Kirsten Lyke - Academia.edu (original) (raw)

Papers by Kirsten Lyke

Research paper thumbnail of Preexisting Enhancing Antibodies in Vaccinated Participants Accelerate Dengue Virus 1 Infection Following Live Virus Human Challenge

Research Square (Research Square), Sep 14, 2023

Research paper thumbnail of Malian children infected with Plasmodium ovale and Plasmodium falciparum display very similar gene expression profiles

Plasmodium parasites caused 241 million cases of malaria and over 600,000 deaths in 2020. Both P.... more Plasmodium parasites caused 241 million cases of malaria and over 600,000 deaths in 2020. Both P. falciparum and P. ovale are endemic to Mali and cause malaria illness, with P. falciparum infections typically being more severe. Here, we sequenced RNA from nine pediatric blood samples collected during uncomplicated, symptomatic infections with either P. falciparum or P. ovale and characterized the host and parasite gene expression profiles. We found that human gene expression varies more between individuals than according to the parasite species causing the infection, while parasite gene expression profiles cluster by species. Additionally, we characterized DNA polymorphisms of the parasites directly from the RNA-seq reads and found comparable levels of genetic diversity in both species despite dramatic differences in prevalence. Our results provide unique insights into host-pathogen interactions during malaria infections and their variations according to the infecting Plasmodium spe...

Research paper thumbnail of Additional file 5. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of variants found in the NF54 assembly. Excel spreadsheet listing SNP and indel diffe... more Description of variants found in the NF54 assembly. Excel spreadsheet listing SNP and indel differences found in the NF54 assembly and 3D7.

Research paper thumbnail of Long-term Maintenance of CD4 T Cell Memory Responses to Malaria Antigens in Malian Children Coinfected with Schistosoma haematobium

Frontiers in Immunology, 2018

Research paper thumbnail of Immunoprofiles associated with controlled human malaria infection and naturally acquired immunity identify a shared IgA pre-erythrocytic immunoproteome

npj Vaccines, 2021

Knowledge of the Plasmodium falciparum antigens that comprise the human liver stage immunoproteom... more Knowledge of the Plasmodium falciparum antigens that comprise the human liver stage immunoproteome is important for pre-erythrocytic vaccine development, but, compared with the erythrocytic stage immunoproteome, more challenging to classify. Previous studies of P. falciparum antibody responses report IgG and rarely IgA responses. We assessed IgG and IgA antibody responses in adult sera collected during two controlled human malaria infection (CHMI) studies in malaria-naïve volunteers and in 1- to 6-year-old malaria-exposed Malian children on a 251 P. falciparum antigen protein microarray. IgG profiles in the two CHMI groups were equivalent and differed from Malian children. IgA profiles were robust in the CHMI groups and a subset of Malian children. We describe immunoproteome differences in naïve vs. exposed individuals and report pre-erythrocytic proteins recognized by the immune system. IgA responses detected in this study expand the list of pre-erythrocytic antigens for further ch...

Research paper thumbnail of Host and Parasite Transcriptomic Changes upon Successive Plasmodium falciparum Infections in Early Childhood

mSystems, 2020

We show that dual RNA-seq from patient blood samples allows characterization of host/parasite int... more We show that dual RNA-seq from patient blood samples allows characterization of host/parasite interactions during malaria infections and can provide a solid framework to study the acquisition of antimalarial immunity, as well as the adaptations of P. falciparum to malaria-experienced hosts.

Research paper thumbnail of Multidose Priming and Delayed Boosting ImprovePlasmodium falciparumSporozoite Vaccine Efficacy Against HeterologousP. falciparumControlled Human Malaria Infection

Clinical Infectious Diseases, 2020

BackgroundA live-attenuated Plasmodium falciparum sporozoite (SPZ) vaccine (PfSPZ Vaccine) has sh... more BackgroundA live-attenuated Plasmodium falciparum sporozoite (SPZ) vaccine (PfSPZ Vaccine) has shown up to 100% protection against controlled human malaria infection (CHMI) using homologous parasites (same P. falciparum strain as in the vaccine). Using a more stringent CHMI, with heterologous parasites (different P. falciparum strain), we assessed the impact of higher PfSPZ doses, a novel multi-dose prime regimen, and a delayed vaccine boost upon vaccine efficacy (VE).MethodsWe immunized 4 groups that each contained 15 healthy, malaria-naive adults. Group 1 received 5 doses of 4.5 x 105 PfSPZ (Days 1, 3, 5, and 7; Week 16). Groups 2, 3, and 4 received 3 doses (Weeks 0, 8, and 16), with Group 2 receiving 9.0 × 105/doses; Group 3 receiving 18.0 × 105/doses; and Group 4 receiving 27.0 × 105 for dose 1 and 9.0 × 105 for doses 2 and 3. VE was assessed by heterologous CHMI after 12 or 24 weeks. Volunteers not protected at 12 weeks were boosted prior to repeat CHMI at 24 weeks.ResultsAt 12...

Research paper thumbnail of Microarray analyses reveal strain-specific antibody responses to Plasmodium falciparum apical membrane antigen 1 variants following natural infection and vaccination

Scientific Reports, 2020

Vaccines based on Plasmodium falciparum apical membrane antigen 1 (AMA1) have failed due to exten... more Vaccines based on Plasmodium falciparum apical membrane antigen 1 (AMA1) have failed due to extensive polymorphism in AMA1. To assess the strain-specificity of antibody responses to malaria infection and AMA1 vaccination, we designed protein and peptide microarrays representing hundreds of unique AMA1 variants. Following clinical malaria episodes, children had short-lived, sequence-independent increases in average whole-protein seroreactivity, as well as strain-specific responses to peptides representing diverse epitopes. Vaccination resulted in dramatically increased seroreactivity to all 263 AMA1 whole-protein variants. High-density peptide analysis revealed that vaccinated children had increases in seroreactivity to four distinct epitopes that exceeded responses to natural infection. A single amino acid change was critical to seroreactivity to peptides in a region of AMA1 associated with strain-specific vaccine efficacy. Antibody measurements using whole antigens may be biased to...

Research paper thumbnail of Dose-Dependent Infectivity of Aseptic, Purified, Cryopreserved Plasmodium falciparum 7G8 Sporozoites in Malaria-Naive Adults

The Journal of Infectious Diseases, 2019

Direct venous inoculation of 3.2 × 103 aseptic, purified, cryopreserved, vialed Plasmodium falcip... more Direct venous inoculation of 3.2 × 103 aseptic, purified, cryopreserved, vialed Plasmodium falciparum (Pf) strain NF54 sporozoites, PfSPZ Challenge (NF54), has been used for controlled human malaria infection (CHMI) in the United States, 4 European countries, and 6 African countries. In nonimmune adults, this results in 100% infection rates. We conducted a double-blind, randomized, dose-escalation study to assess the infectivity of the 7G8 clone of Pf (PfSPZ Challenge [7G8]). Results showed dose-dependent infectivity from 43% for 8 × 102 PfSPZ to 100% for 4.8 × 103 PfSPZ. PfSPZ Challenge (7G8) will allow for more complete assessment by CHMI of antimalarial vaccines and drugs.

Research paper thumbnail of The Controlled Human Malaria Infection Experience at the University of Maryland

The American Journal of Tropical Medicine and Hygiene, 2019

Research paper thumbnail of Immunoglobulin G subclass and antibody avidity responses in Malian children immunized with Plasmodium falciparum apical membrane antigen 1 vaccine candidate FMP2.1/AS02A

Research paper thumbnail of Corrigendum: Protection against malaria at 1 year and immune correlates following PfSPZ vaccination

Nature medicine, Jun 7, 2016

Research paper thumbnail of Immunogenomic profile at baseline predicts host susceptibility to clinical malaria

Frontiers in Immunology

IntroductionHost gene and protein expression impact susceptibility to clinical malaria, but the b... more IntroductionHost gene and protein expression impact susceptibility to clinical malaria, but the balance of immune cell populations, cytokines and genes that contributes to protection, remains incompletely understood. Little is known about the determinants of host susceptibility to clinical malaria at a time when acquired immunity is developing.MethodsWe analyzed peripheral blood mononuclear cells (PBMCs) collected from children who differed in susceptibility to clinical malaria, all from a small town in Mali. PBMCs were collected from children aged 4-6 years at the start, peak and end of the malaria season. We characterized the immune cell composition and cytokine secretion for a subset of 20 children per timepoint (10 children with no symptomatic malaria age-matched to 10 children with >2 symptomatic malarial illnesses), and gene expression patterns for six children (three per cohort) per timepoint. ResultsWe observed differences between the two groups of children in the express...

Research paper thumbnail of Gene expression analyses reveal differences in children’s response to malaria according to their age

In Bandiagara, Mali, children experience on average two clinical malaria episodes per season. How... more In Bandiagara, Mali, children experience on average two clinical malaria episodes per season. However, even in the same transmission area, the number of uncomplicated symptomatic infections, and their parasitemia, vary dramatically among children. To examine the factors contributing to these variations, we simultaneously characterized the host and parasite gene expression profiles from 136 children with symptomatic falciparum malaria and analyzed the expression of 9,205 human and 2,484 Plasmodium genes. We used gene expression deconvolution to estimate the relative proportion of immune cells and parasite stages in each sample and to adjust the differential gene expression analyses. Parasitemia explained much of the variation in both host and parasite gene expression and revealed that infections with higher parasitemia had more neutrophils and fewer T cells, suggesting parasitemia-dependent neutrophil recruitment and/or T cell extravasation to secondary lymphoid organs. The child’s a...

Research paper thumbnail of MOESM1 of Immunoglobulin G subclass and antibody avidity responses in Malian children immunized with Plasmodium falciparum apical membrane antigen 1 vaccine candidate FMP2.1/AS02A

Additional file 1. AMA1 IgG subclass titers, total IgG titers, and cytophilic ratios for AMA1 vac... more Additional file 1. AMA1 IgG subclass titers, total IgG titers, and cytophilic ratios for AMA1 vaccine and control groups.

Research paper thumbnail of Additional file 3. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of structural variants. Excel spreadsheet describing structural variants identified i... more Description of structural variants. Excel spreadsheet describing structural variants identified in each of the four PfSPZ strain assemblies.

Research paper thumbnail of MOESM1 of Serologic responses to the PfEMP1 DBL-CIDR head structure may be a better indicator of malaria exposure than those to the DBL-Îą tag

Additional file 1. Sequences, classifications, and domains of the PfEMP1 antigens used to populat... more Additional file 1. Sequences, classifications, and domains of the PfEMP1 antigens used to populate the custom protein microarray.

Research paper thumbnail of Additional file 4. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of var exon 1 sequences. Excel spreadsheet describing var exon 1 sequences recovered ... more Description of var exon 1 sequences. Excel spreadsheet describing var exon 1 sequences recovered from each of the four PfSPZ strains.

Research paper thumbnail of Additional file 2. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Supplemental Text, Tables, and Figures. Word document containing supplemental information as cite... more Supplemental Text, Tables, and Figures. Word document containing supplemental information as cited in the main manuscript.

Research paper thumbnail of Malian adults maintain serologic responses to virulent PfEMP1s amid seasonal patterns of fluctuation

Scientific Reports, 2021

Plasmodium falciparumerythrocyte membrane protein-1s (PfEMP1s), diverse malaria proteins expresse... more Plasmodium falciparumerythrocyte membrane protein-1s (PfEMP1s), diverse malaria proteins expressed on the infected erythrocyte surface, play an important role in pathogenesis, mediating adhesion to host vascular endothelium. Antibodies to particular non-CD36-binding PfEMP1s are associated with protection against severe disease. We hypothesized that given lifelongP. falciparumexposure, Malian adults would have broad PfEMP1 serorecognition and high seroreactivity levels during follow-up, particularly to non-CD36-binding PfEMP1s such as those that attach to endothelial protein C receptor (EPCR) and intercellular adhesion molecule-1 (ICAM-1). Using a protein microarray, we determined serologic responses to 166 reference PfEMP1 fragments during a dry and subsequent malaria transmission season in Malian adults. Malian adult sera had PfEMP1 serologic responses throughout the year, with decreased reactivity to a small subset of PfEMP1 fragments during the dry season and increases in reactiv...

Research paper thumbnail of Preexisting Enhancing Antibodies in Vaccinated Participants Accelerate Dengue Virus 1 Infection Following Live Virus Human Challenge

Research Square (Research Square), Sep 14, 2023

Research paper thumbnail of Malian children infected with Plasmodium ovale and Plasmodium falciparum display very similar gene expression profiles

Plasmodium parasites caused 241 million cases of malaria and over 600,000 deaths in 2020. Both P.... more Plasmodium parasites caused 241 million cases of malaria and over 600,000 deaths in 2020. Both P. falciparum and P. ovale are endemic to Mali and cause malaria illness, with P. falciparum infections typically being more severe. Here, we sequenced RNA from nine pediatric blood samples collected during uncomplicated, symptomatic infections with either P. falciparum or P. ovale and characterized the host and parasite gene expression profiles. We found that human gene expression varies more between individuals than according to the parasite species causing the infection, while parasite gene expression profiles cluster by species. Additionally, we characterized DNA polymorphisms of the parasites directly from the RNA-seq reads and found comparable levels of genetic diversity in both species despite dramatic differences in prevalence. Our results provide unique insights into host-pathogen interactions during malaria infections and their variations according to the infecting Plasmodium spe...

Research paper thumbnail of Additional file 5. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of variants found in the NF54 assembly. Excel spreadsheet listing SNP and indel diffe... more Description of variants found in the NF54 assembly. Excel spreadsheet listing SNP and indel differences found in the NF54 assembly and 3D7.

Research paper thumbnail of Long-term Maintenance of CD4 T Cell Memory Responses to Malaria Antigens in Malian Children Coinfected with Schistosoma haematobium

Frontiers in Immunology, 2018

Research paper thumbnail of Immunoprofiles associated with controlled human malaria infection and naturally acquired immunity identify a shared IgA pre-erythrocytic immunoproteome

npj Vaccines, 2021

Knowledge of the Plasmodium falciparum antigens that comprise the human liver stage immunoproteom... more Knowledge of the Plasmodium falciparum antigens that comprise the human liver stage immunoproteome is important for pre-erythrocytic vaccine development, but, compared with the erythrocytic stage immunoproteome, more challenging to classify. Previous studies of P. falciparum antibody responses report IgG and rarely IgA responses. We assessed IgG and IgA antibody responses in adult sera collected during two controlled human malaria infection (CHMI) studies in malaria-naïve volunteers and in 1- to 6-year-old malaria-exposed Malian children on a 251 P. falciparum antigen protein microarray. IgG profiles in the two CHMI groups were equivalent and differed from Malian children. IgA profiles were robust in the CHMI groups and a subset of Malian children. We describe immunoproteome differences in naïve vs. exposed individuals and report pre-erythrocytic proteins recognized by the immune system. IgA responses detected in this study expand the list of pre-erythrocytic antigens for further ch...

Research paper thumbnail of Host and Parasite Transcriptomic Changes upon Successive Plasmodium falciparum Infections in Early Childhood

mSystems, 2020

We show that dual RNA-seq from patient blood samples allows characterization of host/parasite int... more We show that dual RNA-seq from patient blood samples allows characterization of host/parasite interactions during malaria infections and can provide a solid framework to study the acquisition of antimalarial immunity, as well as the adaptations of P. falciparum to malaria-experienced hosts.

Research paper thumbnail of Multidose Priming and Delayed Boosting ImprovePlasmodium falciparumSporozoite Vaccine Efficacy Against HeterologousP. falciparumControlled Human Malaria Infection

Clinical Infectious Diseases, 2020

BackgroundA live-attenuated Plasmodium falciparum sporozoite (SPZ) vaccine (PfSPZ Vaccine) has sh... more BackgroundA live-attenuated Plasmodium falciparum sporozoite (SPZ) vaccine (PfSPZ Vaccine) has shown up to 100% protection against controlled human malaria infection (CHMI) using homologous parasites (same P. falciparum strain as in the vaccine). Using a more stringent CHMI, with heterologous parasites (different P. falciparum strain), we assessed the impact of higher PfSPZ doses, a novel multi-dose prime regimen, and a delayed vaccine boost upon vaccine efficacy (VE).MethodsWe immunized 4 groups that each contained 15 healthy, malaria-naive adults. Group 1 received 5 doses of 4.5 x 105 PfSPZ (Days 1, 3, 5, and 7; Week 16). Groups 2, 3, and 4 received 3 doses (Weeks 0, 8, and 16), with Group 2 receiving 9.0 × 105/doses; Group 3 receiving 18.0 × 105/doses; and Group 4 receiving 27.0 × 105 for dose 1 and 9.0 × 105 for doses 2 and 3. VE was assessed by heterologous CHMI after 12 or 24 weeks. Volunteers not protected at 12 weeks were boosted prior to repeat CHMI at 24 weeks.ResultsAt 12...

Research paper thumbnail of Microarray analyses reveal strain-specific antibody responses to Plasmodium falciparum apical membrane antigen 1 variants following natural infection and vaccination

Scientific Reports, 2020

Vaccines based on Plasmodium falciparum apical membrane antigen 1 (AMA1) have failed due to exten... more Vaccines based on Plasmodium falciparum apical membrane antigen 1 (AMA1) have failed due to extensive polymorphism in AMA1. To assess the strain-specificity of antibody responses to malaria infection and AMA1 vaccination, we designed protein and peptide microarrays representing hundreds of unique AMA1 variants. Following clinical malaria episodes, children had short-lived, sequence-independent increases in average whole-protein seroreactivity, as well as strain-specific responses to peptides representing diverse epitopes. Vaccination resulted in dramatically increased seroreactivity to all 263 AMA1 whole-protein variants. High-density peptide analysis revealed that vaccinated children had increases in seroreactivity to four distinct epitopes that exceeded responses to natural infection. A single amino acid change was critical to seroreactivity to peptides in a region of AMA1 associated with strain-specific vaccine efficacy. Antibody measurements using whole antigens may be biased to...

Research paper thumbnail of Dose-Dependent Infectivity of Aseptic, Purified, Cryopreserved Plasmodium falciparum 7G8 Sporozoites in Malaria-Naive Adults

The Journal of Infectious Diseases, 2019

Direct venous inoculation of 3.2 × 103 aseptic, purified, cryopreserved, vialed Plasmodium falcip... more Direct venous inoculation of 3.2 × 103 aseptic, purified, cryopreserved, vialed Plasmodium falciparum (Pf) strain NF54 sporozoites, PfSPZ Challenge (NF54), has been used for controlled human malaria infection (CHMI) in the United States, 4 European countries, and 6 African countries. In nonimmune adults, this results in 100% infection rates. We conducted a double-blind, randomized, dose-escalation study to assess the infectivity of the 7G8 clone of Pf (PfSPZ Challenge [7G8]). Results showed dose-dependent infectivity from 43% for 8 × 102 PfSPZ to 100% for 4.8 × 103 PfSPZ. PfSPZ Challenge (7G8) will allow for more complete assessment by CHMI of antimalarial vaccines and drugs.

Research paper thumbnail of The Controlled Human Malaria Infection Experience at the University of Maryland

The American Journal of Tropical Medicine and Hygiene, 2019

Research paper thumbnail of Immunoglobulin G subclass and antibody avidity responses in Malian children immunized with Plasmodium falciparum apical membrane antigen 1 vaccine candidate FMP2.1/AS02A

Research paper thumbnail of Corrigendum: Protection against malaria at 1 year and immune correlates following PfSPZ vaccination

Nature medicine, Jun 7, 2016

Research paper thumbnail of Immunogenomic profile at baseline predicts host susceptibility to clinical malaria

Frontiers in Immunology

IntroductionHost gene and protein expression impact susceptibility to clinical malaria, but the b... more IntroductionHost gene and protein expression impact susceptibility to clinical malaria, but the balance of immune cell populations, cytokines and genes that contributes to protection, remains incompletely understood. Little is known about the determinants of host susceptibility to clinical malaria at a time when acquired immunity is developing.MethodsWe analyzed peripheral blood mononuclear cells (PBMCs) collected from children who differed in susceptibility to clinical malaria, all from a small town in Mali. PBMCs were collected from children aged 4-6 years at the start, peak and end of the malaria season. We characterized the immune cell composition and cytokine secretion for a subset of 20 children per timepoint (10 children with no symptomatic malaria age-matched to 10 children with >2 symptomatic malarial illnesses), and gene expression patterns for six children (three per cohort) per timepoint. ResultsWe observed differences between the two groups of children in the express...

Research paper thumbnail of Gene expression analyses reveal differences in children’s response to malaria according to their age

In Bandiagara, Mali, children experience on average two clinical malaria episodes per season. How... more In Bandiagara, Mali, children experience on average two clinical malaria episodes per season. However, even in the same transmission area, the number of uncomplicated symptomatic infections, and their parasitemia, vary dramatically among children. To examine the factors contributing to these variations, we simultaneously characterized the host and parasite gene expression profiles from 136 children with symptomatic falciparum malaria and analyzed the expression of 9,205 human and 2,484 Plasmodium genes. We used gene expression deconvolution to estimate the relative proportion of immune cells and parasite stages in each sample and to adjust the differential gene expression analyses. Parasitemia explained much of the variation in both host and parasite gene expression and revealed that infections with higher parasitemia had more neutrophils and fewer T cells, suggesting parasitemia-dependent neutrophil recruitment and/or T cell extravasation to secondary lymphoid organs. The child’s a...

Research paper thumbnail of MOESM1 of Immunoglobulin G subclass and antibody avidity responses in Malian children immunized with Plasmodium falciparum apical membrane antigen 1 vaccine candidate FMP2.1/AS02A

Additional file 1. AMA1 IgG subclass titers, total IgG titers, and cytophilic ratios for AMA1 vac... more Additional file 1. AMA1 IgG subclass titers, total IgG titers, and cytophilic ratios for AMA1 vaccine and control groups.

Research paper thumbnail of Additional file 3. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of structural variants. Excel spreadsheet describing structural variants identified i... more Description of structural variants. Excel spreadsheet describing structural variants identified in each of the four PfSPZ strain assemblies.

Research paper thumbnail of MOESM1 of Serologic responses to the PfEMP1 DBL-CIDR head structure may be a better indicator of malaria exposure than those to the DBL-Îą tag

Additional file 1. Sequences, classifications, and domains of the PfEMP1 antigens used to populat... more Additional file 1. Sequences, classifications, and domains of the PfEMP1 antigens used to populate the custom protein microarray.

Research paper thumbnail of Additional file 4. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Description of var exon 1 sequences. Excel spreadsheet describing var exon 1 sequences recovered ... more Description of var exon 1 sequences. Excel spreadsheet describing var exon 1 sequences recovered from each of the four PfSPZ strains.

Research paper thumbnail of Additional file 2. of Strains used in whole organism Plasmodium falciparum vaccine trials differ in genome structure, sequence, and immunogenic potential

Supplemental Text, Tables, and Figures. Word document containing supplemental information as cite... more Supplemental Text, Tables, and Figures. Word document containing supplemental information as cited in the main manuscript.

Research paper thumbnail of Malian adults maintain serologic responses to virulent PfEMP1s amid seasonal patterns of fluctuation

Scientific Reports, 2021

Plasmodium falciparumerythrocyte membrane protein-1s (PfEMP1s), diverse malaria proteins expresse... more Plasmodium falciparumerythrocyte membrane protein-1s (PfEMP1s), diverse malaria proteins expressed on the infected erythrocyte surface, play an important role in pathogenesis, mediating adhesion to host vascular endothelium. Antibodies to particular non-CD36-binding PfEMP1s are associated with protection against severe disease. We hypothesized that given lifelongP. falciparumexposure, Malian adults would have broad PfEMP1 serorecognition and high seroreactivity levels during follow-up, particularly to non-CD36-binding PfEMP1s such as those that attach to endothelial protein C receptor (EPCR) and intercellular adhesion molecule-1 (ICAM-1). Using a protein microarray, we determined serologic responses to 166 reference PfEMP1 fragments during a dry and subsequent malaria transmission season in Malian adults. Malian adult sera had PfEMP1 serologic responses throughout the year, with decreased reactivity to a small subset of PfEMP1 fragments during the dry season and increases in reactiv...