Malaria is the deadliest known vector born infectious disease. Malaria can be controlled by killing of mosquitoes with insecticides, drug treatment of patients, and vaccination of humans. Although insecticides and drugs have reduced malaria death, this approach is facing difficulties due to selection of resistant mosquitoes and parasites. Moreover, an effective malaria vaccine is yet to be implemented. The malaria parasite has a complex life cycle with multiple stages in the mosquito and in humans, each step involving specific host cell recognition. Therefore, targeting the [parasite ligand-host cell receptor] pair is a prime goal of malaria vaccine development.
Human infection starts with the release of ~50 sporozoites into the human skin by the bite of an infected
Anopheles mosquito [
1,
2]. Sporozoites enter the blood circulation and move to the first target organ, the liver. Circulating sporozoites are retained by the liver via electrostatic interaction between the positively charged CSP protein that covers the sporozoite surface and the negatively charged glycosaminoglycans (GAGs) produced by Stellate cells in the liver parenchyma and protruded through the fenestrations of the liver sinusoidal (blood vessel) lining [
3]. Next, sporozoites traverse the liver sinusoidal lining by invading macrophage-like Kupffer cells or endothelial cells [
4,
5], followed by an invasion of a hepatocyte to establish a productive infection. Although only a few sporozoites reach their destination, each infected liver cell generates around 30,000 hepatic merozoites that are released into the blood circulation, where they proliferate and cause pathogenesis [
2,
6]. Sporozoite liver infection constitutes the most dramatic malaria parasite population bottleneck and has been a focus of malaria vaccine development. The most advanced malaria vaccine RTS,S/AS01 targets the sporozoite CSP to interfere with liver infection [
7,
8]. Malaria vaccines that target liver infection (before RBC infection) are called pre-erythrocytic vaccines (PEV), and vaccines that target asexual blood-stage parasite antigens, mainly on the merozoites surface, are called blood-stage vaccines (BSV). Since the blood stage starts with the release of large number of hepatic merozoites, followed by quick (30~70 seconds) invasion of RBCs utilizing redundant ligand-receptor pairs [
9], development of blood-stage vaccines is more challenging. Indeed, no sterile protection has been reported from human BSV trials [
7]. In addition to liver infection, another parasite population bottleneck occurs at the initial stages of mosquito infection [
10,
11]. In an infected human, less than 5 % of
Plasmodium blood-stage parasites are committed to develop into sexual stage gametocytes [
12], the only form that can survive in the mosquito. In the blood bolus, male and female gametocytes are rapidly activated into gametes. One male gametocyte generates eight microgametes after three rounds of DNA replication. Microgametes actively move in search of activated female macrogametes for fertilization and formation of zygotes. Zygotes differentiate into motile ookinetes that move in the blood bolus and invade the mosquito midgut to form oocysts lodged between the midgut epithelium and the basal lamina. Each oocyst generates thousands of sporozoites that when released, invade the mosquito salivary glands from where they are transmitted to a new human host. Out of thousands of ingested gametocytes, only few oocysts form [
11], defining a strong bottleneck.
Transition through bottlenecks involves specific cell-cell recognition steps. For liver infection, sporozoites specifically interact with the phagocytic Kupffer cells that line the sinusoids to exit the circulation and then specifically infect hepatocytes, and no other cell type. In the mosquito, fertilization requires specific recognition between male and female gametes and ookinete traversal involves its recognition of mosquito midgut epithelium receptors. Using a phage-peptide display approach, [parasite ligand-host cell receptor] pairs involved in these parasite bottlenecks have been identified [
13,
14,
15,
16]. Interestingly, many of the parasite surface ligands are conserved moonlighting proteins that have acquired separate ligand functions. This review provides an overview of these parasite ligands and evaluates their potential for development of novel malaria vaccine antigens.