301
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Silva JP, Appelberg R, Gama FM. Antimicrobial peptides as novel anti-tuberculosis therapeutics. Biotechnol Adv 2016; 34:924-940. [PMID: 27235189 DOI: 10.1016/j.biotechadv.2016.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/20/2016] [Accepted: 05/22/2016] [Indexed: 12/30/2022]
Abstract
Tuberculosis (TB), a disease caused by the human pathogen Mycobacterium tuberculosis, has recently joined HIV/AIDS as the world's deadliest infectious disease, affecting around 9.6 million people worldwide in 2014. Of those, about 1.2 million died from the disease. Resistance acquisition to existing antibiotics, with the subsequent emergence of Multi-Drug Resistant mycobacteria strains, together with an increasing economic burden, has urged the development of new anti-TB drugs. In this scope, antimicrobial peptides (AMPs), which are small, cationic and amphipathic peptides that make part of the innate immune system, now arise as promising candidates for TB treatment. In this review, we analyze the potential of AMPs for this application. We address the mechanisms of action, advantages and disadvantages over conventional antibiotics and how problems associated with its use may be overcome to boost their therapeutic potential. Additionally, we address the challenges of translational development from benchside to bedside, evaluate the current development pipeline and analyze the expected global impact from a socio-economic standpoint. The quest for more efficient and more compliant anti-TB drugs, associated with the great therapeutic potential of emerging AMPs and the rising peptide market, provide an optimal environment for the emergence of AMPs as promising therapies. Still, their pharmacological properties need to be enhanced and manufacturing-associated issues need to be addressed.
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Affiliation(s)
- João P Silva
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal.
| | - Rui Appelberg
- Department of Immunophysiology, University of Porto, 4050-313 Porto, Portugal
| | - Francisco Miguel Gama
- CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, Braga 4710-057, Portugal.
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302
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Myllymäki H, Bäuerlein CA, Rämet M. The Zebrafish Breathes New Life into the Study of Tuberculosis. Front Immunol 2016; 7:196. [PMID: 27242801 PMCID: PMC4871865 DOI: 10.3389/fimmu.2016.00196] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022] Open
Abstract
Tuberculosis (TB) is a global health emergency. Up to one-third of the world’s population is infected with Mycobacterium tuberculosis, and the pathogen continues to kill 1.5 million people annually. Currently, the means for preventing, diagnosing, and treating TB are unsatisfactory. One of the main reasons for the poor progress in TB research has been a lack of good animal models to study the latency, dormancy, and reactivation of the disease. Although sophisticated in vitro and in silico methods suitable for TB research are constantly being developed, they cannot reproduce the complete vertebrate immune system and its interplay with pathogens and vaccines. However, the zebrafish has recently emerged as a useful alternative to more traditional models, such as mice, rabbits, guinea pigs, and non-human primates, for studying the complex pathophysiology of a mycobacterial infection. The model is based on the similarity between Mycobacterium marinum – a natural fish pathogen – and M. tuberculosis. In both zebrafish larvae and adult fish, an infection with M. marinum leads to the formation of macrophage aggregates and granulomas, which resemble the M. tuberculosis infections in humans. In this review, we will summarize the current status of the zebrafish model in TB research and highlight the advantages of using zebrafish to dissect mycobacterial virulence strategies as well as the host immune responses elicited against them. In addition, we will discuss the possibilities of using the adult zebrafish model for studying latency, dormancy, and reactivation in a mycobacterial infection.
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Affiliation(s)
| | | | - Mika Rämet
- BioMediTech, University of Tampere, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
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303
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Bellini I, Nastasi A, Boccalini S. Clinical and economic impact of a specific BCG vaccination program implemented in Prato, central Italy, involving foreign newborns on hospitalizations. Hum Vaccin Immunother 2016; 12:2383-90. [PMID: 27184892 DOI: 10.1080/21645515.2016.1182274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In Tuscany (Central Italy), the average annual notification rate of tuberculosis (TB) in the years 2007-2012 was 7.5-9.8 per 100,000 people, with the Local Health Unit of Prato (LHU4) showing the highest rate compared to the other regional area. Therefore, in order to reduce the burden of TB, foreign newborns in the LHU4 are being given the Bacillus Calmette-Guérin (BCG) vaccine since 2000. The aim of this study is to assess the impact of BCG vaccination in Prato, in terms of TB-related hospitalizations and costs. The regional archive containing all TB-related discharges and costs in the period 2007-2014 was consulted. Data regarding foreigners living in the LHU4 who have been vaccinated since 2000 were compared with those living in the other Tuscan LHUs and never vaccinated. These populations were then disaggregated by a threshold age of 15 y. After calculating the standardized hospitalization rates, the expected number of hospitalizations for TB among unvaccinated adults (in both populations) was found to be similar in the LHU4 and the other LHUs (165 vs. 156). However, expected number of hospitalizations among children in the other Tuscan LHUs (67) was double that of the LHU4 (34). If the same vaccine had been administrated everywhere, each year 29 hospitalizations could have been avoided and EUR 343,525 saved. Overall, BCG vaccinations cost EUR 14,879 in the LHU4, but 69 hospitalizations were avoided and EUR 107,435 saved. The introduction of the BCG immunization program in the LHU4 of Prato has led to significant reductions in the clinical and economic impact of TB.
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Affiliation(s)
- Irene Bellini
- a Specialization Medical School of Hygiene and Preventive Medicine , University of Florence , Florence , Italy
| | - Antonino Nastasi
- b Department of Health Sciences , University of Florence , Florence , Italy
| | - Sara Boccalini
- b Department of Health Sciences , University of Florence , Florence , Italy
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304
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Omar SV, Peters RPH, Ismail NA, Jonkman K, Dreyer AW, Said HM, Gwala T, Ismail N, Fourie PB. Field evaluation of a novel preservation medium to transport sputum specimens for molecular detection of Mycobacterium tuberculosis in a rural African setting. Trop Med Int Health 2016; 21:776-82. [PMID: 27098085 DOI: 10.1111/tmi.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the performance of an innovative method of transporting sputum to centralised facilities for molecular detection of Mycobacterium tuberculosis: using a swab to inoculate sputum in a transport medium, PrimeStore(®) Molecular Transport Medium (PS-MTM). METHODS Two sputum specimens were obtained from suspected patients with tuberculosis (TB) at rural healthcare facilities in South Africa. A swab was taken from each specimen and placed into PS-MTM, prior to it being processed by either liquid culture or Xpert MTB/RIF assay (Xpert). RESULTS A total of 141 patients (including 47 with laboratory-confirmed TB) were included in this analysis. M. tuberculosis was detected at 29% by culture and 29% by Xpert, whereas 31% tested positive by IS6110 real-time PCR of PS-MTM from the culture and 36% from the Xpert-paired specimen. Concordance between the method under evaluation with culture was 82% (McNemar, P = 0.55) and 84% (McNemar, P = 0.05) for Xpert. Stratified by culture result, the detection rate by IS6110 real-time PCR of PS-MTM was similar to Xpert for patients with positive culture (P = 0.32), but significantly higher if culture was negative (P = 0.008). CONCLUSIONS These results suggest that swab collection of sputum into PS-MTM for transport is a promising method for diagnosis of TB in rural healthcare settings, thereby potentially improving the options available for molecular diagnosis of TB in countries incapable of applying decentralised high-tech molecular testing.
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Affiliation(s)
- Shaheed V Omar
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Remco P H Peters
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Anova Health Institute, Johannesburg, South Africa
| | - Nazir A Ismail
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Andries W Dreyer
- Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Halima M Said
- Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Thabisile Gwala
- Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Nabila Ismail
- Centre for Tuberculosis, National TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - P Bernard Fourie
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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305
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García-Basteiro AL, Ruhwald M, Lange C. Design of tuberculosis vaccine trials under financial constraints. Expert Rev Vaccines 2016; 15:799-801. [PMID: 27078056 DOI: 10.1080/14760584.2016.1178067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Alberto L García-Basteiro
- a Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique.,b ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB) , Hospital Clínic - Universitat de Barcelona , Barcelona , Spain.,c Amsterdam Institute for Global Health and Development (AIGHD) , Amsterdam , The Netherlands
| | - Morten Ruhwald
- d Human immunology, Dept. of infectious disease immunology , Statens Serum Institut , Copenhagen , Denmark
| | - Christoph Lange
- e Division of Clinical Infectious Diseases , Research Center Borstel , Borstel , Germany.,f German Center for Infection Research , Clinical Tuberculosis Center , Borstel , Germany.,g International Health/Infectious Diseases , University of Lübeck , Lübeck , Germany.,h Department of Medicine , Karolinska Institute , Stockholm , Sweden.,i Department of Internal Medicine , University of Namibia School of Medicine , Windhoek , Namibia
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306
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Kjærgaard J, Stensballe LG, Birk NM, Nissen TN, Foss KT, Thøstesen LM, Pihl GT, Andersen A, Kofoed PE, Pryds O, Greisen G. Lack of a Negative Effect of BCG-Vaccination on Child Psychomotor Development: Results from the Danish Calmette Study - A Randomised Clinical Trial. PLoS One 2016; 11:e0154541. [PMID: 27123570 PMCID: PMC4849633 DOI: 10.1371/journal.pone.0154541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives To assess the non-specific effect of Bacillus Calmette-Guérin (BCG) vaccination at birth on psychomotor development. Design This is a pre-specified secondary outcome from a randomised, clinical trial. Setting Maternity units and paediatric wards at three university hospitals in Denmark. Participants Children born at gestational age (GA) 32 weeks and above. All women planning to give birth at the three sites were invited during the recruitment period. Out of 4262 randomised children, 144 were premature (GA < 37 weeks). There were 2129 children (71 premature) randomised to BCG and 2133 randomised (73 premature) to the control group. Interventions BCG vaccination 0.05 ml was given intradermally in the upper left arm at the hospital within seven days of birth. Children in the control group did not receive any intervention. Parents were not blinded to allocation. Main outcome measures Psychomotor development measured using Ages and Stages Questionnaire (ASQ) completed by the parents at 12 months. Additionally, parents of premature children (gestational age < 37 weeks) completed an ASQ at 6 and 22 months. Developmental assessment was available for 3453/4262 (81%). Results The mean difference in ASQ score at 12 months adjusted for age and prematurity was -0.7 points (BCG vs. control, 95% confidence interval; -3.7 to 2.4), p = 0.67, corresponding to an effect size of Cohen’s d = -0.015 (-0.082 to 0.052). The mean difference in ASQ score for premature children at 22 months was -7.8 points (-20.6 to 5.0, p = 0.23), d = -0.23 (-0.62 to 0.15). Conclusions A negative non-specific effect of BCG vaccination at birth on psychomotor development was excluded in term children. Trial Registration ClinicalTrials.gov NCT01694108
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Affiliation(s)
- Jesper Kjærgaard
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Neonatal Department, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Lone Graff Stensballe
- The Department of Paediatrics and Adolescent Medicine, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Marie Birk
- Department of Paediatrics 460, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Kim Thestrup Foss
- Department of Neurology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | | | - Gitte Thybo Pihl
- Department of Paediatrics, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Andreas Andersen
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, Copenhagen, Denmark
| | - Poul-Erik Kofoed
- Department of Paediatrics, Kolding Hospital, University of Southern Denmark, Kolding, Denmark
| | - Ole Pryds
- Department of Paediatrics 460, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Gorm Greisen
- The Neonatal Department, Juliane Marie Centret, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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307
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Leung CC, Chan K, Yam WC, Lee MP, Chan CK, Wong KH, Ho PL, Mak I, Tam CM. Poor agreement between diagnostic tests for latent tuberculosis infection among HIV-infected persons in Hong Kong. Respirology 2016; 21:1322-9. [PMID: 27121551 DOI: 10.1111/resp.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The tuberculin skin test (TST), T-Spot.TB (T-Spot) and QuantiFERON-TB Gold-In Tube (QFT) were compared in diagnosing latent tuberculosis infection (LTBI) among human immunodeficiency virus (HIV)-infected persons. METHODS Human immunodeficiency virus-infected persons without previous history of tuberculosis or LTBI were simultaneously tested by TST, T-Spot and QFT annually and followed up for tuberculosis. RESULTS Among 110 HIV-infected subjects with 85% previous TST screening coverage, 75% on anti-retroviral therapy, well-preserved median CD4 count (414/μL) and low median viral load (<75/μL), baseline TST, T-Spot and QFT were positive in 5.5%, 5.6% and 4.9%, respectively, with almost complete discordance of positive results. Among 91 (83%), 66 (60%) and 26 (24%) subjects successfully undergoing the first, second and third annual retesting, TST, T-Spot and QFT were, respectively, positive in 11/123 (8.9%), 13/173 (7.5%) and 21/182 (11.5%) on retesting, with similar discordance of positive results. There was no significant association with the concurrent CD4 count or viral load. Conversion occurred in 11/123 (8.9%), 8/160 (5.0%) and 18/168 (10.7%) of TST, T-Spot and QFT, respectively, and none was associated with changes in CD4 count or viral load. More than half of the positive T-SPOT and QFT results reverted to negative on follow-up. None of these tests picked up the single case of culture-confirmed tuberculosis observed after 798 person-years of follow-up. CONCLUSION Major discordance in positive results, high reversion rates and low tuberculosis incidence among test-positive subjects cast serious doubt on the utility of the currently available LTBI tests in the annual screening of HIV-infected persons in an intermediate tuberculosis burden area.
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Affiliation(s)
| | - Kenny Chan
- Special Preventive Programme, Centre for Health Protection, Department of Health
| | - Wing Cheong Yam
- Centre of Infection and Department of Microbiology, Queen Mary Hospital, The University of Hong Kong
| | - Man Po Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | | | - Ka Hing Wong
- Special Preventive Programme, Centre for Health Protection, Department of Health
| | - Pak Leung Ho
- Centre of Infection and Department of Microbiology, Queen Mary Hospital, The University of Hong Kong
| | - Ida Mak
- TB and Chest Service, Centre for Health Protection
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308
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Abstract
Adaptive immunity towards tuberculosis (TB) has been extensively studied for many years. In addition, in recent years the profound contribution of innate immunity to host defence against this disease has become evident. The discovery of pattern recognition receptors, which allow innate immunity to tailor its response to different infectious agents, has challenged the view that this arm of immunity is nonspecific. Evidence is now accumulating that innate immunity can remember a previous exposure to a microorganism and respond differently during a second exposure. Although the specificity and memory of innate immunity cannot compete with the highly sophisticated adaptive immune response, its contribution to host defence against infection and to vaccine-induced immunity should not be underestimated and needs to be explored. Here, we present the concept of trained immunity and discuss how this may contribute to new avenues for control of TB.
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Affiliation(s)
- M Lerm
- Division of Microbiology and Molecular Medicine, Faculty of Medicine and Health Sciences, Linköping, Sweden
| | - M G Netea
- Radboud Institute for Molecular Life Sciences, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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309
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Abstract
Recent anecdotal reports of HIV-infected children who received early antiretroviral therapy (ART) and showed sustained control of viral replication even after ART discontinuation have raised the question of whether there is greater intrinsic potential for HIV remission, or even eradication ('cure'), in paediatric infection than in adult infection. This Review describes the influence of early initiation of ART, of immune ontogeny and of maternal factors on the potential for HIV cure in children and discusses the unique immunotherapeutic opportunities and obstacles that paediatric infection may present.
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Affiliation(s)
- Philip J Goulder
- Department of Paediatrics, University of Oxford, Oxford OX1 3SY, UK
| | - Sharon R Lewin
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne 3000, Australia
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne 3004, Australia
| | - Ellen M Leitman
- Department of Paediatrics, University of Oxford, Oxford OX1 3SY, UK
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310
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Marais BJ, Seddon JA, Detjen AK, van der Werf MJ, Grzemska M, Hesseling AC, Curtis N, Graham SM. Interrupted BCG vaccination is a major threat to global child health. THE LANCET RESPIRATORY MEDICINE 2016; 4:251-3. [PMID: 27016867 DOI: 10.1016/s2213-2600(16)00099-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Ben J Marais
- The Children's Hospital at Westmead, University of Sydney, Sydney, NSW 2145, Australia.
| | - James A Seddon
- Department of Paediatrics, Imperial College London, London, UK
| | - Anne K Detjen
- United Nations Children's Fund (UNICEF), New York, NY, USA
| | | | | | - Anneke C Hesseling
- Desmond Tutu Centre Tuberculosis Centre, Stellenbosch University, Tygerberg, South Africa
| | - Nigel Curtis
- The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Australia
| | - Stephen M Graham
- The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Australia
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311
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Gengenbacher M, Kaiser P, Schuerer S, Lazar D, Kaufmann SHE. Post-exposure vaccination with the vaccine candidate Bacillus Calmette-Guérin ΔureC::hly induces superior protection in a mouse model of subclinical tuberculosis. Microbes Infect 2016; 18:364-8. [PMID: 26994939 DOI: 10.1016/j.micinf.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 11/26/2022]
Abstract
The tuberculosis vaccine BCG ΔureC::hly is the most advanced BCG replacement candidate in phase II clinical development. Here we assess the protective capacity of the construct administered to mice as homologous prime-boost vaccine prior Mycobacterium tuberculosis infection and as post-exposure vaccine. Multiple immunization did not improve the superior protection of BCG ΔureC::hly over BCG. Animals with subclinical tuberculosis were better protected when vaccinated with BCG ΔureC::hly as compared to BCG. Our findings suggest further consideration of BCG ΔureC::hly as post-exposure vaccine.
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Affiliation(s)
- Martin Gengenbacher
- Max Planck Institute for Infection Biology, Department of Immunology, Charitéplatz 1, 10117 Berlin, Germany; National University of Singapore, Yong Loo Lin School of Medicine, Department of Microbiology and Immunology, 5 Science Drive 2, Block MD4, Level 3, Singapore 117545, Singapore
| | - Peggy Kaiser
- Max Planck Institute for Infection Biology, Department of Immunology, Charitéplatz 1, 10117 Berlin, Germany
| | - Stefanie Schuerer
- Max Planck Institute for Infection Biology, Department of Immunology, Charitéplatz 1, 10117 Berlin, Germany
| | - Doris Lazar
- Max Planck Institute for Infection Biology, Department of Immunology, Charitéplatz 1, 10117 Berlin, Germany
| | - Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Department of Immunology, Charitéplatz 1, 10117 Berlin, Germany.
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312
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Baillet A, Gossec L, Carmona L, Wit MD, van Eijk-Hustings Y, Bertheussen H, Alison K, Toft M, Kouloumas M, Ferreira RJO, Oliver S, Rubbert-Roth A, van Assen S, Dixon WG, Finckh A, Zink A, Kremer J, Kvien TK, Nurmohamed M, van der Heijde D, Dougados M. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis 2016; 75:965-73. [DOI: 10.1136/annrheumdis-2016-209233] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/27/2016] [Indexed: 01/15/2023]
Abstract
In chronic inflammatory rheumatic diseases, comorbidities such as cardiovascular diseases and infections are suboptimally prevented, screened for and managed. The objective of this European League Against Rheumatism (EULAR) initiative was to propose points to consider to collect comorbidities in patients with chronic inflammatory rheumatic diseases. We also aimed to develop a pragmatic reporting form to foster the implementation of the points to consider. In accordance with the EULAR Standardised Operating Procedures, the process comprised (1) a systematic literature review of existing recommendations on reporting, screening for or preventing six selected comorbidities: ischaemic cardiovascular diseases, malignancies, infections, gastrointestinal diseases, osteoporosis and depression and (2) a consensus process involving 21 experts (ie, rheumatologists, patients, health professionals). Recommendations on how to treat the comorbidities were not included in the document as they vary across countries. The literature review retrieved 42 articles, most of which were recommendations for reporting or screening for comorbidities in the general population. The consensus process led to three overarching principles and 15 points to consider, related to the six comorbidities, with three sections: (1) reporting (ie, occurrence of the comorbidity and current treatments); (2) screening for disease (eg, mammography) or for risk factors (eg, smoking) and (3) prevention (eg, vaccination). A reporting form (93 questions) corresponding to a practical application of the points to consider was developed. Using an evidence-based approach followed by expert consensus, this EULAR initiative aims to improve the reporting and prevention of comorbidities in chronic inflammatory rheumatic diseases. Next steps include dissemination and implementation.
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313
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Ankrah AO, van der Werf TS, de Vries EFJ, Dierckx RAJO, Sathekge MM, Glaudemans AWJM. PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging 2016; 4:131-144. [PMID: 27077068 PMCID: PMC4820496 DOI: 10.1007/s40336-016-0164-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022]
Abstract
Tuberculosis has a high morbidity and mortality worldwide. Mycobacterium tuberculosis (Mtb) has a complex pathophysiology; it is an aerobic bacillus capable of surviving in anaerobic conditions in a latent state for a very long time before reactivation to active disease. In the latent tuberculosis infection, the individual has no clinical evidence of active disease, but exhibits a hypersensitive response to proteins of Mtb. Only some 5–10 % of latently infected individuals appear to have reactivation of tuberculosis at any one time point after infection, and neither imaging nor immune tests have been shown to predict tuberculosis reactivation reliably. The complex pathology of the organism provides multiple molecular targets for imaging the infection and targeting therapy. Positron emission tomography (PET) integrated with computer tomography (CT) provides a unique opportunity to noninvasively image the whole body for diagnosing, staging and assessing therapy response in many infectious and inflammatory diseases. PET/CT is a powerful noninvasive tool that can rapidly provide three-dimensional views of disease deep within the body and conduct longitudinal assessment over time in one particular patient. Some PET tracers, such as 18F-fluorodeoxyglucose (18F-FDG), have been found to be useful in various infectious diseases for detection, assessing disease activity, staging and monitoring response to therapy. This tracer has also been used for imaging tuberculosis. 18F-FDG PET relies on the glucose uptake of inflammatory cells as a result of the respiratory burst that occurs with infection. Other PET tracers have also been used to image different aspects of the pathology or microbiology of Mtb. The synthesis of the complex cell membrane of the bacilli for example can be imaged with 11C-choline or 18F-fluoroethylcholine PET/CT while the uptake of amino acids during cell growth can be imaged by 3′-deoxy-3′-[18F]fluoro-l-thymidine. PET/CT provides a noninvasive and sensitive method of assessing histopathological information on different aspects of tuberculosis and is already playing a role in the management of tuberculosis. As our understanding of the pathophysiology of tuberculosis increases, the role of PET/CT in the management of this disease would become more important. In this review, we highlight the various tracers that have been used in tuberculosis and explain the underlying mechanisms for their use.
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Affiliation(s)
- Alfred O Ankrah
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands ; Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Tjip S van der Werf
- Department of Internal Medicine, Infectious Diseases, and Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
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314
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González-Saldaña N, Hernández-Porras M, Macías-Parra M, Monroy-Colín VA, Acebo-Arcentales JJ, Juarez-Olguin H. Tuberculous meningitis: symptoms, diagnosis and evaluation experienced in 532 patients in a pediatric hospital. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(15)61015-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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315
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Abstract
PURPOSE OF REVIEW The paediatric HIV epidemic is changing. Over the past decade, new infections have substantially reduced, whereas access to antiretroviral therapy (ART) has increased. Overall this success means that numbers of children living with HIV are climbing. In addition, the problems observed in adult infection resulting from chronic inflammation triggered by persistent immune activation even following ART mediated suppression of viral replication are magnified in children infected from birth. RECENT FINDINGS Features of immune ontogeny favour low immune activation in early life, whereas specific aspects of paediatric HIV infection tend to increase it. A subset of ART-naïve nonprogressing children exists in whom normal CD4 cell counts are maintained in the setting of persistent high viremia and yet in the context of low immune activation. This sooty mangabey-like phenotype contrasts with nonprogressing adult infection which is characterized by the expression of protective HLA class I molecules and low viral load. The particular factors contributing to raised or lowered immune activation in paediatric infection, which ultimately influence disease outcome, are discussed. SUMMARY Novel strategies to circumvent the unwanted long-term consequences of HIV infection may be possible in children in whom natural immune ontogeny in early life militates against immune activation. Defining the mechanisms underlying low immune activation in natural HIV infection would have applications beyond paediatric HIV.
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Affiliation(s)
- Julia M Roider
- aDepartment of Paediatrics, University of Oxford, Peter Medawar Building for Pathogen Research, Oxford, UK bHIV Pathogenesis Programme, The Doris Duke Medical Research Institute cKwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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316
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Arregui S, Sanz J, Marinova D, Martín C, Moreno Y. On the impact of masking and blocking hypotheses for measuring the efficacy of new tuberculosis vaccines. PeerJ 2016; 4:e1513. [PMID: 26893956 PMCID: PMC4756732 DOI: 10.7717/peerj.1513] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 11/26/2015] [Indexed: 12/20/2022] Open
Abstract
Over the past 60 years, the Mycobacterium bovis bacille Calmette–Guérin (BCG) has been used worldwide to prevent tuberculosis (TB). However, BCG has shown a very variable efficacy in different trials, offering a wide range of protection in adults against pulmonary TB. One of the most accepted hypotheses to explain these inconsistencies points to the existence of a pre-existing immune response to antigens that are common to environmental sources of mycobacterial antigens and Mycobacterium tuberculosis. Specifically, two different mechanisms have been hypothesized to explain this phenomenon: the masking and the blocking effects. According to masking hypothesis, previous sensitization confers some level of protection against TB that masks vaccine’s effects. In turn, the blocking hypothesis postulates that previous immune response prevents vaccine taking of a new TB vaccine. In this work we introduce a series of models to discriminate between masking and blocking mechanisms and address their relative likelihood. We apply our methodology to the data reported by BCG-REVAC clinical trials, which were specifically designed for studying BCG efficacy variability. Our results yield estimates that are consistent with high levels of blocking (41% in Manaus -95% CI [14–68]- and 96% in Salvador -95% CI [52–100]-). Moreover, we also show that masking does not play any relevant role in modifying vaccine’s efficacy either alone or in addition to blocking. The quantification of these effects around a plausible model constitutes a relevant step towards impact evaluation of novel anti-tuberculosis vaccines, which are susceptible of being affected by similar effects, especially if applied on individuals previously exposed to mycobacterial antigens.
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Affiliation(s)
- Sergio Arregui
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain; Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain
| | - Joaquín Sanz
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain; Sainte-Justine Hospital Research Centre, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Dessislava Marinova
- Department of Microbiology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martín
- Department of Microbiology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Service of Microbiology, Miguel Servet Hospital, Zaragoza, Aragón, Spain
| | - Yamir Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Spain; Department of Theoretical Physics, University of Zaragoza, Zaragoza, Spain; Complex Networks and Systems Lagrange Lab, Institute for Scientific Interchange, Turin, Italy
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317
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Nardell EA. Indoor environmental control of tuberculosis and other airborne infections. INDOOR AIR 2016; 26:79-87. [PMID: 26178270 DOI: 10.1111/ina.12232] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/03/2015] [Indexed: 05/22/2023]
Abstract
Tuberculosis (TB) remains the airborne infection of global importance, although many environmental interventions to control TB apply to influenza and other infections with airborne potential. This review focuses on the global problem and the current state of available environmental interventions. TB transmission is facilitated in overcrowded, poorly ventilated congregate settings, such as hospitals, clinics, prisons, jails, and refugee camps. The best means of TB transmission control is source control- to identify unsuspected infectious cases and to promptly begin effective therapy. However, even with active case finding and rapid diagnostics, not every unsuspected case will be identified, and environmental control measures remain the next intervention of choice. Natural ventilation is the main means of air disinfection and has the advantage of wide availability, low cost, and high efficacy-under optimal conditions. It is usually not applicable all year in colder climates and may not be effective when windows are closed on cold nights in warm climates, for security, and for pest control. In warm climates, windows may be closed when air conditioning is installed for thermal comfort. Although mechanical ventilation, if properly installed and maintained, can provide adequate air disinfection, it is expensive to install, maintain, and operate. The most cost-effective way to achieve high levels of air disinfection is upper room germicidal irradiation. The safe and effective application of this poorly defined intervention is now well understood, and recently published evidence-based application guidelines will make implementation easier.
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Affiliation(s)
- E A Nardell
- Harvard Medical School, Harvard School of Public Health, Brigham & Women's Hospital, Boston, MA, USA
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318
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Biraro IA, Kimuda S, Egesa M, Cose S, Webb EL, Joloba M, Smith SG, Elliott AM, Dockrell HM, Katamba A. The Use of Interferon Gamma Inducible Protein 10 as a Potential Biomarker in the Diagnosis of Latent Tuberculosis Infection in Uganda. PLoS One 2016; 11:e0146098. [PMID: 26771653 PMCID: PMC4714877 DOI: 10.1371/journal.pone.0146098] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022] Open
Abstract
Background In the absence of a gold standard for the diagnosis of latent tuberculosis (TB) infection (LTBI), the current tests available for the diagnosis of LTBI are limited by their inability to differentiate between LTBI and active TB disease. We investigated IP-10 as a potential biomarker for LTBI among household contacts exposed to sputum positive active TB cases. Methods Active TB cases and contacts were recruited into a cohort with six months’ follow-up. Contacts were tested for LTBI using QuantiFERON®-TB Gold In-Tube (QFN) assay and the tuberculin skin test (TST). Baseline supernatants from the QFN assay of 237 contacts and 102 active TB cases were analysed for Mycobacterium tuberculosis (MTB) specific and mitogen specific IP-10 responses. Results Contacts with LTBI (QFN+TST+) had the highest MTB specific IP-10 responses at baseline, compared to uninfected contacts (QFN-TST-) p<0.0001; and active cases, p = 0.01. Using a cut-off of 8,239 pg/ml, MTB specific IP-10 was able to diagnose LTBI with a sensitivity of 87.1% (95% CI, 76.2–94.3) and specificity of 90.9% (95% CI, 81.3–96.6). MTB specific to mitogen specific IP-10 ratio was higher in HIV negative active TB cases, compared to HIV negative latently infected contacts, p = 0.0004. Concentrations of MTB specific IP-10 were higher in contacts with TST conversion (negative at baseline, positive at 6-months) than in those that were persistently TST negative, p = 0.001. Conclusion IP-10 performed well in differentiating contacts with either latent or active TB from those who were uninfected but was not able to differentiate LTBI from active disease except when MTB specific to mitogen specific ratios were used in HIV negative adults. In addition, IP-10 had the potential to diagnose ‘recent TB infection’ in persons classified as having LTBI using the TST. Such individuals with strong IP-10 responses would likely benefit from chemoprophylaxis.
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Affiliation(s)
- Irene Andia Biraro
- Makerere University College of Health Sciences, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- * E-mail:
| | - Simon Kimuda
- Makerere University College of Health Sciences, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Moses Egesa
- Makerere University College of Health Sciences, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Moses Joloba
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Steven G. Smith
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, United Kingdom
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319
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Long-term protectiveness of BCG. THE LANCET. INFECTIOUS DISEASES 2015; 16:140-2. [PMID: 26603175 DOI: 10.1016/s1473-3099(15)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/22/2015] [Indexed: 11/23/2022]
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320
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Syal K. BCG vaccine fails to prevent the reactivation of latent tuberculosis. Med Hypotheses 2015; 88:82. [PMID: 26639529 DOI: 10.1016/j.mehy.2015.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/19/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Kirtimaan Syal
- Molecular Biophysics Unit, Indian Institute of Science, Bangalore 560012, India.
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321
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Karp CL, Wilson CB, Stuart LM. Tuberculosis vaccines: barriers and prospects on the quest for a transformative tool. Immunol Rev 2015; 264:363-81. [PMID: 25703572 PMCID: PMC4368410 DOI: 10.1111/imr.12270] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The road to a more efficacious vaccine that could be a truly transformative tool for decreasing tuberculosis morbidity and mortality, along with Mycobacterium tuberculosis transmission, is quite daunting. Despite this, there are reasons for optimism. Abetted by better conceptual clarity, clear acknowledgment of the degree of our current immunobiological ignorance, the availability of powerful new tools for dissecting the immunopathogenesis of human tuberculosis, the generation of more creative diversity in tuberculosis vaccine concepts, the development of better fit-for-purpose animal models, and the potential of more pragmatic approaches to the clinical testing of vaccine candidates, the field has promise for delivering novel tools for dealing with this worldwide scourge of poverty.
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Affiliation(s)
- Christopher L Karp
- Discovery and Translational Sciences, Global Health, The Bill & Melinda Gates Foundation, Seattle, WA, USA
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322
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Nguipdop-Djomo P, Heldal E, Rodrigues LC, Abubakar I, Mangtani P. Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study. THE LANCET. INFECTIOUS DISEASES 2015; 16:219-26. [PMID: 26603173 DOI: 10.1016/s1473-3099(15)00400-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about how long the BCG vaccine protects against tuberculosis. We assessed the long-term vaccine effectiveness (VE) in Norwegian-born individuals. METHODS In this retrospective population-based cohort study, we studied Norwegian-born individuals aged 12-50 years who were tuberculin skin test (TST) negative and eligible for BCG vaccination as part of the last round of Norway's mandatory mass tuberculosis screening and BCG vaccination programme between 1962 and 1975. We excluded individuals who had tuberculosis before or in the year of screening and those with unknown TST and BCG status. We obtained TST and BCG information and linked it to the National Tuberculosis Register, population and housing censuses, and the population register for emigrations and deaths. We followed individuals up to their first tuberculosis episode, emigration, death, or Dec 31, 2011. We used Cox regressions to estimate VE against all tuberculosis and just pulmonary tuberculosis by time since vaccination, adjusted for age, time, county-level tuberculosis rates, and demographic and socioeconomic indicators. FINDINGS Median follow-up was 41 years (IQR 32-49) for 83 421 BCG-unvaccinated and 44 years (41-46) for 297 905 vaccinated individuals, with 260 tuberculosis episodes. Tuberculosis rates were 3·3 per 100 000 person-years in unvaccinated and 1·3 per 100 000 person-years in vaccinated individuals. The adjusted average VE during 40 year follow-up was 49% (95% CI 26-65), although after 20 years, the VE was not significant (up to 9 years VE [excluding tuberculosis episodes in the first 2 years] 61% [95% CI 24-80]; 10-19 years 58% [27-76]; 20-29 years 38% [-32 to 71]; 30-40 years 42% [-24 to 73]). VE against pulmonary tuberculosis up to 9 years (excluding tuberculosis episodes in the first 2 years) was 67% (95% CI 27-85), 10-19 years was 63% (32-80), 20-29 years was 50% (-19 to 79), and 30-40 years was 40% (-46 to 76). INTERPRETATION Findings are consistent with long-lasting BCG protection, but waning of VE with time. The vaccine could be more cost effective than has been previously estimated FUNDING Norwegian Institute of Public Health and London School of Hygiene & Tropical Medicine.
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Affiliation(s)
- Patrick Nguipdop-Djomo
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Einar Heldal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ibrahim Abubakar
- Institute of Epidemiology and Health, and Centre for Infectious Disease Epidemiology, Faculty of Population Health Sciences, University College London, London, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK
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323
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Geldmacher C, Hatherill M. First-in-human trial of a live-attenuated Mycobacterium tuberculosis vaccine. THE LANCET RESPIRATORY MEDICINE 2015; 3:906-7. [PMID: 26598142 DOI: 10.1016/s2213-2600(15)00474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, and German Center for Infection Research (DZIF), Medical Center of the University of Munich, LMU, Munich 80802, Germany.
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
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324
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Lechiche C, Charpille M, Saissi G, Sotto A. [Assessment of BCG vaccine practices]. Arch Pediatr 2015; 23:34-8. [PMID: 26552631 DOI: 10.1016/j.arcped.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
Tuberculosis is a major public health problem. In France, the vaccine against tuberculosis (Bacillus Calmette-Guerin, BCG) is in decline. This decline is firstly due to changes in BGG administration that were implemented in 2006 and secondly because of new recommandations in 2007 that ended compulsory vaccination. To determine their position on this vaccine, in 2013-2014 we asked general practitioners, pediatricians, and Maternal and Infantile Protection Center physicians in the Gard and Herault departments (in Southern France) why this vaccine was not administered and their suggestions for improvement. Most of these doctors (73.9%) stated that they did not oppose this vaccination for children. They expressed concern about potential side effects, technical problems (intradermic injection, multi-dose bottles) and parents' refusal. One quarter of these physicians would have preferred that this vaccine remains compulsory and one third that this vaccine be administered in the maternity hospital. They also requested simplified criteria for patient eligibility, technical improvements (training for intradermal injection, single-dose vaccine) and more information for the public concerning this vaccination.
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Affiliation(s)
- C Lechiche
- Service des maladies infectieuses et tropicales, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France.
| | - M Charpille
- Service des maladies infectieuses et tropicales, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - G Saissi
- Réanimation chirurgicale, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
| | - A Sotto
- Réanimation chirurgicale, CHU Caremeau, place du Pr-Debré, 30029 Nîmes cedex 9, France
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325
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Abstract
BACKGROUND High immigration rates from tuberculosis (TB) endemic countries to low-incidence countries have caused new TB guidelines in these countries to reconsider latent TB infection (LTBI) screening in these immigrants. OBJECTIVES We performed a systematic review with the primary outcome of evaluating the number of cases recommended LTBI treatment with the tuberculin skin test (TST) or interferon gamma release assay (IGRA). Secondary objectives were to examine prevalence of positive LTBI diagnostic tests stratified by age and incidence of TB in country of origin. METHODS We performed a systematic search of seven electronic databases for studies assessing TST and/or IGRA performance in immigrant populations to low incidence countries. Demographics, LTBI diagnosis, longitudinal TB development, and test result data were the primary data extracted from the studies. Prevalence of positive test data was stratified by age and country of origin. Studies were evaluated using a modified SIGN checklist for diagnostic studies. Data was compared using Fisher's exact test or χ (2) test, where appropriate. RESULTS Our literature search yielded 51 studies (n = 34 TST, n = 9 IGRA, n = 8 both). Recommendation of LTBI treatment was less common in those tested with an IGRA compared to TST (p < 0.0001), while long-term development of active TB appears higher in those with a positive IGRA. There was no difference in the sensitivity and specificity of the IGRA and TST for prevalent TB (p > 0.05). Prevalence of a positive test was significantly lower in those who were <18 years of age compared to those ≥18 years of age (p < 0.0001) and those from low TB incidence countries compared to high incidence countries (p < 0.0001) for both TST and IGRA. When comparing the two tests within the 2 subgroups: age and TB incidence in country of origin, the prevalence of positive results was significantly lower for the IGRA than the TST (p < 0.0001). LIMITATIONS The number of available studies evaluating the IGRA and longitudinal active TB development in those tested limits this study. CONCLUSION Prevalence of positive test results were significantly lower in immigrants who were tested with an IGRA, resulting in fewer immigrants being recommended for LTBI treatment compared to TST. Coupled with comparable performance for detecting prevalent TB cases, the IGRA appears to exhibit better specificity than the TST and may be preferred as the standard of care for detecting LTBI in immigrants moving to low TB incidence countries.
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326
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Mascart F, Locht C. Integrating knowledge ofMycobacterium tuberculosispathogenesis for the design of better vaccines. Expert Rev Vaccines 2015; 14:1573-85. [DOI: 10.1586/14760584.2015.1102638] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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327
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Cha SB, Kim WS, Kim JS, Kim H, Kwon KW, Han SJ, Eum SY, Cho SN, Shin SJ. Repeated Aerosolized-Boosting with Gamma-Irradiated Mycobacterium bovis BCG Confers Improved Pulmonary Protection against the Hypervirulent Mycobacterium tuberculosis Strain HN878 in Mice. PLoS One 2015; 10:e0141577. [PMID: 26509812 PMCID: PMC4624807 DOI: 10.1371/journal.pone.0141577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022] Open
Abstract
Mycobacterium bovis bacillus Calmette-Guerin (BCG), the only licensed vaccine, shows limited protection efficacy against pulmonary tuberculosis (TB), particularly hypervirulent Mycobacterium tuberculosis (Mtb) strains, suggesting that a logistical and practical vaccination strategy is urgently required. Boosting the BCG-induced immunity may offer a potentially advantageous strategy for advancing TB vaccine development, instead of replacing BCG completely. Despite the improved protection of the airway immunization by using live BCG, the use of live BCG as an airway boosting agent may evoke safety concerns. Here, we analyzed the protective efficacy of γ-irradiated BCG as a BCG-prime boosting agent for airway immunization against a hypervirulent clinical strain challenge with Mycobacterium tuberculosis HN878 in a mouse TB model. After the aerosol challenge with the HN878 strain, the mice vaccinated with BCG via the parenteral route exhibited only mild and transient protection, whereas BCG vaccination followed by multiple aerosolized boosting with γ-irradiated BCG efficiently maintained long-lasting control of Mtb in terms of bacterial reduction and pathological findings. Further immunological investigation revealed that this approach resulted in a significant increase in the cellular responses in terms of a robust expansion of antigen (PPD and Ag85A)-specific CD4+ T cells concomitantly producing IFN-γ, TNF-α, and IL-2, as well as a high level of IFN-γ-producing recall response via both the local and systemic immune systems upon further boosting. Collectively, aerosolized boosting of γ-irradiated BCG is able to elicit strong Th1-biased immune responses and confer enhanced protection against a hypervirulent Mycobacterium tuberculosis HN878 infection in a boosting number-dependent manner.
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Affiliation(s)
- Seung Bin Cha
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Sik Kim
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Seok Kim
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Hongmin Kim
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kee Woong Kwon
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Jung Han
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok-Yong Eum
- Division of Immunopathology and Cellular Immunology, International Tuberculosis Research Center, Changwon, South Korea
| | - Sang-Nae Cho
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Jae Shin
- Department of Microbiology, Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail:
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328
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Chen C, Zhu T, Wang Z, Peng H, Kong W, Zhou Y, Shao Y, Zhu L, Lu W. High Latent TB Infection Rate and Associated Risk Factors in the Eastern China of Low TB Incidence. PLoS One 2015; 10:e0141511. [PMID: 26505997 PMCID: PMC4624631 DOI: 10.1371/journal.pone.0141511] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022] Open
Abstract
Objectives To disclose the associated risk factors for latent tuberculosis infection (LTBI) and the current situation of LTBI in the eastern China. Methods A cross-sectional study was undertaken to evaluate the LTBI rate and risk factors. Results A total of 5305 subjects were finally included, with the IGRA positive rate of 19.98% (1060/5305). The LTBI rates were increasing with age (ORs were in significance from 6.60 to 20.92). Male gender significantly increased the risk of LTBI by 0.52 fold (OR = 1.52). Both smoking and drinking significantly increased the risk of LTBI (OR = 1.83 and OR = 1.67, respectively). Meanwhile, overweight and close contact with tuberculosis were risk factors for LTBI (OR = 1.36 and OR = 2.38, respectively). However, higher level of education and BCG vaccination lowered the risk of LTBI (OR = 0.16 and OR = 0.39, respectively). The multivariate logistic regression showed that age, male gender, smoking, overweight and close contacting with tuberculosis were risk factors for LTBI, but BCG vaccination was a protective factor for LTBI. Conclusions BCG vaccination exerted protective effect on tuberculosis. However, LTBI rate in the Chinese rural area was critical and subjects above 30 years, male, smoking, overweight and close contact with tuberculosis wound be the targets for LTBI screening and source of tuberculosis.
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Affiliation(s)
- Cheng Chen
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Tao Zhu
- Department of tuberculosis control, Center for Disease Control and Prevention of Danyang County, Danyang, China
| | - Zhijian Wang
- Department of tuberculosis control, Center for Disease Control and Prevention of Danyang County, Danyang, China
| | - Hong Peng
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Wen Kong
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yang Zhou
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yan Shao
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Limei Zhu
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Wei Lu
- Department of Chronic Infectious Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
- * E-mail:
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329
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Güneş A, Uluca Ü, Aktar F, Konca Ç, Şen V, Ece A, Hoşoğlu S, Taş MA, Gürkan F. Clinical, radiological and laboratory findings in 185 children with tuberculous meningitis at a single centre and relationship with the stage of the disease. Ital J Pediatr 2015; 41:75. [PMID: 26467304 PMCID: PMC4606503 DOI: 10.1186/s13052-015-0186-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/06/2015] [Indexed: 08/30/2023] Open
Abstract
Background A delay in the diagnosis and treatment of tuberculosis meningitis (TBM) may lead to increased mortality and morbidity. The aim of this study was to describe the clinical, radiological and laboratory findings of TBM on a cohort of 185 pediatric patients at a single centre over a 10 year period and to investigate relationship between the stage of the disease. Methods The hospital records of 185 TBM children that presented to the Pediatric Clinics of Dicle University Hospital were retrospectively evaluated. The age, gender, family history of tuberculosis, result of Mantoux skin test, status of BCG vaccination, stage of TBM at hospitalization, and clinical, laboratory and radiological features were recorded. Clinical staging of TBM was defined as follows: Stage I, no focal neurological findings and Glasgow Coma Scale (GCS) score 15; Stage II, GCS 15 presenting with focal neurological deficit or all the patients with GCS 10–14; Stage III, all the patients with GCS < 10. Relationships between results and stages of TBM were investigated. Results The mean age of the patients was 53.5 ± 44.9 months (4 months–18 years). 121 (65.4 %) of the patients were male and 64 (34.6 %) female. Family history of tuberculosis was defined in 62 (33.5 %) patients. Forty five (24.3 %) children had BCG vaccination scar. Mantoux skin test was interpreted as positive in 35 (18.9 %) patients. Sixty-eight (36.8 %) children were at stage I TBM, 57 (30.8 %) at stage II and 60 (32.4 %) were at stage III on admission. Mean duration of hospitalization was 23.9 ± 14.1 days. Totally, 90 patients (48.6 %) had abnormal chest X-ray findings (parenchymal infiltration in 46 (24.9 %), mediastinal lymphadenopathy in 36 (19.5 %), miliary opacities in 25 (13.5 %), pleural effusion in 2 (1.1 %), and atelectasis in 2 (1.1 %) patients). One hundred sixty seven (90.3 %) patients had hydrocephalus in cranial computerized tomography. There were 24 (13.0 %) patients with positive culture for Mycobacterium tuberculosis and 3 (1.6 %) patients with positive acid-fast bacilli in cerebrospinal fluid. Overall mortality rate was 24 (13.0 %). Among the findings; patients at Stage III had less frequent positive chest X-ray abnormality, miliary opacities and BCG vaccination scar when compared with patients at Stage I and II (p = 0,005; p = 0,007, p = 0.020, respectively). Conclusions Children with TBM and positive chest X-ray findings at hospital admission were more frequently diagnosed at Stage I, and BCG vaccination might be protective from the Stage III of the disease.
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Affiliation(s)
- Ali Güneş
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Ünal Uluca
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Fesih Aktar
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Çapan Konca
- Medical School Department of Pediatrics, Adiyaman University, Adiyaman, Turkey.
| | - Velat Şen
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Aydın Ece
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Salih Hoşoğlu
- Medical School Department of Infectious Diseases, Dicle University, Diyarbakir, Turkey.
| | - Mehmet Ali Taş
- Medical School Department of Pediatrics, Dicle University, Diyarbakir, Turkey.
| | - Fuat Gürkan
- Medical School Department of Pediatric Pulmonology, Dicle University, Diyarbakir, Turkey.
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Abstract
The world is in need of more effective approaches to controlling tuberculosis. The development of improved control strategies has been hampered by deficiencies in the tools available for detecting Mycobacterium tuberculosis and defining the dynamic consequences of the interaction of M. tuberculosis with its human host. Key needs include a highly sensitive, specific nonsputum diagnostic; biomarkers predictive of responses to therapy; correlates of risk for disease development; and host response-independent markers of M. tuberculosis infection. Tools able to sensitively detect and quantify total body M. tuberculosis burden might well be transformative across many needed use cases. Here, we review the current state of the field, paying particular attention to needed changes in experimental paradigms that would facilitate the discovery, validation, and development of such tools.
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Affiliation(s)
- Jennifer L Gardiner
- Discovery and Translational Sciences, Global Health, Bill & Melinda Gates Foundation, Seattle, WA 98102
| | - Christopher L Karp
- Discovery and Translational Sciences, Global Health, Bill & Melinda Gates Foundation, Seattle, WA 98102
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331
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Eisenhut M. Preventing Mycobacterium tuberculosis infection by enhancement of innate immunity. Med Hypotheses 2015; 85:512. [PMID: 26165787 DOI: 10.1016/j.mehy.2015.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022]
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332
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Kalu EI, Ojide CK, Nwadike VU, Korie FC, Ibeneme CA, Okafor GC. Childhood tuberculosis in sub-Saharan Africa: A call to action. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60928-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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333
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Ng TW, Saavedra-Ávila NA, Kennedy SC, Carreño LJ, Porcelli SA. Current efforts and future prospects in the development of live mycobacteria as vaccines. Expert Rev Vaccines 2015; 14:1493-507. [PMID: 26366616 DOI: 10.1586/14760584.2015.1089175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The development of more effective vaccines against Mycobacterium tuberculosis (Mtb) remains a major goal in the effort to reduce the enormous global burden of disease caused by this pathogen. Whole-cell vaccines based on live mycobacteria with attenuated virulence represent an appealing approach, providing broad antigen exposure and intrinsic adjuvant properties to prime durable immune responses. However, designing vaccine strains with an optimal balance between attenuation and immunogenicity has proven to be extremely challenging. Recent basic and clinical research efforts have broadened our understanding of Mtb pathogenesis and created numerous new vaccine candidates that have been designed to overcome different aspects of immune evasion by Mtb. In this review, we provide an overview of the current efforts to create improved vaccines against tuberculosis based on modifications of live attenuated mycobacteria. In addition, we discuss the use of such vaccine strains as vectors for stimulating protective immunity against other infectious diseases and cancers.
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Affiliation(s)
- Tony W Ng
- a 1 Albert Einstein College of Medicine - Microbiology & Immunology, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Noemí A Saavedra-Ávila
- a 1 Albert Einstein College of Medicine - Microbiology & Immunology, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Steven C Kennedy
- a 1 Albert Einstein College of Medicine - Microbiology & Immunology, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Leandro J Carreño
- a 1 Albert Einstein College of Medicine - Microbiology & Immunology, 1300 Morris Park Avenue, Bronx, NY 10461, USA.,b 2 Millennium Institute on Immunology and Immunotherapy, Programa Disciplinario de Inmunologia, Instituto de Ciencias Biomedicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Steven A Porcelli
- a 1 Albert Einstein College of Medicine - Microbiology & Immunology, 1300 Morris Park Avenue, Bronx, NY 10461, USA
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334
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Marcus SA, Steinberg H, Talaat AM. Protection by novel vaccine candidates, Mycobacterium tuberculosis ΔmosR and ΔechA7, against challenge with a Mycobacterium tuberculosis Beijing strain. Vaccine 2015; 33:5633-5639. [PMID: 26363381 DOI: 10.1016/j.vaccine.2015.08.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/07/2015] [Accepted: 08/28/2015] [Indexed: 11/18/2022]
Abstract
Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), infects over two billion people, claiming around 1.5 million lives annually. The only vaccine approved for clinical use against this disease is the Bacillus Calmette-Guérin (BCG) vaccine. Unfortunately, BCG has limited efficacy against the adult, pulmonary form of tuberculosis. This vaccine was developed from M. bovis with antigen expression and host specificity that differ from M. tuberculosis. To address these problems, we have designed two novel, live attenuated vaccine (LAV) candidates on an M. tuberculosis background: ΔmosR and ΔechA7. These targeted genes are important to M. tuberculosis pathogenicity during infection. To examine the efficacy of these strains, C57BL/6 mice were vaccinated subcutaneously with either LAV, BCG, or PBS. Both LAV strains persisted up to 16 weeks in the spleens or lungs of vaccinated mice, while eliciting minimal pathology prior to challenge. Following challenge with a selected, high virulence M. tuberculosis Beijing strain, protection was notably greater for both groups of LAV vaccinated animals as compared to BCG at both 30 and 60 days post-challenge. Additionally, vaccination with either ΔmosR or ΔechA7 elicited an immune response similar to BCG. Although these strains require further development to meet safety standards, this first evidence of protection by these two new, live attenuated vaccine candidates shows promise.
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Affiliation(s)
- Sarah A Marcus
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Howard Steinberg
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA.
| | - Adel M Talaat
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53706, USA; Department of Food Hygiene and Control, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt.
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335
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Severe tuberculous retinal vasculitis in healthy adults. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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336
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Mothé BR, Lindestam Arlehamn CS, Dow C, Dillon MBC, Wiseman RW, Bohn P, Karl J, Golden NA, Gilpin T, Foreman TW, Rodgers MA, Mehra S, Scriba TJ, Flynn JL, Kaushal D, O'Connor DH, Sette A. The TB-specific CD4(+) T cell immune repertoire in both cynomolgus and rhesus macaques largely overlap with humans. Tuberculosis (Edinb) 2015; 95:722-735. [PMID: 26526557 DOI: 10.1016/j.tube.2015.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/23/2015] [Accepted: 07/26/2015] [Indexed: 01/05/2023]
Abstract
Non-human primate (NHP) models of tuberculosis (TB) immunity and pathogenesis, especially rhesus and cynomolgus macaques, are particularly attractive because of the high similarity of the human and macaque immune systems. However, little is known about the MHC class II epitopes recognized in macaques, thus hindering the establishment of immune correlates of immunopathology and protective vaccination. We characterized immune responses in rhesus macaques vaccinated against and/or infected with Mycobacterium tuberculosis (Mtb), to a panel of antigens currently in human vaccine trials. We defined 54 new immunodominant CD4(+) T cell epitopes, and noted that antigens immunodominant in humans are also immunodominant in rhesus macaques, including Rv3875 (ESAT-6) and Rv3874 (CFP10). Pedigree and inferred restriction analysis demonstrated that this phenomenon was not due to common ancestry or inbreeding, but rather presentation by common alleles, as well as, promiscuous binding. Experiments using a second cohort of rhesus macaques demonstrated that a pool of epitopes defined in the previous experiments can be used to detect T cell responses in over 75% of individual monkeys. Additionally, 100% of cynomolgus macaques, irrespective of their latent or active TB status, responded to rhesus and human defined epitope pools. Thus, these findings reveal an unexpected general repertoire overlap between MHC class II epitopes recognized in both species of macaques and in humans, showing that epitope pools defined in humans can also be used to characterize macaque responses, despite differences in species and antigen exposure. The results have general implications for the evaluation of new vaccines and diagnostics in NHPs, and immediate applicability in the setting of macaque models of TB.
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Affiliation(s)
- Bianca R Mothé
- Department of Biology, CSUSM, San Marcos, CA 92096, USA; La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA.
| | | | - Courtney Dow
- Department of Biology, CSUSM, San Marcos, CA 92096, USA
| | - Myles B C Dillon
- La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA
| | - Roger W Wiseman
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Patrick Bohn
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Julie Karl
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Nadia A Golden
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Trey Gilpin
- Department of Biology, CSUSM, San Marcos, CA 92096, USA
| | - Taylor W Foreman
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - Mark A Rodgers
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15216, USA
| | - Smriti Mehra
- Tulane National Primate Research Center, Covington, LA 70433, USA; Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University Baton Rouge, LA 70803, USA
| | - Thomas J Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, and Department of Pediatrics and Child Health, University of Cape Town, Cape Town 7925, South Africa
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15216, USA
| | - Deepak Kaushal
- Tulane National Primate Research Center, Covington, LA 70433, USA
| | - David H O'Connor
- Wisconsin National Primate Research Center and Department of Pathology and Laboratory Medicine, UW-Madison, Madison, WI 53706, USA
| | - Alessandro Sette
- La Jolla Institute for Allergy & Immunology, La Jolla, CA 92037, USA
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337
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Ranaivomanana P, Raharimanga V, Dubois PM, Richard V, Rasolofo Razanamparany V. Study of the BCG Vaccine-Induced Cellular Immune Response in Schoolchildren in Antananarivo, Madagascar. PLoS One 2015. [PMID: 26214514 PMCID: PMC4516324 DOI: 10.1371/journal.pone.0127590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective Although the Bacillus Calmette-Guérin vaccine (BCG) protects young children against serious forms of TB, protection against pulmonary TB is variable. We assessed BCG vaccine-induced cellular immune responses and determined for how long they could be detected during childhood in Antananarivo, Madagascar. Methods We assessed BCG vaccine-induced cellular immune responses by TST and IGRA (in-house ELISPOT assay) using BCG and PPD as stimulation antigen, and compared results between vaccinated and non-vaccinated schoolchildren of two age groups, 6-7 and 13-14 years old. Results Three hundred and sixty-three healthy schoolchildren were enrolled. TST was performed on 351 children and IGRA on 142. A high proportion (66%; 229/343) of the children had no TST reactivity (induration size 0 mm). TST-positive responses (≥15 mm) were more prevalent among 13-14 year-old (31.7%) than 6-7 year old (16.5%) children, both in the non-vaccinated (43% vs. 9%, p<0.001) and vaccinated (29% vs. 13%, p=0.002) subgroups. There were no significant differences in TST responses between vaccinated and non-vaccinated children in either of the age groups. The IGRA response to BCG and to PPD stimulation was not significantly different according to BCG vaccination record or to age group. A high rate (15.5%; 22/142) of indeterminate IGRA responses was observed. There was very poor agreement between TST and IGRA-PPD findings (k= 0.08) and between TST and IGRA-BCG findings (k= 0.02) Conclusion Analysis of TST and IGRA response to stimulation with BCG and PPD revealed no difference in immune response between BCG-vaccinated and non-vaccinated children; also no decrease of the BCG vaccine-induced cellular immune response over time was observed. We conclude that TST and IGRA have limitations in assessing a role of BCG or tuberculosis-related immunity.
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Affiliation(s)
| | | | | | - Vincent Richard
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Epidemiology Unit, Institut Pasteur de Dakar, Dakar, Sénégal
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338
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Abstract
SUMMARY Tuberculosis (TB) is a leading cause of death worldwide despite the availability of effective chemotherapy for over 60 years. Although Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccination protects against active TB disease in some populations, its efficacy is suboptimal. Development of an effective TB vaccine is a top global priority that has been hampered by an incomplete understanding of protective immunity to TB. Thus far, preventing TB disease, rather than infection, has been the primary target for vaccine development. Several areas of research highlight the importance of including preinfection vaccines in the development pipeline. First, epidemiology and mathematical modeling studies indicate that a preinfection vaccine would have a high population-level impact for control of TB disease. Second, immunology studies support the rationale for targeting prevention of infection, with evidence that host responses may be more effective during acute infection than during chronic infection. Third, natural history studies indicate that resistance to TB infection occurs in a small percentage of the population. Fourth, case-control studies of BCG indicate that it may provide protection from infection. Fifth, prevention-of-infection trials would have smaller sample sizes and a shorter duration than disease prevention trials and would enable opportunities to search for correlates of immunity as well as serve as a criterion for selecting a vaccine product for testing in a larger TB disease prevention trial. Together, these points support expanding the focus of TB vaccine development efforts to include prevention of infection as a primary goal along with vaccines or other interventions that reduce the rate of transmission and reactivation.
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339
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Myllymäki H, Niskanen M, Oksanen KE, Rämet M. Animal models in tuberculosis research - where is the beef? Expert Opin Drug Discov 2015; 10:871-83. [PMID: 26073097 DOI: 10.1517/17460441.2015.1049529] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Tuberculosis (TB) is a major global health problem, and new drugs and vaccines are urgently needed. As clinical trials in humans require tremendous resources, preclinical drug and vaccine development largely relies on valid animal models that recapitulate the pathology of human disease and the immune responses of the host as closely as possible. AREAS COVERED This review describes the animal models used in TB research, the most widely used being mice, guinea pigs and nonhuman primates. In addition, rabbits and cattle provide models with a disease pathology resembling that of humans. Invertebrate models, including the fruit fly and the Dictyostelium amoeba, have also been used to study mycobacterial infections. Recently, the zebrafish has emerged as a promising model for studying mycobacterial infections. The zebrafish model also facilitates the large-scale screening of drug and vaccine candidates. EXPERT OPINION Animal models are needed for TB research and provide valuable information on the mechanisms of the disease and on ways of preventing it. However, the data obtained in animal studies need to be carefully interpreted and evaluated before making assumptions concerning humans. With an increasing understanding of disease mechanisms, animal models can be further improved to best serve research goals.
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Affiliation(s)
- Henna Myllymäki
- BioMediTech, University of Tampere , FIN 33014 Tampere , Finland
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340
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Developing vaccines to prevent sustained infection with Mycobacterium tuberculosis : Conference proceedings. Vaccine 2015; 33:3056-64. [DOI: 10.1016/j.vaccine.2015.03.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/10/2015] [Accepted: 03/18/2015] [Indexed: 01/08/2023]
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341
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Immunogenicity of infectious pathogens and vaccine antigens. BMC Immunol 2015; 16:31. [PMID: 26021448 PMCID: PMC4446803 DOI: 10.1186/s12865-015-0095-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/20/2015] [Indexed: 12/28/2022] Open
Abstract
The concept of the immunogenicity of an antigen is frequently encountered in the context of vaccine development, an area of intense interest currently due to the emergence or re-emergence of infectious pathogens with the potential for worldwide spread. However, the theoretical notion of immunogenicity as discussed in older textbooks of immunology needs reconsideration due to advances in our understanding of immunologic responses. Immunogenicity is a property that can either be a desirable attribute, for example in the generation of an effective protective immunity against infectious pathogens or an undesirable trait, for example when it relates to novel therapeutic compounds and drugs, where an immune response needs to be prevented or inhibited. In this Forum Article, we aimed to revisit the issue of immunogenicity to discuss a series of simple questions relevant to the concept that are frequently rephrased but incompletely resolved in the immunologic literature.
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342
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Campbell JR, Chen W, Johnston J, Cook V, Elwood K, Krot J, Marra F. Latent Tuberculosis Infection Screening in Immigrants to Low-Incidence Countries: A Meta-Analysis. Mol Diagn Ther 2015; 19:107-17. [DOI: 10.1007/s40291-015-0135-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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343
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Non-tuberculous mycobacteria in children: muddying the waters of tuberculosis diagnosis. THE LANCET RESPIRATORY MEDICINE 2015; 3:244-56. [DOI: 10.1016/s2213-2600(15)00062-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 11/24/2022]
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344
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Leung CC, Yam WC, Ho PL, Yew WW, Chan CK, Law WS, Lee SN, Chang KC, Tai LB, Tam CM. T-Spot.TB outperforms tuberculin skin test in predicting development of active tuberculosis among household contacts. Respirology 2015; 20:496-503. [PMID: 25689894 DOI: 10.1111/resp.12483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/14/2014] [Accepted: 12/11/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE In Hong Kong, neonatal Bacillus Calmette-Guerin (BCG) vaccination is practiced with 99% coverage. This study was to compare the performance of T-Spot.TB and tuberculin skin test (TST) in predicting tuberculosis (TB) among household contacts. METHODS From 1 March 2006 to 31 July 2010, 1049 asymptomatic household contacts of smear-positive patients were simultaneously tested with T-Spot.TB and TST, and then followed for up to 5 years for development of TB. Attending clinicians and subjects were blinded to the results of T-Spot.TB. RESULTS T-Spot.TB gave a significantly higher positive rate (32.7% vs 22.1%) and better association with exposure time than TST at the 15 mm cut-off. Agreement between T-Spot.TB and TST using cut-offs of 5, 10 and 15 mm were relatively poor (kappa 0.25-0.41) irrespective of presence or absence of BCG scar. Only T-Spot.TB positivity was negatively associated with BCG scar. Both T-Spot.TB (incidence rate ratio between test-positive and test-negative subjects, IRR: 8.2) and TST (IRR: 4.1, 6.1 and 2.8, using cut-offs of 5 mm, 10 mm and 15 mm, respectively) helped to predict TB. Using a TST cut-off of 15 mm, 56% of future TB cases and 62.5% of bacteriologically confirmed cases were missed. Lowering the TST cut-off to 10 mm or 5 mm could achieve sensitivity comparable with that of T-Spot.TB, but at the expense of lower specificities, with more positive tests (thus requiring treatment) per case of TB predicted. CONCLUSIONS T-Spot.TB outperformed TST in predicting TB among household contacts in a high-income area with widespread BCG vaccination coverage.
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Affiliation(s)
- Chi Chiu Leung
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong, China
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345
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Eisenhut M. Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity. Med Hypotheses 2015; 84:189-93. [PMID: 25639709 DOI: 10.1016/j.mehy.2014.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
The currently used vaccine for prevention of tuberculosis is Bacillus Calmette Guerin, which has been associated with a protective effect of 51% against tuberculosis. New vaccination strategies based on an enhancement of adaptive T-cell based immunity have been unsuccessful in increasing the efficiency of BCG immunisation. The proposed hypothesis is that a reduction of Mycobacterium (M.) tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity. Evidence to support the hypothesis is a systematic review, which showed that BCG protects against M. tuberculosis infection as evident from negative interferon gamma release assay results in BCG immunised exposed people. BCG has been shown to enhance innate immunity in monocytes via nucleotide binding oligomerisation domain 2 receptor activation by muramyldipeptide. An alternative hypothesis may be that T-suppressor cells induced by BCG immunisation may be the reason for the absence of an interferon gamma response mimicking absence of infection in immunized people. In order to test the primary hypothesis an ultra-low dose mouse model of M. tuberculosis infection could be used. Innate immunity could be enhanced by administration of murabutide and groups with and without murabutide enhanced BCG immunisation and with and without elimination of T-suppressor cells compared. The contribution of training of innate immunity in reduction of infection could hereby be demonstrated by treatment of mice prior to immunisation with an inhibitor of epigenetic programming. Confirmation of the hypothesis could provide the foundation of a new approach to an improved vaccine against M. tuberculosis infection.
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Affiliation(s)
- Michael Eisenhut
- Luton & Dunstable University Hospital NHS Foundation Trust, Lewsey Road, Luton LU4ODZ, United Kingdom.
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346
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Chatterjee D, Pramanik AK. Tuberculosis in the African continent: A comprehensive review. ACTA ACUST UNITED AC 2015; 22:73-83. [PMID: 25620557 DOI: 10.1016/j.pathophys.2014.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/27/2014] [Accepted: 12/30/2014] [Indexed: 02/01/2023]
Abstract
Tuberculosis continues to be a major global health problem, causing an estimated 8.8 million new cases and 1.45 million deaths annually. New drugs in the 1940s made it possible to beat the disease, and consequently, the number of cases reduced drastically. Fast-forward a few decades, drugresistant strains of varied virulence are reported consistently, disease is again on the rise and the treatment has not kept pace. Tuberculosis is the leading cause of death among HIV-infected persons in many resource-constrained settings however, it is curable and preventable. The unprecedented growth of the tuberculosis epidemic in Africa is attributable to several factors, the most important being the HIV epidemic. Analysis of molecular-based data have shown diverse genetic backgrounds among both drug-sensitive and MDR TB isolates in Africa presumably due to underlying genetic and environmental differences. The good news is that there have been important advances recently in TB drugs and diagnostics. Despite the availability of revolutionary tests that allow for faster diagnosis and of new drugs and regimens that offer better and safer treatment it is now becoming clearer that national efforts on TB control should be enhanced and focus on improving the quality of prevention, diagnosis, treatment and care services; strengthening program management, implementation and supervision. This review is an assessment of the trend in TB in Africa.
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Affiliation(s)
- Delphi Chatterjee
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-1682, USA.
| | - Arun K Pramanik
- Department of Pediatrics/Neonatology, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA 71103-4228, USA
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347
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Fischer J, Plum G. Current Treatment Options in Tuberculosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2014. [DOI: 10.1007/s40506-014-0031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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348
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BCG-induced protection: Effects on innate immune memory. Semin Immunol 2014; 26:512-7. [DOI: 10.1016/j.smim.2014.09.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 01/23/2023]
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349
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Geller G, Dvoskin R, Thio CL, Duggal P, Lewis MH, Bailey TC, Sutherland A, Salmon DA, Kahn JP. Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice. Genome Med 2014; 6:106. [PMID: 25593592 PMCID: PMC4295297 DOI: 10.1186/s13073-014-0106-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advances in genomics are contributing to the development of more effective, personalized approaches to the prevention and treatment of infectious diseases. Genetic sequencing technologies are furthering our understanding of how human and pathogen genomic factors - and their interactions - contribute to individual differences in immunologic responses to vaccines, infections and drug therapies. Such understanding will influence future policies and procedures for infectious disease management. With the potential for tailored interventions for particular individuals, populations or subpopulations, ethical, legal and social implications (ELSIs) may arise for public health and clinical practice. Potential considerations include balancing health-related benefits and harms between individuals and the larger community, minimizing threats to individual privacy and autonomy, and ensuring just distribution of scarce resources. In this Opinion, we consider the potential application of pathogen and host genomic information to particular viral infections that have large-scale public health consequences but differ in ELSI-relevant characteristics such as ease of transmission, chronicity, severity, preventability and treatability. We argue for the importance of anticipating these ELSI issues in advance of new scientific discoveries, and call for the development of strategies for identifying and exploring ethical questions that should be considered as clinical, public health and policy decisions are made.
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Affiliation(s)
- Gail Geller
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA ; Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Rachel Dvoskin
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Chloe L Thio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Priya Duggal
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Michelle H Lewis
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Theodore C Bailey
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Andrea Sutherland
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Daniel A Salmon
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA ; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Jeffrey P Kahn
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205 USA ; Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
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350
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Yasui K. Immunity against Mycobacterium tuberculosis and the risk of biologic anti-TNF-α reagents. Pediatr Rheumatol Online J 2014; 12:45. [PMID: 25317081 PMCID: PMC4196001 DOI: 10.1186/1546-0096-12-45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/28/2014] [Indexed: 11/26/2022] Open
Abstract
A third of the world's population is exposed to Mycobacterium tuberculosis in their lifetime. Over eight million people develop a tuberculosis (TB) illness and 1.3 million people die from the disease every year. Acquired immunity (cytotoxic CD8+ T cells (CBT), Th1 CD4+ helper T cells) macrophages, and dendritic cells all play important roles in TB infection. Recently, it is well established that innate immunity as well plays a definitive role in the development of TB immunity under the effects of several cytokines, microbicidal proteins and Toll-like receptors. Meanwhile, the introduction and widespread use of biological disease-modifying anti-rheumatic reagents over the last 15 years worldwide has dramatically advanced and improved the standard care and prognosis of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). However, as clinical experience with these drugs has grown, the risk of granulomatous infections, especially disseminated TB and fungal infections, has become apparent, especially because having RA or JIA may innately increase the risk of infection (bacterial, viral and fungal). The knowledge of basic immunology has also advanced over the past 10 years and adult and pediatric rheumatologists should increase their understanding of this dynamic between arthritis diseases, anti-TNF-α medications, and TB. This review will provide an up-to-date discussion of both the immunology of the TB organism in the human host and the pathophysiologic mechanisms of the TNF-α blockers in the development of secondary (disseminated) tuberculosis.
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Affiliation(s)
- Kozo Yasui
- Department of Pediatrics, Hiroshima-City Hospital, Moto-Machi 7-33, Naka-Ku Hiroshima, 730-8518 Japan ,Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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