The Protective Effects of BCG Vaccination against Tuberculosis. In: Bendinelli M, Friedman H, editors. Mycobacterium tuberculosis. Boston: Springer US; 1988. pp. 341-70. [DOI: 10.1007/978-1-4684-5418-5_16]

Protective effect of BCG among children vaccinated under universal immunization programme

A case-control study was conducted to estimate the protective effect of BCG vaccination against tuberculosis among children. The children with suspicion of tuberculosis (TB) attending two hospitals in Bangalore city were registered into the study and subjected to detailed clinical examination and investigations. The presence of BCG scar was taken as evidence of vaccination. Modified Stegen-Jones scoring method was adopted for diagnosing TB. The hospital children with score of 7 were considered as TB cases. Children residing in the neighbourhood of cases were similarly investigated and those scoring 4 were labeled as controls. A total of 118 age-sex matched case-control pairs were identified and final analysis was confined to 113 cases and 109 controls after excluding children with doubtful BCG scar. A low protective effect of BCG vaccination at 31% (not significant, statistically) was observed against TB - all forms combined, among children vaccinated as under Universal Immunization Programme. Though the protective efficacy against extra-pulmonary TB was observed to be higher than for pulmonary TB, it was also not significant, statistically. It will be appropriate to conduct further studies on protection rendered by BCG vaccination against tuberculous meningitis and other severe forms of TB. Besides, the quality of vaccination programme including cold chain maintenance also needs to be evaluated.

Reactivation of tuberculosis is associated with a shift from type 1 to type 2 cytokines

The pattern of cytokines produced by T cells from mice with latent tuberculosis and during reactivation of tuberculosis was determined. A type 1 cytokine pattern was observed in T cells isolated from the lung of mice with latent disease. Reactivation of mycobacterial growth, by activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulted in a shift from a type 1 to a type 2 cytokine pattern in both CD4 and CD8 T cells. Classification of the T cells based on their differential expression of CD45 and CD44 showed that the phenotypically different populations of CD4 and CD8 cells exhibited a type 1 cytokine pattern at latency and that reactivation of latent tuberculosis was associated with a shift in cytokines produced by these populations to a type 2 cytokine response. Control of mycobacterial growth resulted in a return to the type 1 cytokine pattern found during latent disease.

Cytokine production by CD4 and CD8 T cells during the growth of Mycobacterium tuberculosis in mice

Changes in the pattern of cytokines found in CD4 and CD8 T cells during the growth of Mycobacterium tuberculosis that resulted in the establishment of a latent infection were monitored. Subsets of T cells were identified based on their differential expression of CD45 and CD44 which allowed them to be classified as naive, activated or memory. We found that the T cells in the lung produced a predominantly type 1 cytokine response. The appearance of large numbers of Th1 cells coincided with the establishment of latency. In contrast, the predominant response in the mediastinal lymph node and spleen was a Th2-type response.

Phenotypic changes in T cell populations during the reactivation of tuberculosis in mice

The phenotypic changes of T lymphocytes during the reactivation of latent Mycobacterium tuberculosis infection by activation of the hypothalamic-pituitary-adrenal (HPA) axis was monitored using flow cytometric analysis. Subsets of CD4+ and CD8+ lymphocyte populations from the lung, spleen and draining lymph nodes of infected mice were identified based on their differential expression of the cell surface antigens CD44 and CD45RB. Latent infection was characterized by an accumulation of both naive, activated and memory CD4 and CD8 T lymphocytes in the lung and mediastinal lymph nodes. No changes were observed in the spleen of mice with latent infection when compared with uninfected mice. Immediately following the activation of the HPA axis, a reduction in all CD4+ and CD8+ T cells in the lung and mediastinal lymph nodes was observed. This correlated with the reactivation of mycobacterial growth. The decrease was transient for memory and naive CD4 and CD8 T lymphocyte populations in the lung. However, the number of naive CD4 and CD8 T lymphocyte populations in the mediastinal lymph node following reactivation was less than that found in mice with latent infection. These data provide the first characterization of T lymphocyte populations which may be functionally involved in the immunological response to HPA axis-induced reactivation of M. tuberculosis infection.

Contribution of alpha/beta and gamma/delta T lymphocytes to immunity against Mycobacterium bovis bacillus Calmette Guérin: studies with T cell receptor-deficient mutant mice

Mutant mice with defined T cell deficiencies were infected with Mycobacterium bovis bacillus Calmette Guérin (BCG) and the relative contribution of alpha/beta T cells and gamma/delta T cells to the host immune response was assessed. Recombinase activating gene (RAG-1)-/- mutants as well as T cell receptor (TcR) beta-/-, but not TcR-delta-/-, mutants succumbed to M. bovis BCG infection and failed to develop granulomatous lesions. Antigen-induced IFN-gamma production by spleen cells in vitro was abrogated in RAG-1-/- mutants and markedly diminished in TcR-beta-/- and TcR-delta-/- mice. Reconstitution experiments suggest that both alpha/beta and gamma/delta T cells are essential for antigen-specific IFN-gamma secretion. Our data formally prove the crucial role of alpha/beta T cells and reveal accessory functions of gamma/delta T cells in optimum immunity against M. bovis BCG.

Tuberculosis: the return of an old enemy

Tuberculosis is an ancient human scourge that continues to be an important public health problem worldwide. The increasing number of multidrug-resistant (MDR) M. tuberculosis isolates from both AIDS and non-AIDS patients is an ominous trend that threatens tuberculosis eradication programs both in the U.S. and overseas. New antituberculosis vaccines with therapeutic properties are urgently needed for human immunodeficiency virus-infected individuals, as well as health care professionals likely to be exposed to MDR tubercle bacilli. Recombinant DNA vaccines bearing protective genes from virulent M. tuberculosis are being developed using shuttle phasmids to transfer genetic material from one mycobacterial species to another. Improved assay procedures are needed to measure the protection afforded by these new vaccines under experimental and field test conditions. Tuberculosis vaccine development should be given a high priority in current medical research goals.

Expression of Mycobacterium tuberculosis and Mycobacterium leprae proteins by vaccinia virus

Eight Mycobacterium tuberculosis and M. leprae genes were inserted into the vaccinia virus genome by in vivo recombination. The resulting virus recombinants were shown to express five different M. tuberculosis proteins (71, 65, 35, 19, and 12 kDa) and three M. leprae proteins (65 and 18 kDa and a biotin-binding protein) by Western immunoblot analysis, radioimmunoprecipitation, or black-plaque assay. When injected into BALB/c mice, the recombinants expressing the M. tuberculosis 71-, 65-, or 35-kDa protein and the M. leprae 65-kDa protein or the biotin-binding protein elicited antibodies against the appropriate M. tuberculosis or M. leprae protein. These vaccinia virus recombinants are being tested for the ability to elicit immune protection against M. tuberculosis or M. leprae challenge in animal model systems. The recombinants are also useful in generating target cells for assays aimed at elucidating the cellular immune responses to mycobacterial proteins in leprosy and tuberculosis. Furthermore, the M. tuberculosis 65-kDa protein and four of the other mycobacterial proteins share homology with known eucaryotic and procaryotic stress proteins, some of which may play a role in autoimmunity.