).
With the renewed interest in whole-organism vaccines (
22,
38,
53), we evaluated the chemical attenuation of parasites using the DNA sequence-specific alkylating agent centanamycin and characterized its effects on sporozoites both in vitro and in vivo. Centanamycin has been shown to block
P. falciparum blood stage growth in vitro, to inhibit blood stage infections with
Plasmodium chabaudi adami and
P. berghei in mice, and to significantly reduce the transmission potential of
P. berghei, with a 99% reduction in sporozoite production (
55). Our studies show that treatment of
P. berghei ANKA sporozoites with centanamycin for 30, 60, or 90 min in vitro does not affect membrane integrity. We found that there was a moderate decrease in gliding motility of treated sporozoites that probably caused the small decrease observed in hepatocyte invasion in vitro. However, this small decrease in hepatocyte invasion did not seem to affect the capacity of treated sporozoites to induce protective responses in mice.
Hepatocyte invasion by sporozoites is an important step in eliciting an immune response to the parasite. Inactivated sporozoites that are not able to infect hepatocytes have consistently failed to induce protective immune responses (
1,
23,
31), although they can efficiently prime the immune system (
15). Conversely, malaria-infected hepatocytes and their extracts induce significant protection when they are injected into rats or mice (
37,
41). Previous experiments suggested that when animals are immunized with RAS, the protection against a challenge dose of sporozoites is dependent upon the persistence of irradiated sporozoites in the liver (
23,
41). However, more recent data indicate that GAS do not require persistence in the liver to induce protective immunity (
26,
28,
46,
50). Our study shows that CAS do produce liver stages in vitro, albeit at significantly lower levels (>85% reduction) than control sporozoites, and these liver stages were much smaller than those of the controls. Whereas RAS and GAS both invade liver cells and transform into the rounded trophozoite stage, they generally do not enter schizogony (
51). GAS-infected hepatocytes normally do not persist longer than 24 to 36 h (
26,
28,
46,
50), compared to RAS-infected hepatocytes, which persist much longer (
20,
41,
45). Our study showed that CAS persist in cultured hepatocytes for at least 42 h. Taken together, these results suggest that the CAS strategy is an effective attenuation strategy that can produce the infective liver stages needed to elicit an immune response.
A dose of 2 × 10
4 CAS in BALB/c and C57BL/6 mice failed to establish a blood stage infection, and the CAS-vaccinated BALB/c mice exhibited protective immunity when they were challenged with 5 × 10
3 untreated, wild-type sporozoites. A multiple-dose regimen was employed to produce sterile immunity in C57BL/6 mice. The genetic restriction observed, where sterile immunization requires more doses of attenuated sporozoites in C57BL/6 mice than in BALB/c mice, has been reported previously (
10,
11,
26,
50). This is probably a consequence of the fact that vaccination with attenuated sporozoites induces different mechanisms of protection in these two mouse strains (
10). The highly susceptible C57BL/6 mice (
24) require booster doses of vaccine to induce fully effective immune responses. In general, both RAS and GAS require higher initial doses of
P. berghei ANKA sporozoites in BALB/c mice (at least 2 × 10
4 sporozoites) to provide complete protection against lower or similar challenge doses of wild-type parasites (1 × 10
3 sporozoites) (
8,
11,
50). This suggests that the CAS approach could be an efficient approach for producing a whole-organism malaria vaccine.
The immune responses against both RAS and GAS are complex and involve both cell-mediated and humoral immunity (
10,
18,
27,
29,
37,
46). In addition, some RAS and GAS seem to induce long-lasting, cross-species protection (
11,
31,
32). Attenuation of irradiated sporozoites presumably occurs due to double-strand breaks in the DNA that lead to a block in liver stage development. Each sporozoite would contain a number of strand breaks randomly distributed in its DNA. In the case of CAS treated with centanamycin, the attenuated sporozoites would contain a set of adducts covalently bound to adenine nucleotides (
40). This compound, like other AT-specific binding compounds, recognizes selective DNA sequences, and the potential number of adducts can be defined bioinformatically (
52,
54). Given that both the CAS and RAS approaches disrupt the integrity of the parasite DNA, it is possible that the immune responses generated by RAS and CAS would be similar, but further studies are necessary to confirm this.
Many issues have been raised concerning the feasibility of both GAS and RAS as whole-organism sporozoite vaccines, including mass production of sterile parasites, proper storage to maintain viability, and the safety of a mosquito-derived vaccine (
3,
16,
22,
38). Both types of attenuation have individual inherent weaknesses. In the case of RAS, the overattenuation of sporozoites has been shown to block liver stage development at the trophozoite stage (
23,
44) and generate poor protection (
23), suggesting that the dose of irradiation is pivotal to the success of each lot of RAS. Uniform exposure of parasites to the radiation source is essential to prevent the escape of sporozoites that could generate a malaria infection following vaccination (
16,
38,
51). In contrast, the risk of “breakthrough infections” with GAS is low due to the gene knockout strategy employed (
17,
26,
50). Yet the widespread distrust of genetically modified products, especially for a vaccine that would be inoculated into humans and invade host cells, may complicate efforts to utilize GAS in the field. Our proposed CAS vaccine has the advantage that the chemical attenuation process can be strictly controlled, leading to a vaccine that is reproducibly attenuated. Given that centanamycin shows covalent DNA sequence specificity similar to that of adozelesin and that the frequency of binding sites for adozelesin has been estimated to be 440 sites per kb of genomic
Plasmodium DNA (
52), treatment of sporozoites with centanamycin could potentially saturate these binding sites to obtain a maximal effect on the parasite. Since the generation of viable, cryopreserved sporozoites is currently being optimized (
22), chemical attenuation using centanamycin could be considered an additional strategy for the production of whole-organism vaccines against malaria. Although the potential toxicity of residual centanamycin in humans is a concern, the risk may be minimal since free drug can be washed from the parasites before vaccine delivery and the drug that is present in treated sporozoites is covalently bound to parasite DNA and thus not available to modify host DNA. Nevertheless, the risk of toxicity needs to be addressed by in-depth pharmacokinetic and mutagenicity studies. More generally, our results suggest that chemical attenuation with drugs such as centanamycin may be a feasible approach for generating live attenuated vaccines for other major parasites with AT-rich DNA, such as
Theileria (
21,
54).