f Significant progress toward the control of malaria has been achieved, especially regarding Plasmodium falciparum infections. However, the unique biology of Plasmodium vivax hampers current control strategies. The early appearance of P. vivax gametocytes in the peripheral blood and the impossibility of culturing this parasite are major drawbacks. Using blood samples from 40 P. vivax-infected patients, we describe here a methodology to purify viable gametocytes and further infect anophelines. This method opens new avenues to validate transmission-blocking strategies.
In a scenario of malaria elimination, strategies based on transmission control, rapid diagnosis, effective vaccines, and specific drugs are vital. Early diagnosis and prompt treatment with effective drugs have led to a considerable decrease in the number of cases of falciparum malaria worldwide (1). However, the control and elimination of Plasmodium vivax still constitute a great challenge due to specific features of the organism, including gametocytes on peripheral blood early during infection (2), occurrence of a dormant stage in the liver (hypnozoite), and the emergence of drug-resistant forms (3, 4). The development of transmissionblocking molecules to reduce transmission is crucial for malaria eradication. However, because of the lack of a robust continuous in vitro culture system (5), studies on P. vivax gametocytes have been hampered. Here, using blood samples from 40 P. vivax-infected patients and membrane feeding assays, we describe a unique methodology to purify and concentrate viable gametocytes capable of infecting anophelines. This methodology opens avenues for testing drugs or vaccines against the gametocytes, the nonreplicating sexual stage responsible for parasite transmission to mosquitoes (2).Patients were recruited at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), a tertiary care center for infectious diseases in Manaus, Amazonas State, Brazil. This study was approved by a Brazilian ethics board (CAAE 0044.0.114.000-11). Up to 9 ml of peripheral blood was collected from infected patients, with parasitemia ranging from 297.5 to 30,600 parasites/l and gametocytemia (mean Ϯ standard deviation [SD]) of 13.3% Ϯ 16.7%. White blood cells were removed from the blood using a cellulose column (Sigma), as previously described (6). Afterwards, to separate asexual and sexual parasites from noninfected erythrocytes, we used a Percoll-45% (P45) or Percoll-60% (P60) gradient (7, 8) and/or magnetic purification (MP) using MACS-Columns LD/LS (Miltenyi Biotec) (9). Blood samples were maintained at 37°C during all procedures to avoid gametocyte exflagellation. For this purpose, we used a hot plate inside the tissue culture hood and preheated solutions, and all centrifugations were performed at 37°C. The percentage of gametocytes was determined by counting parasites on thin Giemsa smears before and after the purification process. Correlations were analyzed using the Spearman test. The normality of the data was evaluated with th...