Globally, malaria is still a major problem with approximately 3.3 billion people
living in areas at risk of malaria transmission in 106 countries (Centers for Disease
Control, 2012). Most of those affected by malaria are young children and pregnant
women residing in sub-Saharan Africa. When I was growing up in Lake Victoria,
in western Kenya, I would watch kids die of malaria. We lost so many children
and adults. So my motivation all along has been to study malaria and get to the
depth of this particular disease. Through my work as a professor, I have met and
collaborated with several researchers in Kenya and globally (especially the United
States) who have the same goals; to understand the genetic makeup of the human
host, the mosquito vector and the malarial parasite, and ultimately work towards
controlling the infection.
The genetics of malaria is still new – much is still unknown. While the genetic
research continues, it is likely that the majority of the children residing in endemic
regions in sub-Saharan Africa will be infected with malaria at some point in their
lives. With the funding that I have been awarded, I hope to increase the presence
of screening labs in these sub-Saharan regions, and to educate others about the
disease. For example, in just three years of our initial research on malaria, we were
able to reduce the morbidity and mortality rates of children in western Kenya.
But the standard methods of sample collection are still not ideal. We are able
to collect blood samples from these children; however, this collection method
presents a specific set of problems due to its invasive nature. If we are able
to identify a non-invasive collection method that can remain stable in these
conditions before the samples return to the centers, it will potentially allow us
to collect a larger number of samples and reach further across to other
affected regions.
I recently conducted a preliminary study in P. falciparum malaria regions in
western Kenya, with the goal of determining if the malarial parasite can be
detected in saliva. The use of saliva, if it presents high enough levels of the parasite
in infected children, would offer us a very useful means of sample collection.
In this study we collected paired blood and saliva samples from children 4 years
and older who presented clinical symptoms of malaria. We decided to use the
OMNIgene®•ORAL self collection kits for our saliva samples as it was easy to use
and would allow us to store the samples outside without the risk of compromising
the sample. Th e DNA obtained was then compared and tested for both malaria
parasite (by PCR using MSP-2 family- specifi c primers) and human highthroughput real-time SNP assays (using Applied Biosystems® assays).
Results from a subset of these samples show that DNA extracted from
OMNIgene•ORAL saliva kits performed equivalently to the DNA extracted from
blood in the detection of circulating P. falciparum parasites as well as in its
performance on high-throughput SNP genotyping. Th e DNA quality obtained
from the OMNIgene/saliva samples were tested using PCR amplifi cation and
demonstrated to have comparable high molecular weight to the paired blood
samples. DNA yield was also equivalent to that extracted from blood.
It is becoming well known that malaria now causes hundreds of millions of
infections worldwide and approximately 1 million deaths every year. In the labs
that we set up in the rural areas, prompt diagnosis and treatment are critical
factors in reducing morbidity and mortality. Given the results yielded in this
preliminary study, I foresee the use of saliva and the OMNIgene•ORAL collection
kits to assist in the detection of P. falciparum via saliva in children living in risk of
infection. I recommend that future approaches should utilize OMNIgene•ORAL
self collection kits to avoid invasive sample collections, improve patient
recruitment, improve the patient experience, and enhance malaria diagnostics
and research.
DNA from saliva is a reliable sample type for malaria detection
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