Malaria remains one of the most prevalent parasitoses worldwide. About 350 to 500 million febrile episodes are observed yearly in African children alone and more than 1 million people die because of malaria each year. Multiple factors have hampered the effective control of this disease, some of which include the complex biology of the Plasmodium parasites, their high polymorphism and their increasingly high resistance to antimalarial drugs, mainly in endemic regions. The ancient interaction between malarial parasites and humans has led to the fixation in the population of several inherited alterations conferring protection against malaria. Some of the mechanisms underlying protection against this disease are described in this review for hemoglobin-inherited disorders (thalassemia, sickle-cell trait, HbC and HbE), erythrocyte polymorphisms (ovalocytosis and Duffy blood group), enzymopathies (G6PD deficiency and PK deficiency) and immunogenetic variants (HLA alleles, complement receptor 1, NOS2, tumor necrosis factor-α promoter and chromosome 5q31–q33 polymorphisms).

The Duffy-binding protein (PvDBP) mediates invasion of reticulocytes by the malaria parasite Plasmodium vivax. PvDBP has been recognized as a good vaccine candidate due to its ability to induce antibody responses capable of inhibiting target cell invasion after natural infections. For the development of subunit-based vaccines, it is important to identify universal epitopes that could be presented by different HLA-DR alleles to induce effective cellular and humoral immune responses. In this study, the antigenicity of universal epitopes from PvDBPII was evaluated by stimulating peripheral blood mononuclear cells (PBMCs) isolated from individuals with different degrees of P. vivax malaria exposure and distinct HLA-DR alleles. Peptides 1635 and 1638 induced lymphoproliferation and stimulated the production of IL-6 and IFN-γ. The results suggest that conserved peptides binding with high activity to red blood cells and with known affinity to HLA-DR proteins could be good components for a P. vivax vaccine.

Selected PvDBP-derived synthetic peptides were tested in competition assays with HLA molecules in order to identify and evaluate their binding to a wide range of MHC class II molecules. Binding was evaluated as the peptide's ability to displace the biotinylated control peptide (HA(306-318)) and was detected by a conventional ELISA. Thus, one epitope for the HLA-DR1 molecule, two epitopes for the HLA-DR4 molecule, six epitopes for the HLA-DR7 molecule and three epitopes for the HLA-DR11 molecule displaying a high binding percentage (above 50%) were experimentally obtained. The in vitro results were compared with the epitope prediction results. Two peptides behaved as universal epitopes since they bound to a larger number of HLA-DR molecules. Given that these peptides are located in the conserved PvDBP region II, they could be considered good candidates to be included in the design of a synthetic vaccine against Plasmodium vivax malaria.