Analysing a review for the nature of its content

Based on: M.F. Good et al. (2005), "Development & Regulation of Cell-Mediated Immune Responses to the Blood Stages of Malaria: Implications for Vaccine Research," Annual Review of Immunology, 23, 69-99.

Note that it may help if you download the original article and compare it with what is written in the table.

Introduction

Questions addressed in review

Comments

How big is the malaria problem worldwide? What are the broad challenges in dealing with the problem?

By identifying the significance of the problem, provides a general motivation for doing the review.

Why is the blood stage of the parasite important to understand? What will the foci of the review be?

Again by identifying the significance of a narrower problem, provides a more specific motivation for the foci of the review.

How does infection of a human host by the malaria parasite proceed? (Description of stages.)

It’s not immediately clear why the writers did this other than to provide general background.

In what stages can human immune responses occur and what vaccine strategies has this led to?

Puts this work in context by identifying what approaches to developing vaccine strategies have already been investigated. Previous paragraph was needed as background to this one, though this could have been made more transparent to the reader.

Immune responses to the blood stages

Identifies variant surface antigens (VSAs) as the means for an immune response to infection of a red blood cell (RBC) by a malaria parasite.

Discusses clearance of parasite from body but also how parasite changes to counter this. Gives reason for why it is then a puzzle “why these immune responses cannot rapidly control parasite growth.”

To solve a problem you need to understand the problem. Thus it’s important to first review what’s known about how the body’s immune system responds to the malaria parasite and why the body has such trouble clearing it.

This knowledge is needed to guide a potentially successful strategy for developing a vaccine.

(1) "The critical factor central to regulation of long-term immunity may be the magnitude of the antibody response following vaccination and the ability of long-lived plasma cells to maintain high antibody levels until first infection." (Then an explanation for why they believe this.)

Regulation of Immune Responses to Merozoite Antigens

  • Given that there are many MSPs which trigger immune responses, why focus on MSP1?

  • What's known about MSP1 that's of relevance and where are our gaps in knowledge?

  • Based on what's known, makes a conjecture about what is needed for successful vaccine-induced immunity (1).

Regulation of CMI to Malaria

  • Introduces and reviews another way the body can limit parasite growth and suggests this might also lead to a successful vaccine strategy.

CMI and Vaccine Approaches 

A Low-Dose Vaccine Strategy

  • Having identified a number of problems and difficulties a malaria vaccine has to overcome, puts forward an argument for one way all these problems might be overcome.

Immunopathology

 

Identifies significant potential side effects as being a big problem that also has to be overcome in a successful solution.

Reviews what little is known about this in humans and from mice studies.

"Although CMI responses can kill parasites, rodent studies clearly demonstrate they can cause significant immunopathology, including cerebral malaria, anemia, and weight loss. ... when considering vaccine approaches that induce CMI, strategies must also be considered to minimize the risk of associated pathology."

Severe malaria

 

Discusses in more detail the immunopathologies mentioned in the previous section. This section "review(s) our current understanding of the pathology leading to these conditions and discuss(es) some of the strategies being developed to prevent them." Does this in sub-sections for:

  • Cerebral Malaria

  • Anemia

  • Respiratory Distress Syndrome

Since the approaches being taken to address these problems are common for all, to reduce repetition, they are discussed in a separate section:

  • Approaches to Prevent and Treat Severe Malaria

Introduces three broad approaches and then reviews each in turn.

Again, to solve a problem you first need to understand the problem. And if others are working on solutions, you need to know what they're trying, how well it's working, and what the ongoing problems they are having. (Maybe you can see possible ways to resolve problems with other people's approaches.)

 "At least three broad approaches are being considered to prevent or treat severe malaria: (a) ..., (b) ..., and (c) ..."

Concluding remarks

 

Briefly identifies deficiencies in current knowledge revealed by the review which need to be addressed if progress is to be made. Identifies the most promising current approach.