A new tactic might take down the greatest killer of women and children.
Jonathan “Jake” Kurtis ’89 MD ’96 PhD’96, professor of pathology and laboratory medicine and director of the Center for International Health Research at Rhode Island Hospital, has studied malaria for more than two decades. The disease infects 200 million people and kills 600,000 each year; 90 percent of cases occur in Africa. Kurtis is creating a malaria vaccine based on his understanding of specific immune responses in endemic populations. A paper proving the effectiveness of his latest vaccine in mice was published in Science last May, and provides new hope for stemming deaths from one of the globe’s greatest health burdens.
Is it true that you actually contracted malaria before you decided to study it?
Yes. It was a bit of an epiphany. I was an undergraduate at Brown University doing a semester abroad in Kenya and two very significant things happened to me: I ended up doing my first independent scientific research project there on coral reef ecology and I contracted cerebral malaria. Suddenly, I realized I had the same disease killing 25 percent of the children under 5 in that country, and it had an enormous impact on me.
Why aren’t prevention and treatment of malaria more effective?
Malaria can kill you in 24 hours. And in remote sub-Saharan countries, where most of the hundreds of millions of patients are, there is no access to effective treatments. Only prevention, including a vaccine, will make a difference. While effective care is great, it is not always possible to deliver.
This prehistoric disease poses a formidable challenge for the human immune system and the ultimate development of a vaccine. Why?
Malaria has a complex lifecycle and it changes its antigens all the time. The proteins it attaches to red blood cells can change weekly. Because of that it can circumvent, evolve, and co-opt our immune systems. So your immune system is constantly making antibodies against something that has moved on. Conceptually it is the same as HIV—your immune system is too late to the ball game to be effective.
Your vaccine is based on what you learned studying some of the children in Tanzania who are resistant to malaria. Can you describe this?
Six percent of children at the age of 2 in endemic areas are immune to malaria. They make an antibody as an adaptive response (similar to some adults) from being infected over and over. We did the genomic gymnastics and figured out what these antibodies look like. I want to make the same antibody so 94 percent of children can look like these special 6 percent of children and never get fatal disease—and that is
our vaccine.
Your vaccine’s unique approach slows the parasite by blocking it from exiting the human red blood cell. But this is not the type of vaccine that will prevent infection, so how will it help?
We hope it will prevent fatalities. This vaccine will attenuate the progression of the disease. Malaria parasites will still get inside the body but they won’t be able to multiply like they do now. We can reduce parasitemia and reduce the number of deaths with this vaccine. The patients will still feel sick and will need to be treated, but they won’t die.
How do you keep your passion for your work?
I encourage myself to keep my eye on the prize. It’s a race and it is not a race for fame or fortune—it’s a race for kids’ lives because it is literally once every 15 to 30 seconds you have a fatality from a treatable disease. Working in endemic areas and coming face to face with this reality is a remarkable motivator. From a global health point of view, there is nothing even close to the importance of finding a vaccine.
