1
|
Fan J, Jin S, Gilmartin L, Toth I, Hussein WM, Stephenson RJ. Advances in Infectious Disease Vaccine Adjuvants. Vaccines (Basel) 2022; 10:1120. [PMID: 35891284 PMCID: PMC9316175 DOI: 10.3390/vaccines10071120] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Vaccines are one of the most significant medical interventions in the fight against infectious diseases. Since their discovery by Edward Jenner in 1796, vaccines have reduced the worldwide transmission to eradication levels of infectious diseases, including smallpox, diphtheria, hepatitis, malaria, and influenza. However, the complexity of developing safe and effective vaccines remains a barrier for combating many more infectious diseases. Immune stimulants (or adjuvants) are an indispensable factor in vaccine development, especially for inactivated and subunit-based vaccines due to their decreased immunogenicity compared to whole pathogen vaccines. Adjuvants are widely diverse in structure; however, their overall function in vaccine constructs is the same: to enhance and/or prolong an immunological response. The potential for adverse effects as a result of adjuvant use, though, must be acknowledged and carefully managed. Understanding the specific mechanisms of adjuvant efficacy and safety is a key prerequisite for adjuvant use in vaccination. Therefore, rigorous pre-clinical and clinical research into adjuvant development is essential. Overall, the incorporation of adjuvants allows for greater opportunities in advancing vaccine development and the importance of immune stimulants drives the emergence of novel and more effective adjuvants. This article highlights recent advances in vaccine adjuvant development and provides detailed data from pre-clinical and clinical studies specific to infectious diseases. Future perspectives into vaccine adjuvant development are also highlighted.
Collapse
Affiliation(s)
- Jingyi Fan
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Shengbin Jin
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Lachlan Gilmartin
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Istvan Toth
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, QLD 4072, Australia
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Waleed M. Hussein
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| | - Rachel J. Stephenson
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia; (J.F.); (S.J.); (L.G.); (I.T.); (W.M.H.)
| |
Collapse
|
2
|
Mohan T, Zhu W, Wang Y, Wang BZ. Applications of chemokines as adjuvants for vaccine immunotherapy. Immunobiology 2017; 223:477-485. [PMID: 29246401 DOI: 10.1016/j.imbio.2017.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
Vaccinations are expected to aid in building immunity against pathogens. This objective often requires the addition of an adjuvant with certain vaccine formulations containing weakly immunogenic antigens. Adjuvants can improve antigen processing, presentation, and recognition, thereby improving the immunogenicity of a vaccine by simulating and eliciting an immune response. Chemokines are a group of small chemoattractant proteins that are essential regulators of the immune system. They are involved in almost every aspect of tumorigenesis, antitumor immunity, and antimicrobial activity and also play a critical role in regulating innate and adaptive immune responses. More recently, chemokines have been used as vaccine adjuvants due to their ability to modulate lymphocyte development, priming and effector functions, and enhance protective immunity. Chemokines that are produced naturally by the body's own immune system could serve as potentially safer and more reliable adjuvant options versus synthetic adjuvants. This review will primarily focus on chemokines and their immunomodulatory activities against various infectious diseases and cancers.
Collapse
Affiliation(s)
- Teena Mohan
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, 100 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Wandi Zhu
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, 100 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Ye Wang
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, 100 Piedmont Ave SE, Atlanta, GA 30303, USA
| | - Bao-Zhong Wang
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, 100 Piedmont Ave SE, Atlanta, GA 30303, USA.
| |
Collapse
|
3
|
Jin Y, Cao C, Li P, Liu X, Huang W, Li C, Ma Q. Boosting immune response to hepatitis B DNA vaccine by coadministration of Prothymosin alpha-expressing plasmid. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2006; 12:1364-9. [PMID: 16339058 PMCID: PMC1317068 DOI: 10.1128/cdli.12.12.1364-1369.2005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
DNA vaccines induce protective humoral and cell-mediated immune responses in several animal models. However, compared to conventional vaccines, DNA vaccines usually induce poor antibody responses. In this study, we report that coadministration of a hepatitis B virus (HBV) DNA vaccine with prothymosin alpha as an adjuvant improves antibody responses to HBV S antigen. We also observed higher seroconversion rates and higher antibody titers. Prothymosin alpha appears to increase the number and affinity of hepatitis B surface antigen-specific, gamma interferon-secreting T cells and to enhance cellular immune response to the PreS2S DNA vaccine. Interestingly, administering the DNA separately from the prothymosin alpha plasmid abrogated the enhancement of DNA vaccine potency. The results suggest that prothymosin alpha may be a promising adjuvant for DNA vaccines.
Collapse
Affiliation(s)
- Yanwen Jin
- P.O. Box 130(8), 27 Taiping Rd., Beijing 100850, China.
| | | | | | | | | | | | | |
Collapse
|
4
|
Cook RF, Cook SJ, Bolin PS, Howe LJ, Zhou W, Montelaro RC, Issel CJ. Genetic immunization with codon-optimized equine infectious anemia virus (EIAV) surface unit (SU) envelope protein gene sequences stimulates immune responses in ponies. Vet Microbiol 2005; 108:23-37. [PMID: 15885929 DOI: 10.1016/j.vetmic.2005.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Revised: 04/05/2005] [Accepted: 04/07/2005] [Indexed: 10/25/2022]
Abstract
In the context of DNA vaccines the native equine infectious anemia virus (EIAV)-envelope gene has proven to be an extremely weak immunogen in horses probably because the RNA transcripts are poorly expressed owing to an unusual codon-usage bias, the possession of multiple RNA splice sites and potential adenosine-rich RNA instability elements. To overcome these problems a synthetic version of sequences encoding the EIAV surface unit (SU) envelope glycoprotein was produced (SYNSU) in which the codon-usage bias was modified to conform to that of highly expressed horse and human genes. In transfected COS-1 cell cultures, the steady state expression levels of SYNSU were at least 30-fold greater than equivalent native SU sequences. More importantly, EIAV-specific humoral and lymphocyte proliferation responses were induced in ponies immunized with a mammalian expression vector encoding SYNSU. However, these immunological responses were unable to confer protection against infection with a virulent EIAV strain.
Collapse
Affiliation(s)
- R Frank Cook
- Department of Veterinary Science, Gluck Equine Research Center, University of Kentucky, Lexington, KY 40546, USA.
| | | | | | | | | | | | | |
Collapse
|
5
|
Manoj S, Babiuk LA, van Drunen Littel-van den Hurk S. Approaches to enhance the efficacy of DNA vaccines. Crit Rev Clin Lab Sci 2004; 41:1-39. [PMID: 15077722 DOI: 10.1080/10408360490269251] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
DNA vaccines consist of antigen-encoding bacterial plasmids that are capable of inducing antigen-specific immune responses upon inoculation into a host. This method of immunization is advantageous in terms of simplicity, adaptability, and cost of vaccine production. However, the entry of DNA vaccines and expression of antigen are subjected to physical and biochemical barriers imposed by the host. In small animals such as mice, the host-imposed impediments have not prevented DNA vaccines from inducing long-lasting, protective humoral, and cellular immune responses. In contrast, these barriers appear to be more difficult to overcome in large animals and humans. The focus of this article is to summarize the limitations of DNA vaccines and to provide a comprehensive review on the different strategies developed to enhance the efficacy of DNA vaccines. Several of these strategies, such as altering codon bias of the encoded gene, changing the cellular localization of the expressed antigen, and optimizing delivery and formulation of the plasmid, have led to improvements in DNA vaccine efficacy in large animals. However, solutions for increasing the amount of plasmid that eventually enters the nucleus and is available for transcription of the transgene still need to be found. The overall conclusions from these studies suggest that, provided these critical improvements are made, DNA vaccines may find important clinical and practical applications in the field of vaccination.
Collapse
Affiliation(s)
- Sharmila Manoj
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
| | | | | |
Collapse
|
6
|
Zheng J, Si L, Song J, Sun X, Yu J, Wang Y. Enhanced immune response to DNA-based HPV16L1 vaccination by costimulatory molecule B7-2. Antiviral Res 2003; 59:61-5. [PMID: 12834862 DOI: 10.1016/s0166-3542(03)00031-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We have investigated whether co-injection of DNA encoding the costimulatory molecule B7-2 augments immune response to the major capsid protein L1 of the high-risk human papillomavirus type 16 (HPV16L1). While immunoglobulin G (IgG) specific to HPV16L1 was detected in sera from mice injected intramuscularly with pcDNA-L1 that encodes HPV16L1, a significantly increased level of IgG was found in sera from mice immunised with pcDNA-L1 in conjunction with pLXHDmB7-2 DNA. Levels of IgG in the anti-sera were correlated with the inhibitory activity of the murine erythrocyte hemagglutination caused by the virus-like particles (VLP) and the binding of VLP to HeLa cells. Moreover, splenic cells isolated from mice co-injected with pLXHDmB7-2 had stronger proliferation and more IFN-gamma producing T cells (CD4(+) and CD8(+)) when stimulated with HPV16 VLP compared with cells from mice that had received pcDNA-L1 alone and mice of the control groups. Furthermore, in footpad swelling test, mice co-immunised with pLXHDmB7-2 had greater skin thickness over those immunised with pcDNA-L1 alone or control mice. We conclude that co-injection of DNA encoding B7-2 can enhance both humoral and cellular immune responses elicited by DNA-based vaccination against HPV16 infection in mice.
Collapse
Affiliation(s)
- Jin Zheng
- Institute for Cancer Research, College of Life Science and Technology, Xi'an Jiaotong University, 710061, Xi'an, PR China
| | | | | | | | | | | |
Collapse
|
7
|
Egan MA, Israel ZR. The use of cytokines and chemokines as genetic adjuvants for plasmid DNA vaccines. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1529-1049(02)00051-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
8
|
Liu LJ, Watabe S, Yang J, Hamajima K, Ishii N, Hagiwara E, Onari K, Xin KQ, Okuda K. Topical application of HIV DNA vaccine with cytokine-expression plasmids induces strong antigen-specific immune responses. Vaccine 2001; 20:42-8. [PMID: 11567744 DOI: 10.1016/s0264-410x(01)00324-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The topical application of DNA vaccine to the skin is a useful method of immunization because of its simplicity, painlessness and economy. But the immune responses that it elicits are relatively low. In this study, we administered human immunodeficiency virus type-1 (HIV-1) DNA vaccine with cytokine-expressing plasmids to the skin of mice by a new topical application technique involving prior elimination of keratinocytes using fast-acting adhesive. Our results revealed that the topical application of HIV-1 DNA vaccine induced high levels of both humoral and cell-mediated immune activity against HIV-1 envelope antigen. Co-administration of the DNA vaccine with cytokine expression plasmids of IL-12 and granulocyte-macrophage colony-stimulating factor (GM-CSF) by this new method raised the levels of both the HIV-specific cytotoxic T lymphocyte (CTL) response and delayed-type hypersensitivity (DTH) and facilitated the induction of substantial immune responses by DNA vaccine. Skin biopsy sections, thus, immunized showed significant increases of S-100 protein-positive dendritic cells (DCs). These results suggest that the topical application method described here is an efficient route of DNA vaccine administration and that the immune response may be induced by DNA plasmids taken in by DCs, Langerhans cells (LCs), or others such as antigen-presenting cells. This new topical application is likely to be of benefit in clinical use.
Collapse
MESH Headings
- AIDS Vaccines/administration & dosage
- AIDS Vaccines/immunology
- Administration, Cutaneous
- Animals
- Biomarkers
- Biopsy
- Dermabrasion
- Drug Evaluation, Preclinical
- Enzyme-Linked Immunosorbent Assay
- Female
- Gene Products, rev/administration & dosage
- Gene Products, rev/genetics
- Gene Products, rev/immunology
- Granulocyte-Macrophage Colony-Stimulating Factor/genetics
- HIV Antibodies/biosynthesis
- HIV Antigens/genetics
- HIV Antigens/immunology
- HIV Envelope Protein gp120/administration & dosage
- HIV Envelope Protein gp120/genetics
- HIV Envelope Protein gp120/immunology
- HIV Envelope Protein gp160/administration & dosage
- HIV Envelope Protein gp160/genetics
- HIV Envelope Protein gp160/immunology
- HIV-1/genetics
- HIV-1/immunology
- Hypersensitivity, Delayed/immunology
- Immunity, Cellular
- Interleukin-12/genetics
- Langerhans Cells/immunology
- Mice
- Mice, Inbred BALB C
- Peptide Fragments/administration & dosage
- Peptide Fragments/genetics
- Peptide Fragments/immunology
- Plasmids/administration & dosage
- Plasmids/genetics
- Recombinant Fusion Proteins/genetics
- S100 Proteins/analysis
- Skin/immunology
- Skin/pathology
- T-Lymphocytes, Cytotoxic/immunology
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/immunology
- rev Gene Products, Human Immunodeficiency Virus
Collapse
Affiliation(s)
- L J Liu
- Department of Bacteriology, School of Medicine, Yokohama City University, 236-0004, Yokohama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Affiliation(s)
- H L Robinson
- Yerkes Regional Primate Research Center, Emory University, Atlanta, Georgia 30322, USA
| | | |
Collapse
|
10
|
Abstract
The relatively low efficacy of DNA vaccines in inducing immune responses, especially in large animal species and humans, has impaired their practical use. Despite considerable effort expended on improving DNA vaccine delivery, only minute amounts of Ag are available for immune induction following DNA vaccination. Two complementary strategies have been used to improve and modulate the immune response induced by DNA vaccines: (i) supplementing DNA vaccines with plasmids encoding cytokines and (ii) targeting the Ag encoded by DNA vaccine through genetically fusing the Ag to molecules binding cell surface receptors. This paper reviews recent progress in these two areas and possible mechanisms responsible for the observed effects.
Collapse
Affiliation(s)
- J Y Scheerlinck
- Centre for Animal Biotechnology, The University of Melbourne, Victoria 3010, Melbourne, Australia.
| |
Collapse
|
11
|
Arai H, Xin KQ, Hamajima K, Lu Y, Watabe S, Takahashi T, Toda S, Okuda K, Kudoh I, Suzuki M, Okuda K. 8 Br-cAMP enhances both humoral and cell-mediated immune responses induced by an HIV-1 DNA vaccine. Gene Ther 2000; 7:694-702. [PMID: 10800093 DOI: 10.1038/sj.gt.3301145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
From a series of preclinical studies and animal experiments, we have been able to demonstrate that DNA vaccines are a promising tool in strategies for protecting hosts from a variety of infectious diseases. Since the promoter activity of the human cytomegalovirus immediate-early promoter/ enhancer (CMV promoter) is known to be responsive to an elevation in the level of intracellular cAMP, we hypothesized that use of cAMP analogue (8-Bromo adenosine 3'5'-cyclic monophosphate, 8 Br-cAMP) would increase the level of transgene expression supported by the CMV, and enhance the ability of DNA vaccines to evoke an immune response against the transgene product in vivo. To evaluate this hypothesis, immune responses against HIV-1 envelope protein, gp160, an immunogenic HIV-1 component expressed under the control of the CMV promoter, were evaluated in BALB/c mice with or without stimulation by 8 Br-cAMP. DNA vaccine with 8 Br-cAMP was intramuscularly (i.m.) or intranasally (i.n.) administered to BALB/c mice twice on days 0 and 14. Regardless of which route was used, the combination increased the serum IgG antibody (Ab) titer, HIV-1-specific cytotoxic T lymphocyte (CTL) activity and the delayed-type hypersensitivity (DTH) response, compared with the effect of using the vaccine alone. When administered via the i.n. route, the combination also remarkably increased the titer of secretory IgA (sIgA). Moreover, it induced increased production of interferon-gamma with reduction in IL-4 synthesis, and decreased the ratio of serum IgG1/IgG2a. However, these enhancements were not observed when 8 Br-cAMP was coadministered with peptide vaccine or protein antigen. These data suggest that 8 Br-cAMP is able to enhance both humoral and cellular immune responses induced by the DNA vaccine. The induction of T helper type 1 (Th1) immunity against HIV-1 was also enhanced by coadministration of 8 Br-cAMP. A CAT assay study demonstrated that the adjuvant effect of 8 Br-cAMP may be due to the activation of the CMV promoter in the DNA vaccine. The virus challenge experiment in a mouse influenza model also proved our hypothesis.
Collapse
MESH Headings
- 8-Bromo Cyclic Adenosine Monophosphate/therapeutic use
- Administration, Intranasal
- Animals
- Combined Modality Therapy
- Cytomegalovirus/genetics
- Dose-Response Relationship, Drug
- Genetic Therapy/methods
- Genetic Vectors/administration & dosage
- HIV Envelope Protein gp160/genetics
- Hypersensitivity, Delayed/drug therapy
- Hypersensitivity, Delayed/immunology
- Immunoglobulin G/analysis
- Injections, Intramuscular
- Mice
- Mice, Inbred BALB C
- Orthomyxoviridae Infections/immunology
- Promoter Regions, Genetic
- T-Lymphocytes, Cytotoxic/drug effects
- T-Lymphocytes, Cytotoxic/immunology
- Vaccines, DNA/therapeutic use
Collapse
Affiliation(s)
- H Arai
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Kusakabe K, Xin KQ, Katoh H, Sumino K, Hagiwara E, Kawamoto S, Okuda K, Miyagi Y, Aoki I, Nishioka K, Klinman D, Okuda K. The timing of GM-CSF expression plasmid administration influences the Th1/Th2 response induced by an HIV-1-specific DNA vaccine. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 164:3102-11. [PMID: 10706700 DOI: 10.4049/jimmunol.164.6.3102] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The mechanism of immune activation induced by a plasmid-encoding GM-CSF (pGM-CSF), administered in combination with a DNA vaccine encoding the envelope of HIV, was studied. Injecting pGM-CSF i.m. into mice 3 days before DNA vaccination primarily induced a Th2 response. Simultaneous administration of the DNA vaccine plus pGM-CSF activated both a Th1 and a Th2 response. When the plasmid was injected 3 days after DNA vaccination, enhancement of Th1 immunity predominated. These results suggest that the timing of cytokine expression determines the phenotype of the resultant Th response. After 3 days of pGM-CSF injection, the increased percentages of CD11c+, CD8+ cells were observed in the regional lymph nodes. In addition, many infiltrated cells, including S-100 protein-positive cells, were found in the pGM-CSF-injected tissue. The importance of these S-100+ cells or both CD8+ and CD11c+ cells, especially that of dendritic cells (DCs), was also studied. DCs derived from bone marrow and cultured in RPMI 1640 medium containing IL-4 and GM-CSF were incubated with DNA vaccine and then transferred into naive mice. Mice receiving DCs showed strong HIV-1-specific Th2 immune responses. Our results suggest that DCs play important roles in the activation or modification of the Th2-type immune response induced by DNA vaccination.
Collapse
Affiliation(s)
- K Kusakabe
- Departments of Bacteriology, Internal Medicine, and Pathology, YokohamaCity University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kato H, Bukawa H, Hagiwara E, Xin KQ, Hamajima K, Kawamoto S, Sugiyama M, Sugiyama M, Noda E, Nishizaki M, Okuda K. Rectal and vaginal immunization with a macromolecular multicomponent peptide vaccine candidate for HIV-1 infection induces HIV-specific protective immune responses. Vaccine 2000; 18:1151-60. [PMID: 10649615 DOI: 10.1016/s0264-410x(99)00385-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
An effective vaccine for human immunodeficiency virus (HIV) is needed to stimulate the immune response of the genital mucus to prevent mucosal transmission of the virus. We have developed a macromolecular multicomponent peptide vaccine candidate, VC1. Both rectal and vaginal immunization of VC1 mixed with cholera toxin (CT) induced HIV-1-specific IgA antibody in mouse fecal extract solution and vaginal wash. These antibody productions were enhanced by the combination with IL-4 or GM-CSF expressing plasmids. Either fecal extract or vaginal wash solution from immunized mice inhibited production of HIV-1IIIB p24 protein. The mononuclear cells from spleen, intestinal lymph nodes, or Peyer's patches from VC1- and CT-immunized mice released IFN-gamma or IL-4, when these cells were co-cultured with VC1 antigen. In addition, the regional lymphoid cells from rectal and vaginal region of mice immunized with VC1 and CT also elicited a substantial level of HIV-1-specific cytotoxic T cell (CTL) response. This CTL response was enhanced by the addition of IL-12 expressing plasmid. Our results clearly demonstrated that both rectal and vaginal immunization could induce systemic and mucosal immunities specific for HIV-1.
Collapse
Affiliation(s)
- H Kato
- Department of Bacteriology, Yokohama City University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Wang S, Liu X, Fisher K, Smith JG, Chen F, Tobery TW, Ulmer JB, Evans RK, Caulfield MJ. Enhanced type I immune response to a hepatitis B DNA vaccine by formulation with calcium- or aluminum phosphate. Vaccine 2000; 18:1227-35. [PMID: 10649624 DOI: 10.1016/s0264-410x(99)00391-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DNA vaccines induce protective humoral and cell-mediated immune responses in several animal models. When compared with conventional vaccines, however, DNA vaccines often induce lower antibody titers. We have now found that formulation of a DNA vaccine encoding hepatitis B surface antigen with calcium- or aluminum phosphate adjuvants can increase antibody titers by 10-100-fold and decrease the immunogenic dose of DNA by 10-fold. Furthermore, boosting an HBs protein-primed response with the adjuvanted DNA vaccine resulted in a dramatic increase in the HBs-specific IgG2a response reflecting a shift towards a TH1 response. The mechanism by which aluminum phosphate exerts its adjuvant effect is not through increased expression of HBsAg in vivo; rather, the adjuvant appears to increase the number and affinity of HBs peptide antigen-specific IFN-gamma and IL-2 secreting T cells.
Collapse
Affiliation(s)
- S Wang
- Department of Virus & Cell Biology, Merck Research Labs, West Point, PA 19486, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ihata A, Watabe S, Sasaki S, Shirai A, Fukushima J, Hamajima K, Inoue J, Okuda K. Immunomodulatory effect of a plasmid expressing CD40 ligand on DNA vaccination against human immunodeficiency virus type-1. Immunology 1999; 98:436-42. [PMID: 10583605 PMCID: PMC2326951 DOI: 10.1046/j.1365-2567.1999.00879.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CD40 ligand is a costimulatory molecule which acts a potent immunomodulator. We found the mice inoculated with human CD40 ligand expression plasmid (pMEhCD40L) combined with human immunodeficiency virus type-1 (HIV-1) DNA vaccine exhibited both humoral and cellular antigen-specific immunological enhancement. The expression of hCD40L induced predominantly antigen-specific immunoglobulin G (IgG) antibody response while it failed to induce mucosal IgA response. Delayed-type hypersensitivity (DTH) and cytotoxic T lymphocyte (CTL) activity were induced in a dose-dependent manner. Examination of the relative levels of the two IgG subclasses showed that co-injection of pMEhCD40L enhanced IgG2a response without suppressing IgG1 response. Similarly, the expression of pMEhCD40L enhanced not only T helper 1 (Th1)- but also Th2-type cytokine production. In conclusion, co-inoculation of pMEhCD40L with DNA vaccine was shown to be a useful way to enhance CTL responses without suppressing the humoral immune response in acquired immune deficiency syndrome (AIDS) patients.
Collapse
Affiliation(s)
- A Ihata
- Department of Bacteriology, Yokohama City University School of Medicine, Japan
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ulmer JB, DeWitt CM, Chastain M, Friedman A, Donnelly JJ, McClements WL, Caulfield MJ, Bohannon KE, Volkin DB, Evans RK. Enhancement of DNA vaccine potency using conventional aluminum adjuvants. Vaccine 1999; 18:18-28. [PMID: 10501231 DOI: 10.1016/s0264-410x(99)00151-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The immunogenicity and protective efficacy of DNA vaccines have been amply demonstrated in numerous animal models of infectious disease. However, the feasibility of DNA vaccines for human use is not yet known. In order to investigate potential means of increasing the potency of DNA vaccines, conventional adjuvants such as aluminum salts were tested. Coadministration of these adjuvants with DNA vaccines substantially enhanced the ability of these vaccines to induce antibody responses up to 100-fold in mice and guinea pigs, and 5-10-fold in non-human primates. Effective formulations had no demonstrable effect on the levels of antigen expression in situ and consisted of adjuvants that did not form complexes with the plasmid DNA; rather they exerted their effects on antigen after expression in situ. Therefore, the potency of DNA vaccines both in laboratory rodents and in non-human primates can be substantially increased by simple formulation with conventional aluminum adjuvants.
Collapse
Affiliation(s)
- J B Ulmer
- Department of Virus & Cell Biology, Merck Research Laboratories, West Point, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Xin KQ, Lu Y, Hamajima K, Fukushima J, Yang J, Inamura K, Okuda K. Immunization of RANTES expression plasmid with a DNA vaccine enhances HIV-1-specific immunity. Clin Immunol 1999; 92:90-6. [PMID: 10413656 DOI: 10.1006/clim.1999.4730] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cytokines play important roles in regulating immune response. This study evaluated the adjuvant effect of an expression plasmid encoding RANTES (regulated on activation normal T-cell expressed and secreted) chemokine on the immunity induced by a DNA vaccine. This vaccine consists of expression plasmids encoding the env and rev genes of human immunodeficiency virus type 1 (HIV-1). DNA vaccination with RANTES plasmid induced significantly higher titers of serum HIV-1-specific IgG and IgG2a antibodies than DNA vaccination alone on both intramuscular and intranasal immunization. This combination also increased HIV-1-specific cytotoxic T lymphocyte activity and delayed-type hypersensitivity. Intranasal immunization induced a higher titer of fecal secretory IgA antibody than intramuscular immunization. These results demonstrate that coadministration of RANTES plasmid dominantly induced HIV-1-specific cell-mediated immunity.
Collapse
MESH Headings
- Adjuvants, Immunologic
- Animals
- Antibodies, Viral/immunology
- Antibody Formation
- Antibody Specificity
- Chemokine CCL5/immunology
- Female
- HIV-1/immunology
- Histiocytes/chemistry
- Histiocytes/cytology
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/pathology
- Hypersensitivity, Delayed/virology
- Immunity, Cellular/immunology
- Lymphocytes/chemistry
- Lymphocytes/cytology
- Mice
- Mice, Inbred BALB C
- Muscle, Skeletal/cytology
- Vaccines, DNA/chemistry
- Vaccines, DNA/immunology
Collapse
Affiliation(s)
- K Q Xin
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, 236, Japan
| | | | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- S Sasaki
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | | | | |
Collapse
|
19
|
Alarcon JB, Waine GW, McManus DP. DNA vaccines: technology and application as anti-parasite and anti-microbial agents. ADVANCES IN PARASITOLOGY 1999; 42:343-410. [PMID: 10050276 DOI: 10.1016/s0065-308x(08)60152-9] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
DNA vaccines have been termed The Third Generation of Vaccines. The recent successful immunization of experimental animals against a range of infectious agents and several tumour models of disease with plasmid DNA testifies to the powerful nature of this revolutionary approach in vaccinology. Among numerous advantages, a major attraction of DNA vaccines over conventional vaccines is that they are able to induce protective cytotoxic T-cell responses as well as helper T-cell and humoral immunity. Here we review the current state of nucleic acid vaccines and cover a wide range of topics including delivery mechanisms, uptake and expression of plasmid DNA, and the types of immune responses generated. Further, we discuss safety issues, and document the use of nucleic acid vaccines against viral, bacterial and parasitic diseases, and cancer. The early potential promise of DNA vaccination has been fully substantiated with recent, exciting developments including the movement from testing DNA vaccines in laboratory models to non-human primates and initial human clinical trials. These advances and the emerging voluminous literature on DNA vaccines highlight the rapid progress that has been made in the DNA immunization field. It will be of considerable interest to see whether the progress and optimism currently prevailing can be maintained, and whether the approach can indeed fulfil the medical and commerical promise anticipated.
Collapse
Affiliation(s)
- J B Alarcon
- Molecular Parasitology Unit, Australian Centre for International and Tropical Health and Nutrition, Queensland Institute of Medical Research, Bancroft Centre, Herston, Australia
| | | | | |
Collapse
|
20
|
Lu Y, Xin KQ, Hamajima K, Tsuji T, Aoki I, Yang J, Sasaki S, Fukushima J, Yoshimura T, Toda S, Okada E, Okuda K. Macrophage inflammatory protein-1alpha (MIP-1alpha) expression plasmid enhances DNA vaccine-induced immune response against HIV-1. Clin Exp Immunol 1999; 115:335-41. [PMID: 9933462 PMCID: PMC1905150 DOI: 10.1046/j.1365-2249.1999.00793.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CD8+ cell-secreted CC-chemokines, MIP-1alpha, and MIP-beta have recently been identified as factors which suppress HIV. In this study we co-inoculated MIP-1alpha expression plasmid with a DNA vaccine constructed from HIV-1 pCMV160IIIB and pcREV, and evaluated the effect of the adjuvant on HIV-specific immune responses following intramuscular and intranasal immunization. The levels of both cytotoxic T lymphocyte (CTL) activity and DTH showed that HIV-specific cell-mediated immunity (CMI) was significantly enhanced by co-inoculation of the MIP-1alpha expression plasmid with the DNA vaccine compared with inoculation of the DNA vaccine alone. The HIV-specific serum IgG1/IgG2a ratio was significantly lowered when the plasmid was co-inoculated in both intramuscular and intranasal routes, suggesting a strong elicitation of the T helper (Th) 1-type response. When the MIP-1alpha expression plasmid was inoculated intramuscularly with the DNA vaccine, an infiltration of mononuclear cells was observed at the injection site. After intranasal administration, the level of mucosal secretory IgA antibody was markedly enhanced. These findings demonstrate that MIP-1alpha expression plasmid inoculated together with DNA vaccine acts as a strong adjuvant for eliciting Th1-derived immunity.
Collapse
MESH Headings
- AIDS Vaccines/genetics
- AIDS Vaccines/immunology
- AIDS Vaccines/pharmacology
- Adjuvants, Immunologic
- Animals
- Chemokine CCL3
- Chemokine CCL4
- Drug Synergism
- Drug Therapy, Combination
- Female
- Gene Products, rev/genetics
- Gene Products, rev/immunology
- HIV Antibodies/blood
- HIV Envelope Protein gp160/genetics
- HIV Envelope Protein gp160/immunology
- HIV Infections/prevention & control
- HIV-1/immunology
- Immunity, Cellular
- Macrophage Inflammatory Proteins/genetics
- Macrophage Inflammatory Proteins/immunology
- Macrophage Inflammatory Proteins/pharmacology
- Mice
- Mice, Inbred BALB C
- T-Lymphocytes, Cytotoxic
- Vaccines, DNA/immunology
- Vaccines, DNA/pharmacology
- rev Gene Products, Human Immunodeficiency Virus
Collapse
Affiliation(s)
- Y Lu
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
DNA vaccines, with which the antigen is synthesized in vivo after direct introduction of its encoding sequences, offer a unique method of immunization that may overcome many of the deficits of traditional antigen-based vaccines. By virtue of the sustained in vivo antigen synthesis and the comprised stimulatory CpG motifs, plasmid DNA vaccines appear to induce strong and long-lasting humoral (antibodies) and cell-mediated (T-help, other cytokine functions and cytotoxic T cells) immune responses without the risk of infection and without boost. Other advantages over traditional antigen-containing vaccines are their low cost, the relative ease with which they are manufactured, their heat stability, the possibility of obtaining multivalent vaccines and the rapid development of new vaccines in response to new strains of pathogens. The antigen-encoding DNA may be in different forms and formulations, and may be introduced into cells of the body by numerous methods. To date, animal models have shown the possibility of producing effective prophylactic DNA vaccines against numerous viruses as well as other infectious pathogens. The strong cellular responses also open up the possibility of effective therapeutic DNA vaccines to treat chronic viral infections.
Collapse
Affiliation(s)
- H L Davis
- Loeb Research Institute, Ottawa Civic Hospital, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | | |
Collapse
|
22
|
Affiliation(s)
- Adam. D. Cohen
- Department of PathologyLaboratory MedicineUniversity of Pennsylvania Philadelphia Pennsylvania 19104 USA
| | - Jean D. Boyer
- Department of PathologyLaboratory MedicineUniversity of Pennsylvania Philadelphia Pennsylvania 19104 USA
| | - David B. Weiner
- Department of PathologyLaboratory MedicineUniversity of Pennsylvania Philadelphia Pennsylvania 19104 USA
| |
Collapse
|
23
|
Hamajima K, Sasaki S, Fukushima J, Kaneko T, Xin KQ, Kudoh I, Okuda K. Intranasal administration of HIV-DNA vaccine formulated with a polymer, carboxymethylcellulose, augments mucosal antibody production and cell-mediated immune response. CLINICAL IMMUNOLOGY AND IMMUNOPATHOLOGY 1998; 88:205-10. [PMID: 9714699 DOI: 10.1006/clin.1998.4566] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We previously reported that intramuscular (i.m.) immunization of DNA vaccine encoding human immunodeficiency virus type 1 (HIV-1)IIIB env and rev genes alone or in combination with appropriate adjuvant induces substantial and enhanced immune response against HIV-1. In the present study, we examined whether a polymer, low-viscosity carboxymethylcellulose sodium salt (CMCS-L), has an adjuvant effect on immune response induced by DNA vaccination. BALB/c mice were immunized with HIV-DNA vaccine formulated with CMCS-L via the intranasal (i.n.) and i.m. routes. The combination with the polymer elicited higher levels of antigen-specific serum IgG and fecal IgA antibodies than DNA vaccine alone. For cell-mediated immunity, HIV-specific delayed-type hypersensitivity response and cytotoxic T lymphocyte activity were measured by the footpad-swelling test and the 51Cr-release assay, respectively. Both were enhanced by the combination with CMCS-L via i.n. and i.m. inoculation. Cytokine analysis in culture media of bulk splenocytes harvested from immunized animals showed higher levels of IL-4 production in i.n. -immunized mice compared with i.m.-immunized mice. Nevertheless, the increased IFN-gamma production resulting from the combination with CMCS-L was observed only in i.n.-immunized mice. These data indicate that i.n. immunization of HIV-DNA vaccine formulated with CMCS-L enhances HIV-specific mucosal antibody (Ab) and systemic Ab and cell-mediated immune response.
Collapse
MESH Headings
- AIDS Vaccines/immunology
- AIDS Vaccines/pharmacology
- Adjuvants, Immunologic/pharmacology
- Administration, Intranasal
- Animals
- Antibodies/blood
- Carboxymethylcellulose Sodium/pharmacology
- Cells, Cultured
- Female
- HIV/genetics
- HIV/immunology
- Hypersensitivity, Delayed
- Immunity, Cellular/drug effects
- Immunity, Mucosal/drug effects
- Immunoglobulin G/classification
- Injections, Intramuscular
- Interferon-gamma/biosynthesis
- Interleukin-4/biosynthesis
- Mice
- Mice, Inbred BALB C
- Polymers/pharmacology
- Spleen/cytology
- Spleen/immunology
- Spleen/metabolism
- Titrimetry
- Vaccines, DNA/immunology
- Vaccines, DNA/pharmacology
Collapse
Affiliation(s)
- K Hamajima
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, 236, Japan
| | | | | | | | | | | | | |
Collapse
|
24
|
Price P, Baxter AG, Allcock RN, Papadimitriou JM. Factors influencing the effects of murine cytomegalovirus on the pancreas. Eur J Clin Invest 1998; 28:546-53. [PMID: 9726035 DOI: 10.1046/j.1365-2362.1998.00314.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND As human cytomegalovirus (HCMV) infections are implicated in insulin-dependent diabetes mellitus (IDDM), the effects of murine (M)CMV infection of inbred mice on the pancreas are of interest. RESULTS Inflammation and periacinar oedema peaked on day 3 and were replaced by a focal inflammation, but infected cells were rare. The islets were spared in C57BL mice. Insulitis normally seen in non-obese diabetic (NOD) mice was accelerated, but infected NOD mice did not become glycosuric. Isotypes of total and autoreactive antibodies suggested a shift to a Th 1 response (IgG2a) in all MCMV-infected mice. MCMV-induced pancreatitis was not affected by MHC genes but was similar or less severe in BALB/c mice. As these lack the Cmv1 gene, which provides a protective natural killer (NK) cell response in C57BL congenic mice, the C57BL background may carry a pancreatitis susceptibility gene able to counter NK-mediated restriction of viral replication. Consistently, congenic mice expressing Cmvl on a BALB/c background did not display pancreatitis, unless depleted of NK cells. In vivo treatment with soluble cytokine receptors suggested that interleukin 1 (IL-1) and/or tumour necrosis factor alpha contribute to acinar necrosis in C57BL mice.
Collapse
Affiliation(s)
- P Price
- Royal Perth Hospital, Perth, Australia.
| | | | | | | |
Collapse
|
25
|
Abstract
Vaccination with attenuated or killed microbes, purified or recombinant subunit proteins and synthetic peptides is often hampered by toxicity, the presence of infectious agents, weak immune responses and prohibiting costs, especially in the developing world. Such problems may be circumvented by genetic immunization which has recently emerged as an attractive alternative to conventional vaccines. Numerous studies have already shown that immunization of experimental animals with plasmid DNA encoding antigens from a wide spectrum of bacteria, viruses, protozoa and cancers leads to protective humoral and cell-mediated immunity. This review deals with the background and progress made so far with DNA vaccines and their theoretical and practical advantages as well as potential risks, discusses proposed mechanisms of DNA transfection of cells and induction of immune responses to the produced vaccine antigen, and evaluates strategies for the control and optimization of such responses.
Collapse
Affiliation(s)
- G Gregoriadis
- Centre for Drug Delivery Research, The School of Pharmacy, London, UK.
| |
Collapse
|
26
|
Sasaki S, Hamajima K, Fukushima J, Ihata A, Ishii N, Gorai I, Hirahara F, Mohri H, Okuda K. Comparison of intranasal and intramuscular immunization against human immunodeficiency virus type 1 with a DNA-monophosphoryl lipid A adjuvant vaccine. Infect Immun 1998; 66:823-6. [PMID: 9453648 PMCID: PMC107976 DOI: 10.1128/iai.66.2.823-826.1998] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We compared immune responses to intranasal and intramuscular DNA vaccinations against human immunodeficiency virus type 1 with monophosphoryl lipid A (MPL) used as an adjuvant. Both routes of vaccination resulted in similar levels of cell-mediated immunity, but the intestinal secretory immunoglobulin A response was higher following intranasal immunization than after intramuscular immunization. MPL demonstrated its adjuvanticity in vaccination by both routes.
Collapse
Affiliation(s)
- S Sasaki
- Department of Bacteriology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Tsuji T, Hamajima K, Ishii N, Aoki I, Fukushima J, Xin KQ, Kawamoto S, Sasaki S, Matsunaga K, Ishigatsubo Y, Tani K, Okubo T, Okuda K. Immunomodulatory effects of a plasmid expressing B7-2 on human immunodeficiency virus-1-specific cell-mediated immunity induced by a plasmid encoding the viral antigen. Eur J Immunol 1997; 27:782-7. [PMID: 9079822 DOI: 10.1002/eji.1830270329] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
B7 co-stimulation is essential for activating resting T cells following antigen recognition by the T cell receptor. To determine whether B7 has adjuvant activities on human immunodeficiency virus type-1 (HIV-1)-specific immunity induced by inoculation of a plasmid encoding HIV-1 env and rev (DNA vaccine), B7-1 and B7-2 expression plasmids were co-inoculated with the DNA vaccine. The delayed-type hypersensitivity response and cytotoxic T lymphocyte (CTL) activity were significantly enhanced when B7-2 expression plasmid was co-inoculated with the DNA vaccine, but were unaffected when the B7-1 expression plasmid was used with the vaccine instead. The immunological response enhanced by B7-2 decreased below the level of mice immunized with the DNA vaccine in combination with CTLA4Ig, an inhibitor of the B7/CD28 co-stimulatory signal, suggesting that this signal is critical for the enhanced response induced by co-inoculation of the DNA vaccine and B7-2 expression plasmid. This enhancement appeared to occur via an interferon-gamma (IFN-gamma)-dependent mechanism, as combined administration of the B7-2 plasmid and neutralizing anti-IFN-gamma antibody abrogated the virus-specific cell-mediated immunity. These results suggest that this gene-based co-inoculation strategy using HIV-1 viral antigen and B7-2 co-stimulatory molecule could be a powerful means of combating HIV-1 infection.
Collapse
Affiliation(s)
- T Tsuji
- Department of Bacteriology, Yokohama City University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|