Plasmodium falciparum malaria: evidence for an isotype imbalance which may be responsible for delayed acquisition of protective immunity

In view of the recent demonstration that antibodies that are protective against Plasmodium falciparum malaria may act in collaboration with blood monocytes, we investigated the isotype content of sera from individuals with defined clinical states of resistance or susceptibility to malaria. Profound differences in the distribution of each immunoglobulin subclass were found. Immunoglobulin G1 (IgG1) and IgG3, two cytophilic isotypes, predominated in protected subjects. In nonprotected subjects, i.e., children and adults that have sustained a primary malarial attack, four different situations were encountered: (i) an imbalance in which IgG2, a noncytophilic class, predominated (mostly seen in primary attacks), (ii) an imbalance also concerning IgG2 but only of a given antigenic specificity, (iii) an imbalance in which mostly IgM antibodies predominated (a frequent event in children), and, less frequently, (iv) an overall low level of antimalarial antibodies. Of 33 nonimmune subjects studied, all but one had one of the above defects. The function of total immunoglobulin presenting such an isotype imbalance was studied in vitro in antibody-dependent cellular inhibition assays. IgG from protected subjects cooperated efficiently with blood monocytes, whereas IgG from nonprotected groups did not. Also, the latter could inhibit the in vitro effect of the former: in competition assays whole IgG from primary-attack cases with increased IgG2 content and IgG or IgM from children from endemic areas competed with IgG from immune adults. This led us to formulate the hypothesis that nonprotected subjects have antibodies to epitopes critical for protection, but that these antibodies are nonfunctional. These results bring some clues to the very long delay required to reach protection against malaria and clearly stress the need to investigate immune responses in both quantitative and qualitative terms.