Antituberculous immunity induced in mice by vaccination with killed tubercle bacilli or with a soluble bacillary extract

Towards the development of subunit vaccines against tuberculosis: The key role of adjuvant

According to the World Health Organization (WHO), tuberculosis (TB) is the leading cause of death triggered by a single infectious agent, worldwide. Bacillus Calmette-Guerin (BCG) is the only currently licensed anti-TB vaccine. However, other strategies, including modification of recombinant BCG vaccine, attenuated Mycobacterium tuberculosis (Mtb) mutant constructs, DNA and protein subunit vaccines, are under extensive investigation. As whole pathogen vaccines can trigger serious adverse reactions, most current strategies are focused on the development of safe anti-TB subunit vaccines; this is especially important given the rising TB infection rate in immunocompromised HIV patients. The whole Mtb genome has been mapped and major antigens have been identified; however, optimal vaccine delivery mode is still to be established. Isolated protein antigens are typically poorly immunogenic so adjuvants are required to induce strong and long-lasting immune responses. This article aims to review the developmental status of anti-TB subunit vaccine adjuvants.

Orchestration of pulmonary T cell immunity during Mycobacterium tuberculosis infection: immunity interruptus

Despite the introduction almost a century ago of Mycobacterium bovis BCG (BCG), an attenuated form of M. bovis that is used as a vaccine against Mycobacterium tuberculosis, tuberculosis remains a global health threat and kills more than 1.5 million people each year. This is mostly because BCG fails to prevent pulmonary disease--the contagious form of tuberculosis. Although there have been significant advances in understanding how the immune system responds to infection, the qualities that define protective immunity against M. tuberculosis remain poorly characterized. The ability to predict who will maintain control over the infection and who will succumb to clinical disease would revolutionize our approach to surveillance, control, and treatment. Here we review the current understanding of pulmonary T cell responses following M. tuberculosis infection. While infection elicits a strong immune response that contains infection, M. tuberculosis evades eradication. Traditionally, its intracellular lifestyle and alteration of macrophage function are viewed as the dominant mechanisms of evasion. Now we appreciate that chronic inflammation leads to T cell dysfunction. While this may arise as the host balances the goals of bacterial sterilization and avoidance of tissue damage, it is becoming clear that T cell dysfunction impairs host resistance. Defining the mechanisms that lead to T cell dysfunction is crucial as memory T cell responses are likely to be subject to the same subject to the same pressures. Thus, success of T cell based vaccines is predicated on memory T cells avoiding exhaustion while at the same time not promoting overt tissue damage.

TB vaccines: current status and future perspectives

Vaccines against intracellular pathogens such as Mycobacterium tuberculosis need to induce strong cellular immune responses. Antigen discovery programs have exploited this and used proteome studies and T-cell recognition in PPD-positive individuals to select proteins and after testing for protective efficacy in animals the most promising proteins have been put together in fusion molecules. Three such fusion proteins are currently in clinical trials, the two most advanced have already passed phase I trials and are entering phase II.

Tuberculosis subunit vaccine design: the conflict of antigenicity and immunogenicity

The attempts to find an effective antituberculous subunit vaccine are based on the assumption that it must drive a Th1 response. In the absence of effective correlates of protection, a vast array of mycobacterial components are being evaluated worldwide either on the basis of their ability to be recognized by T lymphocytes in in vitro assays during early stage of animal or human infection (antigenicity) or their capacity to induce T cell response following immunization in animal models (immunogenicity). The putative vaccine candidates selected using either of these strategies are then subjected to challenge studies in different animal models to evaluate the protective efficacy. Here we review the outcome of this current scheme of selection of vaccine candidates using an 'antigenicity' or 'immunogenicity' criterion on the actual protective efficacy observed in experimental animal models. The possible implications for the success of some of the leading vaccine candidates in clinical trials will also be discussed.

Studies on tubercle bacillus-monocyte relationship. III. Conditions affecting the action of serum and cells; modification of bacilli in an immune system

Studies of the relationship of protective serum factor to cellular resistance and to tuberculin skin sensitivity have demonstrated that protective serum factor may exist independently of a high level of cellular resistance, and that both protective factor and cellular resistance may be demonstrable without a concomitant hypersensitivity of the delayed type. The experiments with absorbed sera and the globulin fraction of immune serum indicated no specific association of protective serum factor with antibody globulin. The protective factor in immune serum was found to be thermostable and non-dialyzable. In vitro exposure of virulent tubercle bacilli to the immune serum from BCG-immunized animals failed to alter the bacterial capacity for destruction of monocytes and for intracellular proliferation. In vitro cultivation of normal and immune monocytes in normal or immune serum was not effective in changing the native susceptibility or resistance of these cells. Effective manifestation of resistance to virulent tubercle bacilli by immune monocytes was found to require the continuous presence of immune serum. The intracellular passage of virulent tubercle bacilli in an immune system (immune monocytes cultivated in immune serum) resulted in a decreased bacterial potential for destruction of normal monocytes when these were cultivated in the presence of immune serum.

Studies on fractions of methanol extracts of tubercle bacilli. I. Fractions which increase resistance to infection

Fractionation procedures yielding partially purified vaccine preparations from a 60°C. methanol extract of tubercle bacilli have been described. Some of the preparations have the characteristics of lipopolysaccharides. Certain ones have been found capable of increasing resistance to experimental tuberculosis in albino mice of the Rockefeller Swiss strain. The levels of resistance elicited by these preparations are equivalent to those following vaccination with BCG (Phipps) in this strain of mice as reported by other authors. The admixture of two of the crude fractions in amounts as small as 0.05 mg. each per dose per mouse affords an even greater increase in resistance. Neither of these substances alone in larger doses can approach this degree of efficacy in mouse protection experiments. The protective activity appears to involve the stimulation of two supplementary mechanisms, one providing a peak resistance between 1 and 3 weeks post vaccination but falling off to a lower level thereafter, the other not responding fully until approximately 6 weeks but continuing undiminished through a 12 week post-vaccination period. The first of these peaks corresponds to an increase in resistance against staphylococci as well as tubercle bacilli. The possibility that the term "broad specificity," rather than "non-specificity," might best describe this phenomenon permits the implication of classical immune mechanisms.

STUDIES ON THE HETEROLOGOUS IMMUNOGENICITY OF A MENTHANOL-INSOLUBLE FRACTION OF ATTENUATED TUBERCLE BACILLI (BCG). I. ANTIMICROBIAL PROTECTION

Small quantities of the non-toxic residue of phenol-killed, acetone-washed, and methanol-extracted tubercle bacilli of the BCG strain conferred a high degree of resistance on mice against otherwise lethal experimental infection with Klebsiella pneumoniae and with a number of other pathogenic bacteria. The heightened resistance reached a peak within 24 hours after administration of the fraction, but was already discernible immediately thereafter. A period of reduced resistance was not observed. The state of heightened resistance was invariably manifested for at least 10 days, and could frequently still be demonstrated after several weeks or months. The methanol-insoluble fraction was immunogenically active even in experimental circumstances under which living BCG exerted no effect. Its protective effect was more marked in females than in males. The optimum dosage must be determined empirically vis-á-vis the strain of infecting organisms and the experimental parameters of administration and testing. Administration of the fraction to breeding females reduced the incidence of a naturally occurring endemic pneumonitis among their young, and increased considerably the breeding productivity of the mothers. These effects were manifested as late as 11 months after treatment.

THE IMMUNOLOGICAL BASIS OF ACQUIRED CELLULAR RESISTANCE

The resistance developed by mice during infection with Listeria monocytogenes, Brucella abortus, or Mycobacterium tuberculosis is not specifically directed against the infecting organism. The processes involved in the induction of acquired resistance, however, are highly specific and seem to depend upon two factors: a state of immunological reactivity of the host and the presence of the specific microbial antigens to which the host has become reactive. When these two coexist in the tissues the host is found to be non-specifically resistant. It is suggested that resistance, which was shown to depend upon an altered state of host macrophages, may be due to the interaction of antigen and a specific antibody adsorbed to the surface of host macrophages; and that the antibody involved in the reaction is perhaps identical with the antibody which confers the state of delayed-type hypersensitivity. The results are discussed in relation to the question of latent infection and infection immunity.

Cloning, sequencing, and expression of the apa gene coding for the Mycobacterium tuberculosis 45/47-kilodalton secreted antigen complex

Effective protection against a virulent challenge with Mycobacterium tuberculosis is induced mainly by previous immunization with living attenuated mycobacteria, and it has been hypothesized that secreted proteins serve as major targets in the specific immune response. To identify and purify molecules present in culture medium filtrate which are dominant antigens during effective vaccination, a two-step selection procedure was used to select antigens able to interact with T lymphocytes and/or antibodies induced by immunization with living bacteria and to counterselect antigens interacting with the immune effectors induced by immunization with dead bacteria. A Mycobacterium bovis BCG 45/47-kDa antigen complex, present in BCG culture filtrate, has been previously identified and isolated (F. Romain, A. Laqueyrerie, P. Militzer, P. Pescher, P. Chavarot, M. Lagranderie, G. Auregan, M. Gheorghiu, and G. Marchal, Infect. Immun. 61:742-750, 1993). Since the cognate antibodies recognize the very same antigens present in M. tuberculosis culture medium filtrates, a project was undertaken to clone, express, and sequence the corresponding gene of M. tuberculosis. An M. tuberculosis shuttle cosmid library was transferred in Mycobacterium smegmatis and screened with a competitive enzyme-linked immunosorbent assay to detect the clones expressing the proteins. A clone containing a 40-kb DNA insert was selected, and by means of subcloning in Escherichia coli, a 2-kb fragment that coded for the molecules was identified. An open reading frame in the 2,061-nucleotide sequence codes for a secreted protein with a consensus signal peptide of 39 amino acids and a predicted molecular mass of 28,779 Da. The gene was referred to as apa because of the high percentages of proline (21.7%) and alanine (19%) in the purified protein. Southern hybridization analysis of digested total genomic DNA from M. tuberculosis (reference strains H37Rv and H37Ra) indicated that the apa gene was present as a single copy on the genome. The N-terminal identity or homology of the M. tuberculosis and M. bovis BCG purified molecules and their similar global and deduced amino acid compositions demonstrated the perfect correspondence between the molecular and chemical analyses. The presence of a high percentage of proline (21.7%) was confirmed and explained the apparent higher molecular mass (45/47 kDa) determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis resulting from the increased rigidity of molecules due to proline residues.(ABSTRACT TRUNCATED AT 400 WORDS)

Isolation of a proline-rich mycobacterial protein eliciting delayed-type hypersensitivity reactions only in guinea pigs immunized with living mycobacteria

Effective protection against a virulent challenge with Mycobacterium tuberculosis is induced only by a previous immunization with living attenuated mycobacteria, usually bacillus Calmette-Guérin (BCG). Living and killed bacteria share a number of common antigens. To identify and to purify molecules that are dominant antigens during immunization with living bacteria, a two-step selection procedure was used. Quantitative delayed-type hypersensitivity (DTH) reactions elicited in guinea pigs immunized either with living or with killed BCG were used to select or counterselect antigens present in BCG culture filtrates. Each major fraction eluted from a series of HPLC columns (gel filtration, DEAE, reverse-phase chromatography) was assayed and titrated on guinea pigs of each group. A protein with an unusual amino acid composition (40% proline, 12% threonine) was purified and N-terminally sequenced. To our knowledge, the sequence Thr-Pro-Pro-Xaa-Glu-Xaa-Pro-Pro-Pro-Pro-Gln-Xaa-Val-Xaa-Leu has not been previously reported. The protein was 100-fold more potent on guinea pigs immunized with living bacteria than on guinea pigs immunized with dead bacteria to elicit a DTH reaction.

Identification of a Mycobacterium bovis BCG 45/47-kilodalton antigen complex, an immunodominant target for antibody response after immunization with living bacteria

Increased protection against a virulent challenge with Mycobacterium tuberculosis is induced mainly by a previous immunization with living avirulent mycobacteria, usually Mycobacterium bovis BCG. Only a transient and marginal protection is obtained after immunization with bacterial extracts or dead bacteria. Both living and heat-killed bacteria share a number of common antigens. In order to identify mycobacterial molecules which are dominant antigens during immunization with living bacteria, a two-step selection method was used. Two groups of guinea pigs were immunized either with living or with heat-killed BCG. Sera were then collected and used to select and counterselect antigens present in BCG culture filtrates. Each major fraction eluted from a series of high-pressure liquid chromatography columns (gel filtration, DEAE, and reverse-phase chromatography) was run on sodium dodecyl sulfate-polyacrylamide gel electrophoresis and transferred on polyvinylidene difluoride sheets. The molecules present on twin immunoblots were stained with antibodies raised in guinea pigs immunized either with living or with heat-killed BCG. Cross-reactive antigens stained in twin immunoblots were eliminated. Major antigens interacting with antibodies raised after immunization only with living bacteria were further purified. A complex of 45- and 47-kDa major molecules (45/47-kDa complex) was thus identified and further purified. The complex was found to interact only with antibodies present in sera of guinea pigs immunized with living bacteria and not at all with antibodies raised after immunization with dead bacteria. The 45/47-kDa antigen complex molecules were resolved on two-dimensional electrophoresis in three major and seven minor proteins detected with silver staining. All the molecules interacted with the antibodies present in sera of guinea pigs immunized with living BCG. The three major proteins (two at 47 kDa and one at 45 kDa) were amino-terminal sequenced. The sequence A-P-E-P-A-P-P-V-P-P-A-A-A-A-P-P-A, which was not previously reported, was the same for these three molecules. By using a competitive enzyme-linked immunosorbent assay, the concentrations of the 45/47-kDa antigen complex were measured in BCG culture filtrates, freeze-dried BCG, and dried heat-killed BCG; they were, respectively, 2, 0.01, and 0.001% of the total mass. The low or very low values compared with the high antibody concentration emphasized the ability of the 45/47-kDa complex delivered through live BCG to trigger an antibody response.

A randomized study of methanol-extraction residue of bacille Calmette-Guerin as postsurgical adjuvant therapy of uveal melanoma

A randomized controlled clinical trial of methanol-extracted residue of bacille Calmette-Guerin adjuvant treatment of posterior uveal melanoma was undertaken. Of 113 patients, 34 patients received adjuvant immunotherapy and 79 patients received no treatment. No difference in survival was observed between the adjuvant-treated group and the control group of patients. This study found that the size of the tumor was a highly significant risk factor for death caused by metastasis of uveal melanomas. The standard deviation of the nucleolar area of the neoplastic cells was a significant risk factor, even though patients with tumors composed of Callender's spindle-type cells were not included in the study.

A preliminary report on the effects of methanol extraction residue of BCG (MER) on cancer patients

Twenty-seven patients with malignant neoplasia were injected intradermally with the methanol extraction residue (MER) fraction of tubercle bacilli. Two schedules of treatment were used: every other week and once a month; 1-10 courses of MER were administered to the patients. The skin reactivity to 3 recall antigens, as well as to the injected MER itself, was used to monitor the immune response. Improvement of skin reactivity occurred in 9 of 18 patients tested with recall antigens. Five of 6 patients treated every other week improved in their immune capacity whereas only 4 of 12 patients improved on the monthly schedule. Thus, repeated injections given every other week were more effective in increasing the cutaneous reactivity than monthly injections of MER. The side-effects of MER treatment were tolerable.

Immunostimulation with bacterial phospholipid extracts

Injection of bacterial phospholipid extracts (EBP) into mice increased their resistance towards a Listeria monocytogenes infection. The blood clearance of virulent Salmonella typhimurium was enhanced and the degree of clearance correlated with the dose of extract injected. The multiplication of Listeria monocytogenes in spleen and liver of mice was inhibited and this inhibition was also correlated with the amount of extract injected. The absence of apparent toxicity in mice, of splenoand hepatomegaly, and of lymphoid hyperplasia, distinguish this immunostimulant from other known bacterial stimulants of host resistance to infection.

Cellular hypersensitivity and cellular immunity in the pathogensis of tuberculosis: specificity, systemic and local nature, and associated macrophage enzymes

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Some biological properties of BCG after the extraction of lipids: the power to irritate tissues, the ability to prepare for and to evoke Bail's phenomenon, and the power to sensitize to tuberculin

Mycobacterium tuberculosis var. bovis BCG was treated with lipid solvents according to Macheboeuf's method and five progressively more fully extracted bacillary residues were obtained. Electron-microscope examination, together with the biological properties studied, showed that a major transformation was brought about in the bacillary residues by methanol extraction. The biological properties of the residues were studied quantitatively in guinea pigs. The power to irritate tissues (i.e., to produce tuberculous-like lesions in tissues), the ability to prepare for and to evoke Bail's phenomenon (i.e., reaction to the intraperitoneal introduction of bacillary bodies in a sensitized guinea pig characterized by an immediate leucocytic response and death within a few hours), and the power to sensitize to tuberculin were directly proportional to the lipid contents of the bacillary bodies and decreased as the extraction progressed. The residues with the lower lipid contents were less irritant, less sensitizing, and less reactive. However, these properties never completely disappeared. The role of the lipids as related to the above properties of mycobacteria was thus indirectly established. With the doses and the routes of injection used, no obvious toxic effects in normal guinea pig were observed.

Antituberculous immunity induced by methanol extracts of tubercle bacilli; its enhancement by adjuvants

It is possible to prepare from tubercle bacilli a fraction soluble in methanol which is capable of eliciting in mice a marked degree of resistance against virulent tuberculous infection. The immunity was evident whether the infective dose was large and caused a disease with a rapid course, or was very small and caused a disease of many months duration. Active material has been obtained by extraction with methanol at 55 degrees C. of bacterial cells killed with 2 per cent phenol, and washed with acetone. The methanol extracts used in the present study have been prepared from the phenol-killed cells of a culture of BCG, and of the avirulent culture H37Ra. Vaccination of mice bas been carried out by the intraperitoneal route, and the challenge infection (with a highly virulent bovine culture), by the intravenous route. Weight for weight, the protective activity of the methanol extract is smaller than that of the bacterial cells from which it is extracted, but its primary toxicity for mice is also considerably lower. The protective activity can be increased, and the immunity prolonged, by using certain adjuvants as vehicle for injection of the vaccine. An oil adjuvant mixture, and small amounts of a highly purified preparation of the somatic antigen of typhoid bacilli, have been found capable of enhancing and prolonging the antituberculous immunity induced by the methanol extract. Under appropriate conditions the resistance resulting from intraperitoneal injection of the methanol extract is of the same order as that which follows vaccination with whole killed tubercle bacilli or with living BCG.

A fraction of tubercle bacilli possessing primary toxicity

Tubercle bacilli separated from young cultures were thoroughly extracted with monochlorobenzene at temperatures never exceeding 50 degrees C. From the soluble material, a fraction corresponding to approximately 1 per cent of the total bacillary weight was separated by fractional precipitation with petrolic ether at temperatures of 0 degrees or 4 degrees C.-depending upon the strain of bacilli. The monochlorobenzene-soluble-ether-insoluble material (fraction 7) prepared from BCG-P was found to contain 0.14 per cent nitrogen and 0.4 per cent phosphorus. Some of its other chemical characteristics are described. Fraction 7 proved unable to elicit tuberculin allergy in guinea pigs, but injection of 5 microg. of it into the skin produced severe local reactions. In albino mice, a single intraperitoneal injection of 20 microg. caused loss of muscular tone and of weight followed by death within 9 days. The only tissue reaction observed was a slight degree of peritonitis. In mice of the C57 BL strain, a single injection of 40 microg. also caused death in the same time, but with pulmonary hemorrhages-usually massive. Material similar to fraction 7 was obtained from one virulent, two attenuated, and one avirulent strain of mammalian tubercle bacilli (bovine and human). The fractions obtained from the various strains differed somewhat in solubility and toxicity. The more virulent the culture, the more toxic was the fraction obtained from it; but it is possible that this relation was the result of differences in the effectiveness of the extraction procedures, rather than of characteristics inherent to the cultures. Evidence is presented that the toxicity of fraction 7 accounts for much of the primary toxicity of tubercle bacilli.