Vaccine value profile for enterotoxigenic Escherichia coli (ETEC)

The role of vaccines in reducing antimicrobial resistance: A review of potential impact of vaccines on AMR and insights across 16 vaccines and pathogens

In 2019, an estimated 4.95 million deaths were linked to antimicrobial resistance (AMR). Vaccines can prevent many of these deaths by averting both drug-sensitive and resistant infections, reducing antibiotic usage, and lowering the likelihood of developing resistance genes. However, their role in mitigating AMR is currently underutilized. This article builds upon previous research that utilizes Vaccine Value Profiles-tools that assess the health, socioeconomic, and societal impact of pathogens-to inform vaccine development. We analyze the effects of 16 pathogens, covered by Vaccine Value Profiles, on AMR, and explore how vaccines could reduce AMR. The article also provides insights into vaccine development and usage. Vaccines are crucial in lessening the impact of infectious diseases and curbing the development of AMR. To fully realize their potential, vaccines must be more prominently featured in the overall strategy to combat AMR. This requires ongoing investment in research and development of new vaccines and the implementation of additional prevention and control measures to address this global threat effectively.

Regulation of oxidative stress in the intestine of piglets after enterotoxigenic Escherichia coli (ETEC) infection

Enterotoxigenic Escherichia coli (ETEC) is recognized globally as a major gastrointestinal pathogen that impairs intestinal function. ETEC infection can lead to oxidative stress and disruption of intestinal integrity. The present study investigated the mechanism of increased oxidative stress and whether restoration of antioxidant defense could improve intestinal integrity in a piglet model with ETEC infection. Weaned piglets were divided into three groups: control, ETEC-infection and ETEC-infection with antibiotic supplementation. The infection caused a significant elevation of serum diamine oxidase activity and D-lactate levels coupled with a reduced intestinal (mid-jejunum) tight-junction protein expression, suggesting increased intestinal permeability and impaired gut function. The infection also inhibited nuclear factor erythroid 2-related factor 2 (Nrf2) activation, decreased the expression of glutathione synthesizing enzymes, superoxide dismutase-1 (SOD1), and heme oxygenase-1 (HO-1) in the intestine. This led to a decreased antioxidant glutathione level and an increased lipid peroxidation in the intestine and serum, indicating oxidative stress. The infection stimulated the expression of pro-inflammatory cytokines (IL-6, TNF-α). Antibiotic supplementation attenuated oxidative stress, in part, through restoration of glutathione levels and antioxidant enzyme expression in the intestine. Such a treatment enhanced tight-junction protein expression and improved intestinal function. Furthermore, induction of oxidative stress in Caco2 cells by hydrogen peroxide inhibited tight-junction protein expression and stimulated inflammatory cytokine expression. Glutathione supplementation effectively attenuated oxidative stress and restored tight-junction protein expression. These results suggest that downregulation of Nrf2 activation may weaken antioxidant defense and increase oxidative stress in the intestine. Mitigation of oxidative stress can improve intestinal function after infection.

Repeat modules and N-linked glycans define structure and antigenicity of a critical enterotoxigenic E. coli adhesin

Enterotoxigenic Escherichia coli (ETEC) cause hundreds of millions of cases of infectious diarrhea annually, predominantly in children from low-middle income regions. Notably, in children, as well as human volunteers challenged with ETEC, diarrheal severity is significantly increased severity in blood group A (bgA) individuals. EtpA, is a secreted glycoprotein adhesin that functions as a blood group A lectin to promote critical interactions between ETEC and blood group A glycans on intestinal epithelia for effective bacterial adhesion and toxin delivery. EtpA is highly immunogenic resulting in robust antibody responses following natural infection and experimental challenge of human volunteers with ETEC. To understand how EtpA directs ETEC-blood group A interactions and stimulates adaptive immunity, we mutated EtpA, mapped its glycosylation by mass-spectrometry (MS), isolated polyclonal (pAbs) and monoclonal antibodies (mAbs) from vaccinated mice and ETEC-infected human volunteers, and determined structures of antibody-EtpA complexes by cryo-electron microscopy. Both bgA and mAbs that inhibited EtpA-bgA interactions and ETEC adhesion, bound to the C-terminal repeat domain highlighting this region as crucial for ETEC pathogen-host interaction. MS analysis uncovered extensive and heterogeneous N-linked glycosylation of EtpA and cryo-EM structures revealed that mAbs directly engage these unique glycan containing epitopes. Finally, electron microscopy-based polyclonal epitope mapping revealed antibodies targeting numerous distinct epitopes on N and C-terminal domains, suggesting that EtpA vaccination generates responses against neutralizing and decoy regions of the molecule. Collectively, we anticipate that these data will inform our general understanding of pathogen-host glycan interactions and adaptive immunity relevant to rational vaccine subunit design.

A Perspective on the Strategy for Advancing ETVAX®, An Anti-ETEC Diarrheal Disease Vaccine, into a Field Efficacy Trial in Gambian Children: Rationale, Challenges, Lessons Learned, and Future Directions

For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6-18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and immunogenic doses for children, and the possible benefit of a mucosal adjuvant, double mutant labile toxin (dmLT). Considering the promising but still underexplored potential of inactivated whole cells in oral vaccination, we present a perspective compiling key observations from past ETVAX® trials that informed The Gambian trial design. This report will update the trial's status and explore future directions for ETEC vaccine trials. Our aim is to provide not only an update on the most advanced ETEC vaccine candidate but also to offer insights beneficial for the development of other much-needed oral whole-cell vaccines against enteric and other pathogens.