Hypoxia restricts the generation of BCG-responsive polycytotoxic T cells.

BackgroundBacillus calmette guerin (BCG) immunization has been associated with a reduction in Mycobacterium tuberculosis (MTB) infection. BCG immunization has been shown to enhance innate immunity. This effect of BCG can be explained by an enhancing effect on innate immunity.ObjectiveThis study aimed to test the following hypotheses: (1) BCG immunization can prevent infection with MTB, (2) prevention of infection occurs via stimulation of NOD2 (nucleotide oligomerization domain) and toll-like receptors 2 (TLR2), and (3) the effect of BCG immunization on prevention of infection with MTB can be enhanced by giving stimulators of NOD2 and TLR2.MethodsTo detect the influence of immunization on infection rates, the ultralow dose (ULD) infection model is used. The infection rate of mice vaccinated with BCG and exposed after 6 weeks to ULD of MTB and unvaccinated mice are compared via cultures of lung homogenates and interferon (IFN) gamma release assay. If a reduced infection rate by BCG immunization is confirmed, the experiment is repeated by giving BCG combined simultaneously or in time sequence with the enhancers of innate immunity murabutide or beta-glycan. The influence of murabutide or beta-glycan alone on infection rates is investigated. To quantify the contribution of innate immunity levels of tumor necrosis factor, IFN gamma expression, histone H3 K4me3 trimethylation, and concentrations of monocytes with features of activation of innate immunity as defined by the Ly6Chigh as well as CD11b positive phenotype in immunized versus unimmunized infected and uninfected mice in the various immunization protocols is compared. The experiments will be repeated with prior application of the inhibitors of epigenetic programming of innate immunity histone methyltransferase inhibitor 5’-deoxy-5’-methylthio-adenosine and histone acetyl transferase inhibitor epigallocatechin-3-gallate. The influence of BCG on innate immunity is further corroborated by a prospective observational study in human infants.ResultsInvestigations of derivatives of muramyl dipeptide (MDP) to enhance early immunity in the C57BL/6 mouse strain (mice aged 7 weeks) by another group used 300 micrograms per mouse of oil-associated 6-0-mycoloyl-N-acetylmuramyl-L-alanyl-D-isoglutamine (mycol-MDP) 50/50 mixed with Freund’s incomplete adjuvant. Comparison of colony-forming unit (CFU) count in the lungs 3 weeks after aerosol challenge with Mycobacterium bovis of groups (n=5) between groups receiving mycol-MDP in oil emulsion (see above) versus controls (n=5) showed a significantly lower CFU count of 94.5 x106 (SD 22.0) in cases versus controls with 204.0 X 106 (SD 77.6). It is important to note that after elimination of T-cells in this model, a reduction of CFU in lungs of mice treated with mycol-MDP persisted albeit without statistical significance, which was possibly related to the small number of animals used.ConclusionsDemonstration of a reduction of MTB infection by enhancement of innate immunity could show a new approach to improving vaccine efficacy against this pathogen.International Registered Report Identifier (IRRID)PRR1-10.2196/13045

Protection against tuberculosis by Bacillus Calmette-Guérin (BCG) vaccination: A historical perspective

Bacillus Calmette-Guerin (BCG) vaccine is the only licensed vaccine for tuberculosis (TB) prevention. Previously, our group demonstrated the vaccine potential of Rv0351 and Rv3628 against Mycobacterium tuberculosis (Mtb) infection by directing Th1-biased CD4+ T cells co-expressing IFN-γ, TNF-α, and IL-2 in the lungs. Here, we assessed immunogenicity and vaccine potential of the combined Ags (Rv0351/Rv3628) formulated in different adjuvants as subunit booster in BCG-primed mice against hypervirulent clinical Mtb strain K (Mtb K). Compared to BCG-only or subunit-only vaccine, BCG prime and subunit boost regimen exhibited significantly enhanced Th1 response. Next, we evaluated the immunogenicity to the combined Ags when formulated with four different types of monophosphoryl lipid A (MPL)-based adjuvants: 1) dimethyldioctadecylammonium bromide (DDA), MPL, and trehalose dicorynomycolate (TDM) in liposome form (DMT), 2) MPL and Poly I:C in liposome form (MP), 3) MPL, Poly I:C, and QS21 in liposome form (MPQ), and 4) MPL and Poly I:C in squalene emulsion form (MPS). MPQ and MPS displayed greater adjuvancity in Th1 induction than DMT or MP did. Especially, BCG prime and subunit-MPS boost regimen significantly reduced the bacterial loads and pulmonary inflammation against Mtb K infection when compared to BCG-only vaccine at a chronic stage of TB disease. Collectively, our findings highlighted the importance of adjuvant components and formulation to induce the enhanced protection with an optimal Th1 response.

Vaccination is considered the most effective strategy for controlling tuberculosis (TB). The existing vaccine, the Bacille Calmette-Guérin (BCG), although partially protective, has a number of limitations. Therefore, there is a need for developing new TB vaccines and several strategies are currently exploited including the use of viral and bacterial delivery vectors. We have previously shown that Lactobacillus plantarum (Lp) producing Ag85B and ESAT-6 antigens fused to a dendritic cell-targeting peptide (referred to as Lp_DC) induced specific immune responses in mice. Here, we analyzed the ability of two Lp-based vaccines, Lp_DC and Lp_HBD (in which the DC-binding peptide was replaced by an HBD-domain directing the antigen to non-phagocytic cells) to activate antigen-presenting cells, induce specific immunity and protect mice from Mycobacterium tuberculosis infection. We tested two strategies: (i) Lp as BCG boosting vaccine (a heterologous regimen comprising parenteral BCG immunization followed by intranasal Lp boost), and (ii) Lp as primary vaccine (a homologous regimen including subcutaneous priming followed by intranasal boost). The results showed that both Lp constructs applied as a BCG boost induced specific cellular immunity, manifested in T cell proliferation, antigen-specific IFN-γ responses and multifunctional T cells phenotypes. More importantly, intranasal boost with Lp_DC or Lp_HBD enhanced protection offered by BCG, as shown by reduced M. tuberculosis counts in lungs. These findings suggest that Lp constructs could be developed as a potential mucosal vaccine platform against mycobacterial infections.

Mycobacterium tuberculosis infection in health care workers has not been adequately studied in developing countries using newer diagnostic tests. To estimate latent tuberculosis infection prevalence in health care workers using the tuberculin skin test (TST) and a whole-blood interferon gamma (IFN-gamma) assay; to determine agreement between the tests; and to compare their correlation with risk factors. A cross-sectional comparison study of 726 health care workers aged 18 to 61 years (median age, 22 years) with no history of active tuberculosis conducted from January to May 2004, at a rural medical school in India. A total of 493 (68%) of the health care workers had direct contact with patients with tuberculosis and 514 (71%) had BCG vaccine scars. Tuberculin skin testing was performed using 1-TU dose of purified protein derivative RT23, and the IFN-gamma assay was performed by measuring IFN-gamma response to early secreted antigenic target 6, culture filtrate protein 10, and a portion of tuberculosis antigen TB7.7. Agreement between TST and the IFN-gamma assay, and comparison of the tests with respect to their association with risk factors. A large proportion of the health care workers were latently infected; 360 (50%) were positive by either TST or IFN-gamma assay, and 226 (31%) were positive by both tests. The prevalence estimates of TST and IFN-gamma assay positivity were comparable (41%; 95% confidence interval [CI], 38%-45% and 40%; 95% CI, 37%-43%, respectively). Agreement between the tests was high (81.4%; kappa = 0.61; 95% CI, 0.56-0.67). Increasing age and years in the health profession were significant risk factors for both IFN-gamma assay and TST positivity. BCG vaccination had little impact on TST and IFN-gamma assay results. Our study showed high latent tuberculosis infection prevalence in Indian health care workers, high agreement between TST and IFN-gamma assay, and similar association between positive test results and risk factors. Although TST and IFN-gamma assay appear comparable in this population, they have different performance and operational characteristics; therefore, the decision to select one test over the other will depend on the population, purpose of testing, and resource availability.

Enhanced and durable protective immune responses induced by a cocktail of recombinant BCG strains expressing antigens of multistage of Mycobacterium tuberculosis

Angiogenesis, formation of new blood vessels, is essential for tumor progression, invasion, and metastasis.1 Vascular endothelial growth factors (VEGFs) and their receptors (VEGFRs) are primary regulators of angiogenesis, coordinating with other angiogenic factors such as fibroblast growth factors (FGFs), hepatic growth factor (HGF), angiopoietins, and Notch-Dll4. Anti-VEGF antibodies (e.g., bevacizumab) and small molecular inhibitors of VEGFRs (e.g., sunitinib and sorafenib) were validated as the first cancer therapeutic agents targeting the tumor microenvironment.1 These anti-angiogenic therapies effectively suppress the growth of solid tumors and are widely used for the treatment of malignant colorectal cancer, some non-small cell lung cancers, hepatocellular carcinoma, kidney cancer, and neuroendocrine tumors. Angiogenesis inhibitors suppress the formation of new tumor vasculature and may normalize existing vasculature, resulting in increased efficacy of combination chemotherapy.2 However, the effectiveness of anti-angiogenic treatments is limited to certain types of cancer. In addition, they may not completely eradicate tumor growth and may elicit malignant progression by, for example, inducing resistance to chemotherapy.3 Thus, the molecular mechanism underlying the elimination of such resistant and refractory cancer cells needs to be elucidated. Following the inhibition of angiogenesis, cancer cells can be exposed to both hypoxia and nutrient starvation, which may stimulate tumor aggressiveness.4 We developed a simple model system to maintain cancer cells under conditions of both hypoxia and nutrient starvation, and demonstrated that long-term hypoxia and nutrient starvation induces tumor aggressiveness.4 Therefore, the tumor microenvironment associated with hypoxia and nutrient starvation may be important in the regulation of tumor progression. However, with the exception of known hypoxia-induced factors, the factors that regulate angiogenesis under conditions of hypoxia and nutrient starvation are unclear. Epigenetic regulation of angiogenesis may play a role, but this has not yet been fully elucidated. Previously, we reported that the histone demethylase JHDM1D is highly expressed in various cancer cells under conditions of nutrient starvation and that subsequent suppression of solid tumor growth was associated with the downregulation of several pro-angiogenic factors such as VEGF-B and angiopoietins.5 Conversely, another histone demethylase JMJD1A stimulated tumor angiogenesis under conditions of hypoxia and nutrient starvation by upregulating the expression of several pro-angiogenic factors, such as angiopoietins, FGFs, and HGF, resulting in increased infiltration of tumor-associated macrophages.4 Importantly, JMJD1A inhibition suppressed tumor growth when used in combination with anti-VEGF (bevacizumab) and anti-VEGFR treatment (sunitinib), possibly by sensitizing the refractory cells of the tumor to anti-angiogenic treatment. This suggests that modification of epigenetic regulators can improve anti-angiogenic therapy.4 The adaptation of cancer cells to tumor microenvironments such as conditions of hypoxia, nutrient deficiency, acidosis, and reactive oxygen species can be achieved via alteration of cancer metabolism and enrichment of cancer stem cells. This is required for tumor progression and metastasis.6,7 The response to oxygen or nutrient deficiency and acidosis can be attained by metabolic alterations to glycolysis (Warburg effect), glutamine metabolism, and other metabolic pathways. Recently, global metabolomic analysis revealed important metabolic pathways in several cancer types. As a result of glucose and glutamine depletion, metabolic pathways other than glycolysis and glutamine metabolism can be utilized under hypoxia and nutrient starvation conditions. Indeed, our preliminary results suggest that histone demethylase JHDM1D may regulate tumor growth and metabolism under conditions of nutrient starvation and may play an important role in tumor aggressiveness.5 Cancer cells, including cancer stem cells, have considerable histological and functional heterogeneity.8 As described above, hypoxia and nutrient starvation induced tumor aggressiveness, at least in part, via epigenetic regulation. Therefore, a hypoxia and nutrient-starved tumor microenvironment may enrich cancer stem cells, thus contributing to tumor aggressiveness and recurrence. In conclusion, strategies to sensitize cells to anti-angiogenic therapies in hypoxic and nutrient-starved tumor microenvironments will potentially prevent tumor recurrence and aggressiveness. (Fig. 1) Figure 1. Schematic regulation of angiogenesis under conditions of hypoxia and nutrient starvation. Tumor tissue induces both hypoxic and nutrient-starved regions. The perivascular region (vascular rich) is rich in both oxygen and nutrients. The ...

Vaccination is an excellent approach to stimulating the host immune response and reducing human morbidity and mortality against microbial infections, such as tuberculosis (TB). Bacillus Calmette–Guerin (BCG) is the most widely administered vaccine in the world and the only vaccine approved by the World Health Organization (WHO) to protect against TB. Although BCG confers “protective” immunity in children against the progression of Mycobacterium tuberculosis (Mtb) infection into active TB, this vaccine is ineffective in protecting adults with active TB manifestations, such as multiple-, extensive-, and total-drug-resistant (MDR/XDR/TDR) cases and the co-existence of TB with immune-compromising health conditions, such as HIV infection or diabetes. Moreover, BCG can cause disease in individuals with HIV infection or other immune compromises. Due to these limitations of BCG, novel strategies are urgently needed to improve global TB control measures. Since live vaccines elicit a broader immune response and do not require an adjuvant, developing recombinant BCG (rBCG) vaccine candidates have received significant attention as a potential replacement for the currently approved BCG vaccine for TB prevention. In this report, we aim to present the latest findings and outstanding questions that we consider worth investigating regarding novel mycobacteria-based live attenuated TB vaccine candidates. We also specifically discuss the important features of two key animal models, mice and rabbits, that are relevant to TB vaccine testing. Our review emphasizes that the development of vaccines that block the reactivation of latent Mtb infection (LTBI) into active TB would have a significant impact in reducing the spread and transmission of Mtb. The results and ideas discussed here are only based on reports from the last five years to keep the focus on recent developments.

Encapsulation is a common strategy among marine invertebrate species. It has been shown that oxygen and food availability independently constrain embryo development during intracapsular development. However, it is unclear how embryos of species with different feeding strategies perceive these two constraints when operating jointly. In the present study, we examined the relative importance of dissolved albumen, as a food source, oxygen condition and their interaction on embryonic growth and the survival of two calyptraeid species, Crepidula coquimbensis and Crepidula fornicata, exhibiting different embryo feeding behaviours (i.e. presence vs absence of intracapsular cannibalism). Two oxygen condition treatments (normoxia and hypoxia) and three albumen concentrations (0, 1 and 2 mg l(-1)) were studied. In addition, albumen intake by embryos was observed using fluorescence microscopy. Our study shows that embryos of both species incorporated dissolved albumen but used a different set of embryonic organs. We observed that embryo growth rates in C. coquimbensis were negatively affected only by hypoxic conditions. Conversely, a combination of low albumen concentration and oxygen availability slowed embryo growth in C. fornicata. These findings suggest that oxygen availability is a limiting factor for the normal embryo development of encapsulated gastropod species, regardless of feeding behaviour or developmental mode. By contrast, the effect of dissolved albumen as an alternative food source on embryo performance may depend on the feeding strategy of the embryos.

Bacillus Calmette-Guérin (BCG) has been used for vaccination against tuberculosis for nearly a century. Here, we analyze immunity induced by a live tuberculosis vaccine candidate, recombinant BCG ΔureC::hly vaccine (rBCG), with proven preclinical and clinical safety and immunogenicity. We pursue in-depth analysis of the endogenous mycobacteria-specific CD4+ T-cell population, comparing the more efficacious rBCG with canonical BCG to determine which T-cell memory responses are prerequisites for superior protection against tuberculosis. rBCG induced higher numbers and proportions of antigen-specific memory CD4+ T cells than BCG, with a CXCR5+CCR7+ phenotype and low expression of the effector transcription factors T-bet and Bcl-6. We found that the superior protection of rBCG, compared with BCG, correlated with higher proportions and numbers of these central memory T cells and of T follicular helper cells associated with specific antibody responses. Adoptive transfer of mycobacteria-specific central memory T cells validated their critical role in protection against pulmonary tuberculosis.

BCG vaccination induces enhanced frequencies of dendritic cells and altered plasma levels of type I and type III interferons in elderly individuals

To compare a RD1-based in-house ELISPOT-interferon-gamma (IFN-gamma) assay with a commercial (T-SPOT.TB) assay for the diagnosis of Mycobacterium tuberculosis (TB) infection and the efficacy of the tuberculin skin test (TST) and ELISPOT assay in detecting latent TB infection (LTBI). Eighty-six subjects (65 household contacts of contagious TB-infected patients, 13 subjects with active or previous TB infection, and 8 with suspected TB infection) were consecutively recruited in the context of a surveillance program. Enrolled subjects underwent the Mantoux TST and two different ELISPOT-IFN-gamma assays: an in-house assay using a pool of selected M. tuberculosis peptides (MTP) and the commercial T-SPOT.TB assay. The in-house and commercial ELISPOT-IFN-gamma assays showed almost complete concordance (99%) in diagnosing acute or LTBI. When comparing the efficacy of the TST with the in-house ELISPOT assay in detecting TB infection, a small agreement was observed (k=0.344, P<0.0001): 36% of the subjects with a positive TST were ELISPOT-MTP negative and 12% with a negative TST were ELISPOT-MTP positive. Furthermore, 78% of the ELISPOT-MTP negative individuals were ELISPOT- Bacillus Calmette-Guérin (BCG) positive, most of whom had received BCG vaccination. Our in-house ELISPOT assay based on a restricted pool of highly selected peptides is equivalent to the commercial T-SPOT.TB assay, is cheaper and is probably not confounded, unlike the TST, by BCG vaccination in our setting.

BCG and protection against Mycobacterium tuberculosis infection

Interferon-γ release assays in tuberculosis contacts: is there a window period?

Tuberculosis (TB) caused by Mycobacterium tuberculosis infection is responsible for the most deaths by a single infectious agent worldwide, with 1.6 million deaths in 2017 alone. The World Health Organization, through its “End TB” strategy, aims to reduce TB deaths by 95% by 2035. In order to reach this goal, a more effective vaccine than the Bacillus Calmette-Guerin (BCG) vaccine currently in use is needed. Subunit TB vaccines are ideal candidates, because they can be used as booster vaccinations for individuals who have already received BCG and would also be safer for use in immunocompromised individuals in whom BCG is contraindicated. However, subunit TB vaccines will almost certainly require formulation with a potent adjuvant. As the correlates of vaccine protection against TB are currently unclear, there are a variety of adjuvants currently being used in TB vaccines in preclinical and clinical development. This review describes the various adjuvants in use in TB vaccines, their effectiveness, and their proposed mechanisms of action. Notably, adjuvants with less inflammatory and reactogenic profiles that can be administered safely via mucosal routes, may have the biggest impact on future directions in TB vaccine design.