Human Antibodies that Slow Erythrocyte Invasion Potentiate Malaria-Neutralizing Antibodies

The Plasmodium falciparum reticulocyte-binding protein homolog 5 (PfRH5) is the leading target for next-generation vaccines against the disease-causing blood-stage of malaria. However, little is known about how human antibodies confer functional immunity against this antigen. We isolated a panel of human monoclonal antibodies (mAbs) against PfRH5 from peripheral blood B cells from vaccinees in the first clinical trial of a PfRH5-based vaccine. We identified a subset of mAbs with neutralizing activity that bind to three distinct sites and another subset of mAbs that are non-functional, or even antagonistic to neutralizing antibodies. We also identify the epitope of a novel group of non-neutralizing antibodies that significantly reduce the speed of red blood cell invasion by the merozoite, thereby potentiating the effect of all neutralizing PfRH5 antibodies as well as synergizing with antibodies targeting other malaria invasion proteins. Our results provide a roadmap for structure-guided vaccine development to maximize antibody efficacy against blood-stage malaria. [Display omitted] •Human PfRH5 vaccination induces cross-reactive neutralizing antimalarial antibodies•Neutralizing human PfRH5 antibodies bind epitopes close to the basigin binding site•Some non-neutralizing antibodies potentiate those binding several malaria proteins•Potentiating antibodies slow erythrocyte invasion by binding a new epitope on PfRH5 Analyses of human monoclonal antibodies against the Plasmodium falciparum protein PfRH5 identify a subset of non-neutralizing antibodies that synergize with a repertoire of other neutralizing antibodies by slowing the ability of malaria-causing parasites to invade red blood cells.