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DOI: 10.1126/science.1078278
, 119 (2002); 298Science
et al.Luke Alphey,
Vectors
Malaria Control with Genetically Manipulated Insect
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and effectively transmit dengue virus even at
very low population densities because they pref-
erentially and frequently bite humans (23). A
successful GMM dengue control program that
falls short of vector eradication will result in a
reduction in human herd immunity and a corre-
sponding decrease in already low transmission
threshold levels. Because there is no commercial-
ly available vaccine or clinical cure for dengue,
predicting and testing transmission thresholds is
among the most important unanswered questions
in dengue epidemiology and GMM-based control
approaches.
Quantitative Analyses of Mosquito
Biology, Disease, and Control by GMM
A goal of future quantitative analyses should be
to accurately predict outcomes of proposed inter-
ventions instead of simulating events retrospec-
tively. For example, continental-scale predictions
of malaria disease burden are currently being
made on the basis of remotely sensed environ-
mental data that influence mosquito population
dynamics and, in turn, patterns of pathogen trans-
mission (24). Simulation models have been used
to predict entomological thresholds for dengue
transmission (25). Mathematical models have
been developed to identify parameters required to
predict the dynamics of transgene drive mecha-
nisms in vector populations (5, 6, 13, 26). Dif-
ferent drive strategies have been examined and
predictions made for the likely success of each
(5). An analysis of population genetics and epi-
demiology has concluded that in areas of intense
malaria transmission, GMM control programs
will have little if any effect unless mosquito
refractoriness is very close to 100% (13).
Conclusions
The meeting participants reached consensus on
four procedural issues. First, there is an urgent
need to develop uniform processes for dealing
with the ethical, legal, and social issues related to
GMM technology (27). It would be most helpful
if an international body like the World Health
Organization established guidelines, regulatory
mechanisms, and safety, containment, and con-
servation protocols. Second, for the GMM ap-
proach to be initially successful and ultimately
sustainable, its proponents must identify and de-
velop the capacity for human resources and re-
search infrastructure at sites earmarked for tech-
nology evaluation and long-term application.
Third, continued evaluation of GMM technology
will require semi-field facilities (such as large
outdoor cages), followed by release of GMM on
isolated oceanic or ecological islands that have
been thoroughly characterized with respect to the
genetic and ecological makeup of local mosquito
vector populations and site-specific patterns of
pathogen transmission and disease. Fourth, in
addition to population replacement, genetic strat-
egies for mosquito population reduction [such as
RIDL (release of insects carrying a dominant
lethal) and negative heterosis] in isolated urban
areas merit consideration (28).
Addressing these goals will require coordi-
nated interaction among scientists from diverse
disciplines. Only by studying the system in total
will we gain greater insight into the complexity
of interactions that are essential for the design,
implementation, and evaluation of progressively
more successful disease management strategies.
Such an ambitious agenda will require adequate
funding, collaboration between ecologists and
molecular geneticists, recruitment of expertise
from outside the vector-borne disease arena,
training for young scientists, and the expectation
of a sustained effort. The longitudinal field stud-
ies required to address some of the ecological
issues identified will last a decade or more. In all
these actions, people from the countries where
GMM technology is most likely to be applied
need to be more fully involved.
References and Notes
1. J. Trape, G. Pison, A. Spiegel, C. Enel, C. Rogier, Trends
Parasitol. 18, 224 (2002).
2. W. Takken, Trop. Med. Int. Health, in press.
3. A. A. James, in Insect Transgenesis: Methods and
Applications, A. M. Handler, A. A. James, Eds. (CRC
Press, Boca Raton, FL, 2000), pp. 319–333.
4. M. Enserink, Science 297, 30 (2002).
5. M. Turelli, A. A. Hoffmann, Insect Mol. Biol. 8, 243
(1999).
6. J. M. Ribeiro, M. G. Kidwell, J. Med. Entomol. 31,10
(1994).
7. F. M. Okanda et al., Malaria J. 1, 10 (2002).
8. M. J. Donnelly, F. Simard, T. Lehmann, Trends Parasi-
tol. 18, 75 (2002).
9. A. della Torre et al., Science 298, 115 (2002).
10. Y. T. Toure´ et al., Med. Vet. Entomol. 12, 74 (1998).
11. C. E. Taylor, Y. T. Toure´, M. Coluzzi, V. Petrarca, Med.
Vet. Entomol. 7, 351 (1993).
12. N. Lorimer, L. P. Lounibos, J. L. Petersen, J. Econ.
Entomol. 69, 405 (1976).
13. C. Boe¨te, J. C. Koella, Malaria J. 1, 3 (2002).
14. J. Ito, A. Ghosh, L. A. Moreira, E. A. Wimmer, M.
Jacobs-Lorena, Nature 417, 452 (2002).
15. C. Boe¨te, J. C. Koella, Trends Parasitol., in press.
16. N. J. White et al., Lancet 353, 1965 (1999).
17. I. S. Novella et al., J. Mol. Biol. 287, 459 (1999).
18. C. Boe¨te, R. E. L. Paul, J. C. Koella, Parasitology 125,93
(2002).
19. J. D. Charlwood et al., Am. J. Trop. Med. Hyg. 59, 243
(1998).
20. T. A. Smith, R. Leuenberger, C. Lengeler, Trends Para-
sitol. 17, 145 (2001).
21. C. A. Maxwell et al., Trop. Med. Int. Health, in press.
22. A. C. Morrison, A. Getis, T. W. Scott, unpublished
data.
23. T. W. Scott et al., J. Med. Entomol. 37, 89 (2000).
24. D. Rogers, S. E. Randolph, R. W. Snow, S. I. Hay,
Nature 415, 702 (2002).
25. D. A. Focks, R. J. Brenner, J. Hayes, E. Daniels, Am. J.
Trop. Med. Hyg. 62, 11 (2000).
26. A. E. Kiszewski, A. Spielman, J. Med. Entomol. 35, 584
(2002).
27. L. Alphey et al., Science 298, 119 (2002).
28. L. Alphey, M. Andreasen, Mol. Biochem. Parasitol.
121, 173 (2002).
29. We thank the following Wageningin meeting partic-
ipants for helpful comments: K. Aultman, P. Billings-
ley, D. Charlwood, C. Curtis, J. Edman, J. Koella, G.
Lanzaro, S. Lindsay, P. Lounibos, D. O’Brochta, S.
Randolph, W. Reisen, D. Rogers, M. Sabelis, A. Spiel-
man, C. Taylor, and Y. Toure´.
VIEWPOINT
Malaria Control with Genetically
Manipulated Insect Vectors
Luke Alphey,
1
C. Ben Beard,
2
Peter Billingsley,
3
Maureen Coetzee,
4
Andrea Crisanti,
5
Chris Curtis,
6
Paul Eggleston,
7
Charles Godfray,
5
Janet Hemingway,
8
Marcelo Jacobs-Lorena,
9
Anthony A. James,
10
Fotis C. Kafatos,
11
Louis G. Mukwaya,
12
Michael Paton,
13
Jeffrey R. Powell,
14
William Schneider,
15
Thomas W. Scott,
16
Barbara Sina,
17
Robert Sinden,
5
Steven Sinkins,
8
Andrew Spielman,
18
Yeya Toure´,
19
Frank H. Collins
20
At a recent workshop, experts discussed the benefits, risks, and research
priorities associated with using genetically manipulated insects in the
control of vector-borne diseases.
This is a partial report of a workshop—Genet-
ically Engineered Arthropod Vectors of Human
Infectious Diseases—jointly sponsored by the
World Health Organization, the MacArthur
Foundation, the National Institute of Allergy
and Infectious Diseases, and London’s Imperial
College—originally planned for 12 September
2001 in London (but reconvened in successive
sessions later in London and Atlanta). These
workshops sought to encourage communication
between the laboratory-oriented molecular bi-
ologists, whose work had suggested the poten-
tial of genetic control strategies, and the popu-
lation geneticists, ecologists, and public health
specialists, whose involvement would be cru-
cial in moving the work beyond the laboratory.
The meeting participants were charged with
considering the benefits and risks of using ge-
netically engineered arthropod vectors as public
www.sciencemag.org SCIENCE VOL 298 4 OCTOBER 2002
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health tools and mapping out a research agenda
for their development. The task of engineering
different vector species and the risks associated
with various methods of genetic engineering
are vastly different and could not be addressed
in a single report. What follows is the consen-
sus of the working group on germline-trans-
formed organisms developed for control of ma-
laria transmission (authors listed above) and
other participants. The reports of the working
groups on paratransgenesis (transformation of
obligate symbionts in insects) and on other
vector-borne diseases will be presented in the
near future.
In 1991, a scientific workshop in Arizona
assessed the prospect for malaria control by
genetic manipulation of vector populations (see
the Viewpoint by Morel et al. on page 79) (1).
The basic concept of genetic control of vector-
borne diseases was proposed by Curtis in 1968
(2), but major advances in the molecular ma-
nipulation of Drosophila melanogaster during
the 1980s encouraged reevaluation of this idea.
The WHO/TDR summary document of the
meeting laid out a clear list of research aims that
would have to be met before a genetic control
strategy could be field tested (3). These aims
fell into three categories: (i) the development of
genetic engineering tools that could be used
with malaria vectors; (ii) the identification of
effector genes that could block parasite trans-
mission; and (iii) the development of effective
methods for driving these effector genes to
fixation in natural vector populations.
The first two aims have been largely
achieved. Several different but effective
methods of germline transformation have
been developed and used in at least three
species of malaria mosquito vector (4– 6);
two different laboratories have developed ge-
netic constructs that significantly reduce vec-
tor competence in experimental malaria mod-
els (7, 8). A large set of molecular markers
has been developed and is being used in
studies of gene flow and population structure
in anopheline malaria vectors (9–13). But
there has been no significant progress in de-
veloping methods for driving desirable genes
into wild populations and especially for en-
suring the necessary unbreakable linkage be-
tween the drive system and the gene to be
driven (see the Viewpoint by Scott et al.on
page 117) (14).
Consideration of the potential use of ge-
netically modified organisms (GMOs) is
driven by the realization of the enormous
human cost of diseases like malaria, and of
the inadequacy of present control measures.
Perhaps the most important theme emerging
from the workshop was the recognition that
control strategies involving GMOs could po-
tentially provoke serious public mistrust and
resistance to their implementation. Therefore
it was strongly recommended that all work
leading to the development of specific genet-
ic control strategies targeted at malaria vec-
tors should involve both public health spe-
cialists and scientists from disease-endemic
countries and (where possible) the general
public in areas where field trials could be
implemented. Because field trials of geneti-
cally modified mosquitoes would have to be
preceded by long-term, longitudinal studies
of potential field-trial sites, the local commu-
nity and its own scientists and health experts
can easily be involved.
The goal of producing GMOs intended to
benefit human health has been perceived more
favorably by the public than that of producing
GMOs for agricultural or domestic animal re-
search. However, meeting participants strongly
argued that this positive public perception could
be rapidly undermined by an actual field trial of
a transgenic arthropod that failed to provide a
significant and tangible health benefit to the
resident human community. It was therefore
recommended that all preliminary research de-
signed to lead to field trials of the efficacy of a
transgenic arthropod-based disease control
strategy should involve fully contained labora-
tory or cage environments. Release should be
permitted only when all relevant parameters
had been investigated in either contained envi-
ronments or in open field studies that did not
involve transgenic arthropods. Furthermore,
field trials involving release of transgenic ar-
thropods should take place only when all mem-
bers of both scientific and local community
review groups were assured that such trials had
a very high probability of producing a signifi-
cant and measurable public health benefit for
the local community.
Many important ecological and popula-
tion genetic issues must be understood before
any release program can be contemplated,
and such issues will be specific not only to
individual vector species but also to local
populations (see the Viewpoint by Scott et al.
on page 117) (14). Understanding the dynam-
ics of a natural population will require years
of study, with the time frame dependent on
the stability and repeatability of yearly cy-
cles. Thus, given progress in the laboratory, it
is important to start the ecological and pop-
ulation genetic study of potential target pop-
ulations soon, as this will be the biggest
scientific limitation to implementing genetic
control field trials. A large number of tech-
nical problems will have to be addressed,
ranging from the feasibility of producing an
effective release strain to the design and as-
sessment of release strategies with specifical-
ly predicted goals. To address such problems
will require the involvement of ecologists and
population geneticists. Most participants rec-
ommended that study of potential field-trial
sites should be initiated immediately at mul-
tiple different locations, recognizing that the
initial phase of fieldwork might show one or
more of the selected sites to be unsuitable.
Because the biology of vector populations at
any such site would have to be studied for
many years before field trials could be de-
signed, the community cannot investigate dif-
ferent sites sequentially.
GMOs could be used in either of two ways
for malaria control. The initial concept (ex-
pressed in the 1991 meeting) was to engineer
mosquitoes with an altered phenotype that
would be introduced into the population in such
a way that the new trait would spread and
become dominant. These strategies target the
malaria parasite, rather than the mosquito itself,
for reduction. There is an immediate research
need for the study of drive systems in Anopheles
species. These drive systems also present a po-
tential hazard because they may generate unin-
tended phenotypes and have unforeseen, poten-
tially harmful ecological effects. Autonomous
transposons, for example, could increase the
mutation rate through multiple genomic inser-
tions, leading to unanticipated alterations in the
biology of the target species. Tight linkage of
the drive system and the engineered gene is also
an important issue in that its loss in the progeny
of released mosquitoes could lead to loss of
public health efficacy and loss of the molecular
tool for future engineering efforts. Although
transposon and symbiont systems have garnered
the most attention to date, participants recog-
nized the need to explore any possible drive
system that could continue to propagate a re-
leased genetic construct through the target pop-
ulation after initial release.
An alternative use of genetic engineering for
malaria control takes a more traditional ap-
proach. This involves targeting the mosqui-
to population per se for reduction. Proposed
improvements in sterile insect techniques,
including release of insects carrying domi-
nant lethals (RIDL) (15), and other mech-
anisms of genetic sexing may alter the
prognosis for these strategies. In these sit-
uations the release of large numbers of
insects presents other specific challenges:
for example, the need to release only male
mosquitoes so as not to increase the number
or nature of mosquito bites per person per
night. In the absence of an existing drive
1
Oxford University, UK.
2
National Center for Infec-
tious Diseases, Centers for Disease Control and Pre-
vention, USA.
3
University of Aberdeen, UK.
4
South
African Institute for Medical Research, South Africa.
5
Imperial College, London, UK.
6
London School of
Tropical Medicine and Hygiene, UK.
7
Keele University,
UK.
8
Liverpool School of Tropical Medicine, UK.
9
Case
Western Reserve University, USA.
10
University of Cal-
ifornia, Irvine, USA.
11
European Molecular Biology
Laboratory, Germany.
12
Uganda Virus Research Insti-
tute, Uganda.
13
Health and Safety Executive, HSC, UK.
14
Yale University, USA.
15
Environmental Protection
Agency, USA.
16
University of California, Davis, USA.
17
Fogarty International Center, NIH, USA.
18
Harvard
School of Public Health, USA.
19
Special Programme
for Research and Training in Tropical Diseases (TDR),
WHO.
20
University of Notre Dame, USA.
4 OCTOBER 2002 VOL 298 SCIENCE www.sciencemag.org120
T HE M OSQUITO G ENOME: A NOPHELES GAMBIAE
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system, participants considered the use of
inundative release of refractory mosquitoes
as a strategy for limited field-testing of the
performance of specific genetically engi-
neered vector strains. Although considered
suitable only for a small vector population
with limited interpopulation gene flow
(such as a real or ecological island setting),
the ability to limit or quickly control un-
foreseen risks in the genetic manipulation
of an island population will be important in
early-stage trials designed to demonstrate
the efficacy of particular genetic modifica-
tions of the vector population.
Although there was support for continued,
intensive research in this area, a clear recom-
mendation emerged that there should be no pre-
cipitous releases of transgenic arthropods. The
malaria group was willing to recommend bar-
ring field trials of transgenic insects that were
designed solely for research; others felt that
initial field safety testing of the various individ-
ual elements of the engineered organism was
crucial to development. The parallel processes
of drug and vaccine development illustrate these
two views. For either product, and indeed for
engineered Anopheles mosquitoes, there is a
requirement for preliminary studies of safety
and efficacy in culture and in animal models
before the first clinical trial is initiated. With
many new drugs (other than cancer drugs), the
first human trials are performed in small num-
bers of normal healthy volunteers, and safety is
the end point examined. In these situations it
would be inappropriate to endanger patients
who are already sick by exposing them to a drug
candidate of unknown toxicity. By contrast,
when new vaccines are developed, they are most
often combined with adjuvants that improve
their potency or direct their effects to one or
more segments of the human immune system.
Under its current guidelines the U.S. Food and
Drug Administration does not allow investiga-
tion of the adjuvants alone without the vaccine
candidate being tested at the same time. The
malaria working group requires tangible bene-
fits at each phase of field testing. The other
working groups—discussing symbionts, trans-
ducing viruses, and other mechanisms of driving
traits into populations—decided to follow drug-
development protocols. These differences may
be appropriate given the different nature of the
engineering tools and the different risks associ-
ated with each one.
Despite nearly universal recognition that
enormous technical and sociological problems
must be overcome before the implementation of
genetic control strategies for malaria can be field
tested, participants concluded that public health
strategies incorporating transgenic vectors offer
the potential of health benefits. Participants
from disease-endemic areas, many of whom had
limited prior exposure to transgenic arthropod
research or policy discussions, were among the
most supportive and optimistic about the public
health goals such strategies hope to achieve.
Participants also noted that the broad scope of
biological research required for the development
of genetic control strategies is likely to contrib-
ute both to the more efficient application of
currently available control tools and to the de-
velopment of new approaches.
References
1. C. M. Morel, Y. T. Toure´, B. Dobrokhotov, A. M. J.
Oduola, Science 298, 79 (2002).
2. C. F. Curtis, Nature 218, 368 (1968).
3. Prospects for malaria control by genetic manipulation
of its vectors (TDR/BCV/MAL-ENT/91.3) (World
Health Organization, Geneva, 1991).
4. C. J. Coates, N. Jasinskiene, L. Miyashiro, A. A. James,,
Proc. Natl. Acad. Sci. U.S.A. 95, 3748 (1998).)
5. F. Caterrucia et al., Nature 405, 959 (2000).
6. G. L. Grossman et al., Insect Mol. Biol. 10, 597 (2001).
7. M. de Lara Capurro, Am. J. Trop. Med. Hyg. 62, 427
(2000).
8. J. Ito et al., Nature 417, 452 (2002).
9. D. Y. Onyabe, J. E. Conn, Heredity 87, 647 (2001).
10. M. J. Donnelly, M. C. Licht, T. Lehmann, Mol. Biol.
Evol. 18, 1353 (2001).
11. W. C. Black IV, G. C. Lanzaro, Insect Mol. Biol. 10,3
(2001).
12. C. Walton et al., Mol. Ecol. 10, 569 (2001).
13. R. Wang, F. C. Kafatos, L. Zheng, Parasitol. Today 15,
33 (1999).
14. T. W. Scott, W. Takken, B. G. J. Knols, C. Boe¨te,
Science 298, 117 (2002).
15. D. D. Thomas, C. A. Donnelly, R. J. Wood, L. S. Alphey,
Science 287, 2474 (2000).
VIEWPOINT
Malaria—a Shadow over Africa
Louis H. Miller
1
and Brian Greenwood
2
Reduction in severe disease and death from falciparum malaria in Africa
requires new, more effective and inexpensive public health measures. The
completed genomes of Plasmodium falciparum and its vector Anopheles
gambiae represent a big step toward the discovery of these needed tools.
The current focus of malaria control programs in
Africa is rightly on the management of sick
children through early treatment with effective
antimalarial drugs. However, this cannot be the
final strategy. The two first-line drugs, chloro-
quine and sulfadoxine/pyrimethamine (Fan-
sidar), are no longer effective in many parts of
East Africa where chloroquine resistance (intro-
duced from Asia) is rampant. Combinations of
new drugs may help to slow the emergence and
spread of resistant parasites (1), but control strat-
egies based on early treatment mean a never-
ending struggle to develop and deploy new drugs
before the Plasmodium malaria parasites become
resistant to existing drugs. Thus, the long-term
control strategy must be to interrupt the trans-
mission of this parasite. Unfortunately, this will
be extremely difficult in parts of Africa where
people may be bitten as many as 1000 times a
year by infected mosquitoes. Insecticide-treated
bed nets—now being vigorously promoted in
many parts of Africa—reduce bites from infect-
ed mosquitoes by as much as 90% (2). However,
their effectiveness is already under threat as a
result of the emergence of pyrethroid resistance
in Anopheles funestus in Mozambique and in A.
gambiae in agricultural areas of West Africa (3).
Household spraying with residual insecticides is
highly effective in reducing malaria in some
parts of Africa, but it is logistically demand-
ing, costly, and may have adverse environ-
mental effects.
There are many ways to reduce malaria
transmission, but none can provide a complete
block in transmission, particularly in the highly
endemic areas of Africa (4), and new approaches
are desperately needed (5). Publication of the
Plasmodium falciparum (6) and Anopheles gam-
biae genomes (7) represents a big step forward
in our search for new tools for controlling ma-
laria. Combined deployment of three strategies
that each have the potential to reduce malaria
transmission by 90%— drug treatment, vaccina-
tion, and vector control—should be sufficient to
stop transmission, even in highly endemic areas
of Africa. We will need to first test such strate-
gies in areas with a low intensity of transmission
before attempting the challenging task of pre-
venting malaria transmission in the highly en-
demic areas of Africa.
Anyone who has thought deeply about the
problem of reducing severe disease and death
from malaria in Africa realizes the crucial need
for a malaria vaccine. Pre-erythrocytic, blood-
stage, and transmission-blocking vaccines have
recently been developed by a number of groups
(8). Each type of vaccine has a part to play in
the complex, highly diverse epidemiology of
malaria and the associated variety of patterns of
1
Laboratory of Malaria and Vector Research, National
Institute of Allergy and Infectious Diseases, Bethesda,
MD 20892, USA.
2
Department of Infectious and Trop-
ical Diseases, London School of Hygiene and Tropical
Medicine, London WC1B 3DP, UK.
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