Measuring cellular immune responses to malaria antigens in endemic populations: epidemiological, parasitological and physiological factors which influence in vitro assays.

Measurements of in vitro cellular immune responses to malaria antigens are influenced by a variety of external factors. The physiological status of the donor, which is affected by, for example, malaria infection, intercurrent illness and pregnancy, can influence the lymphoproliferative response to specific antigens. Prior exposure to malaria antigens, determined by malaria endemicity, seasonal variations in transmission and the degree of polymorphism of the particular antigen, will also affect the prevalence and intensity of responses. Malaria-related immunosuppression may be both generalised and antigen specific. Although in vitro responses to malaria antigens are profoundly suppressed in acutely infected individuals, there is evidence that lymphocyte activation does occur in vivo. We conclude that longitudinal studies, correlating specific immune responses with subsequent malaria morbidity are required, to identify potentially protective antigens and appropriate effector mechanisms.