Introduction
Background on malaria and Plasmodium falciparum
The global burden of malaria remains huge particularly in sub-Saharan Africa and Southeast Asia
where majority of the fatalities occur mostly in children under 5 years and pregnant women [1].
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According to World Health Organization (WHO) report of 2022, it is estimated that there were
249 million cases of malaria with 608,000 deaths reported in 85 countries. African nations are
immensely disproportionately affected and account for 94% of the total reported cases and 95% of
deaths [2]. The causative agent for malaria is Plasmodium spp, of which Plasmodium falciparum
is the most virulent and is responsible for most of the morbidity and mortality. Infection
transmission is initiated when infected female anopheles mosquitoes bite non-infected humans
transferring sporozoites that undergo developmental stages in humans to become infective.
Anopheles gambiae is the dominant transmission vector in most areas [3]. Despite an array of
public health interventions aimed at halting transmission such as insecticide-treated bed nets,
spraying of homes with insecticides and use of WHO recommended artemisinin-based
combination therapies (ACT), malaria prevention faces the main setback drug and insecticide
resistance by P. falciparum and mosquitoes respectively. Thus, the development of novel malaria
interventions is a pressing priority.
The life cycle of Plasmodium falciparum is distinctly complex, comprising of numerous stages in
the mosquito and human hosts [4]. When entering the human host, P. falciparum infects red blood
cells, which are killed and thus start causing symptoms of severe disease, including anemia,
cerebral malaria, and multi-organ failure [5,6]. It is worth noting that besides being resistant to
majority of the traditional antimalarial agents, the pathogen is also able to evade human immunity
by antigenic variation [7]. In addition to that, P. falciparum exhibits extreme genetic diversity that
allows it to adjust to various environments via population processes [8].
Importance of Vaccine Development
Significant progress has been made in creating malaria vaccines, most notably the RTS,S/AS01
vaccine [9] that has been reported to decrease cases of clinical malaria (by approximately 56 to 60
per cent) and severe malaria (by approximately 47 to 60 per cent) in children aged 5-17 years one
year after vaccination [10]. Moreover, by providing herd immunity, the RTS,S//AS01 vaccine can
also diminish malaria transmission within populations [11]. Mathematical modeling estimates that
were the vaccine’s coverage to reach the levels attained during routine vaccination of children,
immense reduction in malaria deaths would be witnessed [12]. Such efficacy points to the
possibility of halting malaria through immunisation as a complementary measure to transmission
control and treatment [13].
Despite the encouraging trend, several outstanding issues remain to be resolved in the search for a
universally efficacious malaria vaccine among them the cost of development [13]. Furthermore,
public awareness of, and acceptance of the vaccine is also critical in the ultimate successful roll-
out. Communities within malaria-endemic districts have been reported to have a positive view of
immunization, with most caregivers responding that they will immunize children against malaria
[14,15]. But misinformation and poor awareness can deter acceptance, making transparent
measures critical to teach people on the benefits of the vaccine [15,16].
Moreover, the RTS,S vaccine also has its effect on herd protection, where it can contribute to herd
immunity and reduce malaria transmission within populations [11]. Mathematical modeling
estimates that where coverage of the vaccine is reached up to levels that have been achieved by
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3
routine vaccinations of children, there can be significant reductions of malaria deaths and malaria
cases [12]. Such possibilities reinforce the means by which malaria immunization can be a key
component of overall population interventions for malaria prevention and, ultimately, malaria
elimination.
Role of T-Cell Receptors in Immune Response
T-cell receptors (TCRs) are of critical significance in malaria immunity, even more on P.
falciparum infection. The role of TCR is to recognize the antigens in the major histocompatibility
complex, and hence induce cell activation thus resulting in immune responses [17]. The activation
of CD4+ and CD8+ cell subsets has a critical role in malaria defense, where cells coordinate
cellular and humoral immune responses capable of containing and clearing the parasite [18].
The CD4+ T cells, also referred to as helper T cells, are also key in the coordination of the immune
response. These cells engage in activating B cells, generating antibodies, and activating the
cytotoxic action of the CD8+ T cells, directly killing infested cells [19]. During malaria infection,
the CD4+ T cells can generate multi-lineages of cells, such as the Th1 cells, of major importance
for the control of malaria infection with Plasmodium via generation of pro-inflammatory cytokines
such as IFN-γ and TNF-α [20]. The action of the Th1 cells has been associated with parasitemia
control and malaria infection outcomes. There also exists the Tr1 cells, a key subset of
immunosuppressive CD4+ T cells, whose action inhibits protection against the parasite by the
action of the Th1 cells, and enhances generation of infection and inhibits immunological disease
of malaria infection [21].
Moreover, the dynamics of T-cells' response to malaria are also influenced by infection chronicity.
Repeated antigenic malaria stimuli can lead to exhaustion of B-cells and also of T-cells. It is
demonstrated that frequent P. falciparum parasites exposure is followed by elevated levels of CD4
T-cells that exhibit phenotypic markers of exhaustiveness. It is evident on programmed cell death-
1 (PD-1) alone and also co-expression of PD-1 along with lymphocyte-activation gene-3 (LAG-
3). The proliferation of PD-1 and co-expression of PD-1/LAG-3 is of specific interest to CD45RA+
CD4 T-cells [22]. It is evident on animal models and also on humans where exhaustively
differentiated T cells exhibit reduced cytokine generation along with proliferative activity [22]. It
is important to understand these processes to determine means of enhancing responses of T-cells,
e.g., by employing therapy that inhibits inhibitory pathways to restore function of T-cells.
In addition to CD4+ cells, CD8+ cells also make important contributions to malaria immunity. The
cytotoxic cells can identify infected hepatocytes and red blood cells and destroy them, thereby
inhibiting proliferation of the parasite [23,24]. It has been shown that malaria can be recognized
by CD8+ cells through cross-presentation, enhancing their ability to respond to infection of the
blood stage [25]. The activity of the CD8+ cells also relies on memory characteristics, and these
can be changed with history of infection, and with access of specific antigen [26].
Molecular Docking and Immunoinformatics
Molecular docking and immunoinformatics have been critical drug discovery tools. The
technologies have contributed immensely in understanding how medicines combat some of the
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4
epidemic diseases such as COVID-19 and malaria. Molecular docking is a computer program
which first made its entry in the 1980s in an effort of making it possible for addressing best pose
of a target molecule when complexing a receptor [27]. The first program for molecular docking,
however, was developed by Kuntz and his group in 1980s [28]. Molecular docking revolutionized
understanding of functions of a molecule on a molecular scale [27]. It made it possible for
complexation of a molecule and a receptor, calculation of affinities of complexation, and actual
medicine designing [29,30]. It accelerates drug discovery making it possible for screening of
thousands of compounds for identifying a potential medicine and reducing effort and time in
confirming results in experiments [31].
On the other hand, immunoinformatics, or computational immunology, employs computational
strategies to analyze and predict immune reactions with a major focus on the design of vaccines.
Immunoinformatics has recently emerged as an important tool in immunological studies, which
include vaccine design and development. Despite that this technology is still evolving, the
computational models have played a significant role during the selection of antigens or proteins
and complex immunologic data analysis, thus facilitating the formulation of new testable
hypotheses [32]. Immunoinformatics is established on the knowledge of the antigens' epitopes that
are the targets of the immune response to develop multi-epitopic vaccines that can elicit strong
immune reactions [33]. One of the key areas of immunoinformatic applications is the prediction
of B-and T-cell epitopes by computational strategies to aid the development of vaccines that can
activate adaptive immunity [34]. It is particularly relevant to emerging pathogens like the SARS-
CoV-2 where classical strategies to the development of vaccines can fail [35]. The combination of
immunoinformatic analysis with molecular docking enables the rational peptide vaccine designing
by predicting the affinities of the peptide-MHC interaction, their recognition by the major
histocompatibility complex (MHC) molecules, and by the T cells. These techniques allow for
selection of best conformations that can be validated through experimental studies. The molecular
docking also enables screening of the potential vaccines to interact with the Toll-like receptors
(TLRs), a major component of initiating the innate immunity [35]. Numerous studies have reported
that reformulating the key proteins used in the vaccine improves efficacy and immunogenicity thus
improving response and protection.
Computational biology has gained popularity in the recent past and it has accelerated drug
discovery and development. The latest technologies involving artificial intelligence (AI) and deep
learning have been widely used on research platforms, thus accelerating drug discovery. Deep
learning is based on the idea of artificial neural networks (ANNs) that can resemble the brain
learning process [36]. In most occasions, AI, that assists in predicting drug-targets, has
significantly enhanced drug discovery by molecular docking and immunology. In this way, over a
single conformation is obtained and the best of them are chosen depending on their binding
capacity. The strategy has helped in developing vaccines and drugs significantly.
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