Longitudinal analysis of naturally acquired PfEMP1 CIDR domain variant antibodies identifies associations with malaria protection

BACKGROUNDMalaria pathogenicity is determined, in part, by the adherence of Plasmodium falciparum-infected erythrocytes to the microvasculature mediated via specific interactions between P. falciparum erythrocyte membrane protein (PfEMP1) variant domains and host endothelial receptors. Naturally acquired antibodies against specific PfEMP1 variants can play an important role in clinical protection against malaria.METHODSWe evaluated IgG responses against a repertoire of PfEMP1 CIDR domain variants to determine the rate and order of variant-specific antibody acquisition and their association with protection against febrile malaria in a prospective cohort study conducted in an area of intense, seasonal malaria transmission.RESULTSUsing longitudinal data, we found that IgG antibodies against the pathogenic domain variants CIDRα1.7 and CIDRα1.8 were acquired the earliest. Furthermore, IgG antibodies against CIDRγ3 were associated with reduced prospective risk of febrile malaria and recurrent malaria episodes.CONCLUSIONThis study provides evidence that acquisition of IgG antibodies against PfEMP1 variants is ordered and demonstrates that antibodies against CIDRα1 domains are acquired the earliest in children residing in an area of intense, seasonal malaria transmission. Future studies will need to validate these findings in other transmission settings and determine the functional activity of these naturally acquired CIDR variant-specific antibodies.TRIAL REGISTRATIONClinicalTrials.gov NCT01322581.FUNDINGDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH.

Malaria-induced interferon-γ drives the expansion of Tbethi atypical memory B cells

Many chronic infections, including malaria and HIV, are associated with a large expansion of CD21⁻CD27⁻ ‘atypical’ memory B cells (MBCs) that exhibit reduced B cell receptor (BCR) signaling and effector functions. Little is known about the conditions or transcriptional regulators driving atypical MBC differentiation. Here we show that atypical MBCs in malaria-exposed individuals highly express the transcription factor T-bet, and that T-bet expression correlates inversely with BCR signaling and skews toward IgG3 class switching. Moreover, a longitudinal analysis of a subset of children suggested a correlation between the incidence of febrile malaria and the expansion of T-bet^hi B cells. The Th1-cytokine containing supernatants of malaria-stimulated PBMCs plus BCR cross linking induced T-bet expression in naïve B cells that was abrogated by neutralizing IFN-γ or blocking the IFN-γ receptor on B cells. Accordingly, recombinant IFN-γ plus BCR cross-linking drove T-bet expression in peripheral and tonsillar B cells. Consistent with this, Th1-polarized Tfh (Tfh-1) cells more efficiently induced T-bet expression in naïve B cells. These data provide new insight into the mechanisms underlying atypical MBC differentiation.

Antibodies are proteins in blood that help kill microbes such as viruses, bacteria and parasites. Antibodies are produced by B cells with the help of T follicular helper (Tfh) cells. Some microbes for which we have no effective vaccines, such as HIV and malaria, establish chronic infections that are not cleared by the immune system. These chronic infections are associated with ‘atypical’ B cells that are less able to produce antibodies. We studied blood samples of malaria-exposed children to understand why normal B cells become atypical B cells. We found that atypical B cells express high levels of T-bet—a protein that is important for determining the fate of other types of immune cells. Children who frequently got malaria had more T-bet expressing B cells than children who rarely got malaria. We also found that malaria parasites cause immune cells to secrete inflammatory substances that cause normal B cells to express T-bet. Similarly, the inflammation-prone Tfh cells that malaria activates, which are relatively poor B cell helpers, also caused normal B cells to express T-bet. This study helps us understand why atypical B cells arise during chronic infections—information that could lead to strategies to improve antibody responses through vaccination.

Atypical memory B cells in human chronic infectious diseases: An interim report

Immunological memory is a remarkable phenomenon in which survival of an initial infection by a pathogen leads to life-long protection from disease upon subsequent exposure to that same pathogen. For many infectious diseases, long-lived protective humoral immunity is induced after only a single infection in a process that depends on the generation of memory B cells (MBCs) and long-lived plasma cells. However, over the past decade it has become increasingly evident that many chronic human infectious diseases to which immunity is not readily established, including HIV-AIDS, malaria and TB, are associated with fundamental alterations in the composition and functionality of MBC compartments. A common feature of these diseases appears to be a large expansion of what have been termed exhausted B cells, tissue-like memory B cells or atypical memory B cells (aMBCs) that, for simplicity's sake, we refer to here as aMBCs. It has been suggested that chronic immune activation and inflammation drive the expansion of aMBCs and that in some way aMBCs contribute to deficiencies in the acquisition of immunity in chronic infectious diseases. Although aMBCs are heterogeneous both within individuals and between diseases, they have several features in common including low expression of the cell surface markers that define classical MBCs in humans including CD21 and CD27 and high expression of genes not usually expressed by classical MBCs including T-bet, CD11c and a variety of inhibitory receptors, notably members of the FcRL family. Another distinguishing feature is their greatly diminished ability to be stimulated through their B cell receptors to proliferate, secrete cytokines or produce antibodies. In this review, we describe our current understanding of the phenotypic markers of aMBCs, their specificity in relation to the disease-causing pathogen, their functionality, the drivers of their expansion in chronic infections and their life span. We briefly summarize the features of aMBCs in healthy individuals and in autoimmune disease. We also comment on the possible relationship of human aMBCs and T-bet⁺, CD11c⁺ age/autoimmune-associated B cells, also a topic of this review volume.

In vitro induction of an atypical memory B cell phenotype in human B cells

Several chronic human infectious diseases including malaria are associated with a large expansion of an unusual population of memory B cells(MBCs) which is referred to as atypical MBCs in malaria. Atypical MBCs in malaria are CD21−, CD27−, CD11c+, FcRL5+, high expression of the transcription factor, T-bet, and have accumulated somatic hyper mutations. These atypical MBCs showed poor B cell receptors signaling and B cell function, ex vivo. These studies suggest that atypical MBCs may contribute to the slow, inefficient acquisition of immunity to malaria in African children. However, the mechanisms by which atypical MBCs are induced during chronic infectious diseases are not known. Recently acute febrile malaria was correlated in African children with increases in peripheral blood TH1-type T follicular helper T cells that secrete inflammatory cytokines, including IFN-γ, and are impaired in their helper function. These results suggested that such T cells or their products may contribute to generation of atypical MBCs. We investigated the conditions under which human B cells can induce an atypical MBC phenotype in vitro. Studying tonsillar B cells we showed that triple combined signaling pathway, BCR, TLR and IFNγ is required for the induction of the malaria-associated atypical MBCs in vitro. In addition, human peripheral blood B cells were induced to express T-bet when incubated anti-Ig and the supernatants of peripheral blood mononuclear cells stimulated by parasite-infected red blood cells. Taken together these results suggest that atypical MBCs may be the product of B cell antigen engagement in the highly inflammatory environments that develop during chronic infections.

Evidence that Th1-polarized Tfh cells drive the differentiation of T-bethi atypical memory B cell expansion in human malaria

Many chronic infections, including malaria and HIV, are associated with a large expansion of CD21−CD27−CXCR3+CD11c+ ‘atypical’ memory B cells (MBCs) that exhibit reduced effector functions. Little is known about the conditions or transcriptional regulators driving atypical MBC differentiation. Here we show that atypical MBCs in malaria-exposed individuals highly express the transcription factor T-bet. Moreover, a longitudinal study of malaria-exposed children demonstrated a positive correlation between the incidence of febrile malaria and the expansion of T-bethi B cells. The Th1-cytokine containing supernatants of malaria-stimulated PBMCs and B cell receptor (BCR) cross- linking induced T-bet expression in peripheral and tonsilar B cells that were blocked by neutralizing IFN-γ. Accordingly, recombinant IFN-γ plus BCR cross-linking drove T-bet expression in peripheral and tonsilar B cells. Consistent with this, Th1-polarized Tfh (Tfh-1) cells more efficiently induced T-bet expression in naïve B cells. These data illuminate the mechanisms underlying atypical MBC differentiation.

Emerging concepts in T follicular helper cell responses to malaria

Antibody responses to malaria and candidate malaria vaccines are short-lived in children, leaving them susceptible to repeated malaria episodes. Because T follicular helper (T_FH) cells provide critical help to B cells to generate long-lived antibody responses, they have become the focus of recent studies of Plasmodium-infected mice and humans. The emerging data converge on common themes, namely, that malaria-induced T_H1 cytokines are associated with the activation of (i) T-like memory T_FH cells with impaired B cell helper function, and (ii) pre-T_FH cells that acquire Th1-like features (T-bet expression, IFN-γ production), which impede their differentiation into fully functional T_FH cells, thus resulting in germinal center dysfunction and suboptimal antibody responses. Deeper knowledge of T_FH cells in malaria could illuminate strategies to improve vaccines through modulating T_FH cell responses. This review summarizes emerging concepts in T_FH cell responses to malaria.

Targeting TIGIT to modulate immunity and disease during experimental malaria

Plasmodium infections and the disease malaria remain global health emergencies. CD4 T cells are essential for coordinating protective immunity against Plasmodium infection and promoting parasite clearance, yet long-lived immunity is rarely acquired. We have linked immune failures during human and experimental Plasmodium infection to the expression of immuno-regulatory networks that impair CD4 T cell activity. Here we show the immuno-inhibitory molecule, TIGIT, is highly expressed by parasite-specific CD4 T cells during human and experimental Plasmodium infection, but not experimental Toxoplasma gondii infection. Strikingly, the bulk (>90%) of TIGIT+ parasite-specific CD4 T cells are T-bet+ Th1 effectors, not Foxp3+ T regulatory cells. Moreover, sustained expression of TIGIT is associated with CD4 T cell-expression of IL-10 and is regulated by systemic inflammation, not persistent antigen or chronic T cell stimulation. Preliminary studies using TIGIT-specific agonistic and antagonistic reagents support the biological relevance of sustained TIGIT expression during Plasmodium infection. Current studies are focused on genetic manipulation of TIGIT to dissect the CD4 T cell subset-intrinsic roles of TIGIT during malaria. Collectively, our data support that TIGIT represents an additional host factor that can be targeted to improve immunity against Plasmodium infection and limit disease severity.

Circulating Th1-Cell-type Tfh Cells that Exhibit Impaired B Cell Help Are Preferentially Activated during Acute Malaria in Children

Malaria-specific antibody responses are short lived in children, leaving them susceptible to repeated bouts of febrile malaria. The cellular and molecular mechanisms underlying this apparent immune deficiency are poorly understood. Recently, T follicular helper (Tfh) cells have been shown to play a critical role in generating long-lived antibody responses. We show that Malian children have resting PD-1(+)CXCR5(+)CD4(+) Tfh cells in circulation that resemble germinal center Tfh cells phenotypically and functionally. Within this population, PD-1(+)CXCR5(+)CXCR3(-) Tfh cells are superior to Th1-polarized PD-1(+)CXCR5(+)CXCR3(+) Tfh cells in helping B cells. Longitudinally, we observed that malaria drives Th1 cytokine responses, and accordingly, the less-functional Th1-polarized Tfh subset was preferentially activated and its activation did not correlate with antibody responses. These data provide insights into the Tfh cell biology underlying suboptimal antibody responses to malaria in children and suggest that vaccine strategies that promote CXCR3(-) Tfh cell responses may improve malaria vaccine efficacy.

Co-inhibitory and co-stimulatory crosstalk regulates helper T cell differentiation and humoral immunity during Plasmodium infection (MPF5P.742)

Pathogen-specific T cells are subject to co-stimulatory and co-inhibitory signals, the balance of which promotes pathogen control while limiting immunopathology. During blood-stage Plasmodium infection, parasite-specific CD4 T cells express PD-1 and LAG-3 co-inhibitory receptors that coordinately limit CD4 T cell function. Blockade of PD-1/LAG-3 co-inhibitory signaling during chronic Plasmodium infection enhances CD4 T cell function and parasite control. In contrast to co-inhibitory receptors, the role of T cell co-stimulatory receptors during established Plasmodium infection has not been investigated. Here we show that CD4 T cells exhibit sustained expression of the co-stimulatory receptor OX40 during both human and experimental malaria. We hypothesized that co-stimulatory signaling can functionally counteract co-inhibitory circuits to maintain protective Plasmodium-specific CD4 T responses. In support of this, therapeutically activating OX40 during established experimental malaria enhances CD4 T cell activity, humoral immunity and parasite clearance. Our data also show that the effects of OX40 signaling are modified following simultaneous PD-1 blockade, which markedly impairs parasite-specific T follicular helper cell responses in an IFN-g-dependent manner. Collectively, our results identify that OX40 can be targeted to limit malaria parasite replication and reveal a previously unrecognized role of IFN-g as a negative regulator of Plasmodium-specific humoral immunity.

Alarmin IL-33 acts as an immunoadjuvant to enhance antigen-specific tumor immunity

Studies of interleukin (IL)-33 reveal a number of pleiotropic properties. Here, we report that IL-33 has immunoadjuvant effects in a human papilloma virus (HPV)-associated model for cancer immunotherapy where cell-mediated immunity is critical for protection. Two biologically active isoforms of IL-33 exist that are full-length or mature, but the ability of either isoform to function as a vaccine adjuvant that influences CD4 T helper 1 or CD8 T-cell immune responses is not defined. We showed that both IL-33 isoforms are capable of enhancing potent antigen-specific effector and memory T-cell immunity in vivo in a DNA vaccine setting. In addition, although both IL-33 isoforms drove robust IFN-γ responses, neither elevated secretion of IL-4 or immunoglobulin E levels. Further, both isoforms augmented vaccine-induced antigen-specific polyfunctional CD4(+) and CD8(+) T-cell responses, with a large proportion of CD8(+) T cells undergoing plurifunctional cytolytic degranulation. Therapeutic studies indicated that vaccination with either IL-33 isoform in conjunction with an HPV DNA vaccine caused rapid and complete regressions in vivo. Moreover, IL-33 could expand the magnitude of antigen-specific CD8(+) T-cell responses and elicit effector-memory CD8(+) T cells. Taken together, our results support the development of these IL-33 isoforms as immunoadjuvants in vaccinations against pathogens, including in the context of antitumor immunotherapy.

DNA vaccine cocktail expressing genotype A and C HBV surface and consensus core antigens generates robust cytotoxic and antibody responses in mice and Rhesus macaques

There are well over a quarter of a billion chronic hepatitis B virus (HBV) carriers across the globe. Most carriers are at high risk for development of liver cirrhosis and subsequent progression to hepatocellular carcinoma. It is therefore imperative to develop new approaches for immunotherapy against this infection. Antibodies and cytotoxic T cells to different HBV antigens are believed to be important for reducing viral load and clearing HBV-infected cells from the liver. Some of the major challenges facing current vaccine candidates have been their inability to induce both humoral and cellular immunity to multiple antigenic targets and the induction of potent immune responses against the major genotypes of HBV. In this study, highly optimized synthetic DNA plasmids against the HBV consensus core (HBc) and surface (HBs) antigens genotypes A and C were developed and evaluated for their immune potential. These plasmids, which encode the most prevalent genotypes of the virus, were observed to individually induce binding antibodies to HBs antigens and drove robust cell-mediated immunity in animal models. Similar responses to both HBc and HBs antigens were observed when mice and non-human primates were inoculated with the HBc-HBs cocktails. In addition to the cytotoxic T lymphocyte activities exhibited by the immunized mice, the vaccine-induced responses were broadly distributed across multiple antigenic epitopes. These elements are believed to be important to develop an effective therapeutic vaccine. These data support further evaluation of multivalent synthetic plasmids as therapeutic HBV vaccines.

Hydrodynamic immunization leads to poor CD8 T-cell expansion, low frequency of memory CTLs and ineffective antiviral protection

Hepatotropic pathogens, such as hepatitis B (HBV) and hepatitis C (HCV), often escape cellular immune clearance resulting in chronic infection. As HBV and HCV infections are the most common causes of hepatocellular carcinoma (HCC), prevention of these infections is believed to be key to the prevention of HCC. It is believed that an effective immune therapy must induce strong cytotonic T lymphocytes (CTLs) that can migrate into the liver, where they can clear infected hepatocytes. Here, we compared the induction of CD8 T cells by two different DNA immunization methods for T-cell differentiation, function, memory programming and their distribution within relevant tissues in a highly controlled fashion. We used hydrodynamic tail vein injection of plasmid to establish liver-specific LCMV-gp antigen (Ag) transient expression, and studied CD8 T cells induced using the P14 transgenic mouse model. CD8 T cells from this group exhibited unique and limited expansion, memory differentiation, polyfunctionality and cytotoxicity compared with T cells generated in intramuscularly immunized mice. This difference in liver-generated expansion resulted in lower memory CD8 T-cell frequency, leading to reduced protection against lethal viral challenge. These data show an unusual induction of naive CD8 T cells contributed to the lower frequency of Ag-specific CTLs observed after immunization in the liver, suggesting that limited priming in liver compared with peripheral tissues is responsible for this outcome.

Highly optimized DNA vaccine targeting human telomerase reverse transcriptase stimulates potent antitumor immunity

High levels of human telomerase reverse transcriptase (hTERT) are detected in more than 85% of human cancers. Immunologic analysis supports that hTERT is a widely applicable target recognized by T cells and can be potentially studied as a broad cancer immunotherapeutic, or a unique line of defense against tumor recurrence. There remains an urgent need to develop more potent hTERT vaccines. Here, a synthetic highly optimized full-length hTERT DNA vaccine (phTERT) was designed and the induced immunity was examined in mice and non-human primates (NHP). When delivered by electroporation, phTERT elicited strong, broad hTERT-specific CD8 T-cell responses including induction of T cells expressing CD107a, IFN-γ, and TNF-α in mice. The ability of phTERT to overcome tolerance was evaluated in an NHP model, whose TERT is 96% homologous to that of hTERT. Immunized monkeys exhibited robust [average 1,834 spot forming unit (SFU)/10(6) peripheral blood mononuclear cells (PBMC)], diverse (multiple immunodominant epitopes) IFN-γ responses and antigen-specific perforin release (average 332 SFU/10(6) PBMCs), suggesting that phTERT breaks tolerance and induces potent cytotoxic responses in this human-relevant model. Moreover, in an HPV16-associated tumor model, vaccination of phTERT slows tumor growth and improves survival rate in both prophylactic and therapeutic studies. Finally, in vivo cytotoxicity assay confirmed that phTERT-induced CD8 T cells exhibited specific cytotoxic T lymphocyte (CTL) activity, capable of eliminating hTERT-pulsed target cells. These findings support that this synthetic electroporation-delivered DNA phTERT may have a role as a broad therapeutic cancer vaccine candidate.

Synthetic DNA immunogen encoding hepatitis B core antigen drives immune response in liver

The prevalence of hepatitis B virus (HBV) infection in Asia and sub-Sahara Africa is alarming. With quarter of a billion people chronically infected worldwide and at risk of developing liver cancer, the need for a prophylactic or therapeutic vaccination approach that can effectively induce protective responses against the different genotypes of HBV is more important than ever. Such a strategy will require both the induction of a strong antigen-specific immune response and the subsequent deployment of immune response towards the liver. Here, we assessed the ability of a synthetic DNA vaccine encoding a recombinant consensus plasmid from genotype A through E of the HBV core antigen (HBcAg), to drive immunity in the liver. Intramuscular vaccination induced both strong antigen-specific T cell and high titer antibody responses systematically and in the liver. Furthermore, immunized mice showed strong cytotoxic responses that eliminate adoptively transferred HBV-coated target cells. Importantly, vaccine-induced immune responses provided protection from HBcAg plasmid-based liver transfection in a hydrodynamic liver transfection model. These data provide important insight into the generation of peripheral immune responses that are recruited to the liver-an approach that can be beneficial in the search for vaccines or immune-therapies to liver disease.

Acute intrahepatic CD8 T cell activation by plasmid DNA induces defective CD8 T cell immune response. (52.3)

The fate of CD8 T cells primed in the liver has been a subject of controversy in the attempt to explain the failure of immunity in chronic liver infections such as HBV, HCV and malaria. While most models show activation of CD8 T cells when liver resident cells present antigen, there are differences in opinion as to what becomes of these T cells after their initial priming. In this study, we used hydrodynamic injection that mimics acute HBV/HCV infection to express antigen in the liver, while taking advantage of the well-established LCMV P14 system, to induce acute intrahepatic T cells activation. We observed comparable CD8 T cells proliferation, up-regulation of CD44 and CD25, down-regulation of L-selectin, to the control (activation in lymphoid tissues). However, CD8 T cells primed in the liver expressed higher levels of pro-apoptotic markers such as Bim and active caspase 3, resulting in the loss of activated cells in all tissues. These liver activated CD8 T cells were incapable of protecting mice from lethal intracranial LCMV challenge. Our results confirm the up-regulation of ‘death markers’ during CD8 T cell priming in the liver, which leads to deletion of activated CD8 T cells needed to control viral infections in the liver. Thus, the failure of T cells to control chronic HBV/HCV is more likely due to defective liver priming of antigen-specific T cells.

Immunogenicity of novel consensus-based DNA vaccines against Hepatitis B core Antigen. (106.1)

Although effective vaccine against hepatitis B virus (HBV) has existed for over 3 decades, it still continues to be a major epidemic, especially among people of Asian and African descent. There are about 370 million people chronically infected and at risk of developing liver cirrhosis and liver cancer. The only therapies available for chronic infected individuals are interferon-α and nucleoside, which unfortunately do not control viral replication in most patients. This failure in protection with current HBV vaccines in 15% of individuals and the difference in response to treatment in the chronic infected are due, but not limited, to the genetic divergence among different HBV genotypes and to the immune escape mutations that often occur within the surface antigen (HBsAg). To circumvent these issues, we propose a novel consensus-based approach to vaccine design for HBV, using DNA vaccine strategy. A plasmid was designed based on HBV core (HBcAg)-specific consensus sequence from (which genotypes of HBV) with modifications such as codon and RNA optimization for maximum expression. We show that the construct was able to induce a strong antigen-specific T cell response systematically and in the liver of C57BL/6 mice. In addition, a high titer antibody response capable of recognizing a native HBcAg was observed in mice systematically immunized with this construct.

Mouse mammary tumor virus uses mouse but not human transferrin receptor 1 to reach a low pH compartment and infect cells

Mouse mammary tumor virus (MMTV) is a pH-dependent virus that uses mouse transferrin receptor 1 (TfR1) for entry into cells. Previous studies demonstrated that MMTV could induce pH 5-dependent fusion-from-with of mouse cells. Here we show that the MMTV envelope-mediated cell–cell fusion requires both the entry receptor and low pH (pH 5). Although expression of the MMTV envelope and TfR1 was sufficient to mediate low pH-dependent syncytia formation, virus infection required trafficking to a low pH compartment; infection was independent of cathepsin-mediated proteolysis. Human TfR1 did not support virus infection, although envelope-mediated syncytia formation occurred with human cells after pH 5 treatment and this fusion depended on TfR1 expression. However, although the MMTV envelope bound human TfR1, virus was only internalized and trafficked to a low pH compartment in cells expressing mouse TfR1. Thus, while human TfR1 supported cell–cell fusion, because it was not internalized when bound to MMTV, it did not function as an entry receptor. Our data suggest that MMTV uses TfR1 for all steps of entry: cell attachment, induction of the conformational changes in Env required for membrane fusion and internalization to an appropriate acidic compartment.