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Ji N, Mukherjee N, Morales EE, Tomasini ME, Hurez V, Curiel TJ, Abate G, Hoft DF, Zhao XR, Gelfond J, Maiti S, Cooper LJ, Svatek RS. Percutaneous BCG enhances innate effector antitumor cytotoxicity during treatment of bladder cancer: a translational clinical trial. Oncoimmunology 2019; 8:1614857. [PMID: 31413921 PMCID: PMC6682354 DOI: 10.1080/2162402x.2019.1614857] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Intravesical bacillus Calmette-Guérin (BCG) is the gold standard immunologic agent for treating patients with high-grade non-muscle invasive bladder cancer (NMIBC). Nevertheless, relapse rates remain high and BCG unresponsive NMIBC often requires bladder removal. Preclinical data suggest that priming with percutaneous BCG vaccine could improve response to intravesical BCG. Methods: A single-arm trial (NCT02326168) was performed to study the safety, immunogenicity, and preliminary efficacy of priming. Percutaneous BCG was given 21 days prior to intravesical BCG instillation in patients (n = 13) with high-risk NMIBC. Immune responses were monitored and compared to a sequentially enrolled cohort of nine control patients receiving only intravesical BCG. The effect of BCG on natural killer (NK) and γδ T cell in vitro cytotoxicity was tested. γδ T cell subsets were determined by T cell receptor gene expression with NanoString. Results: Priming was well tolerated and caused no grade ≥3 adverse events. The 3-month disease-free rate for prime patients was 85% (target goal ≥ 75%). Priming boosted BCG-specific immunity at 3 months and increased the activation status of in vitro expanded circulating NK and γδ T cells and their cytotoxicity against bladder cancer cells through receptor NKG2D. BCG enhanced the cytotoxicity of NK and γδ T cells against K562, RT4, and UM-UC6 but not against T24, UM-UC-3, or UM-UC-14 cells. Infiltrating γδ T cell subsets identified in the bladder includes γ9δ2 and γ8δ2. Conclusions: BCG priming is safe and tolerable. Poor sensitivity to NK and γδ T cell cytotoxicity by some bladder tumors represents a potential BCG-resistance mechanism.
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Affiliation(s)
- Niannian Ji
- Department of Urology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Neelam Mukherjee
- Department of Urology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Edwin E. Morales
- Department of Urology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Maggie E. Tomasini
- Department of Urology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Vincent Hurez
- Department of Medicine/Hematology & Medical Oncology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Tyler J. Curiel
- Department of Medicine/Hematology & Medical Oncology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Getahun Abate
- Department of Internal Medicine, Division of Infectious Diseases, Allergy and Immunology, Saint Louis University Edward A. Doisy Research Center, .St. Louis, MO, USA
| | - Dan F. Hoft
- Department of Internal Medicine, Division of Infectious Diseases, Allergy and Immunology, Saint Louis University Edward A. Doisy Research Center, .St. Louis, MO, USA
| | - Xiang-Ru Zhao
- Department of Medicine/Hematology & Medical Oncology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Jon Gelfond
- Department of Epidemiology and Biostatistics, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | | | | | - Robert S. Svatek
- Department of Urology, School of Medicine, the University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Basybekov SZ, Bazarbayev MB, Yespembetov BA, Mussaeva A, Kanatbayev SG, Romashev KM, Dossanova AK, Yelekeyev TA, Akmatova EK, Syrym NS. Diagnostics of tuberculosis and differentiation of nonspecific tuberculin reactions in animals. Braz J Microbiol 2017; 49:329-335. [PMID: 29153452 PMCID: PMC5913827 DOI: 10.1016/j.bjm.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 05/17/2017] [Accepted: 07/17/2017] [Indexed: 11/28/2022] Open
Abstract
Tuberculosis is a serious disease of humans and animals, caused by bacteria of the Mycobacterium genus. This leads to complications in the life of the sick person, and subsequently to death. The cattle, who have been diagnosed with this bacterium, are usually sent to the slaughter, with the result that their livestock is reduced. Mycobacteriosis is also a disease, after determining which cattle are most often sent to slaughter. Such a reduction in livestock numbers has a negative effect on the economy. Of the 300 samples from the animals, 25 cultures of atypical bacteria responding to tuberculin were isolated. A series of tests – intravenous tuberculin test, ophthalmic test, palpebral test, “ZhAT” test, showed that most of the tuberculosis changes in cattle were found in regional lymph nodes more often than in internal organs. In healthy for tuberculosis cows, at the age of 4–9 years, seasonal nonspecific sensitivity to tuberculin is observed. Implementation of the developed express method of glutaraldehyde test on farms in healthy tuberculosis will speed up the diagnosis of tuberculosis and mycobacteriosis in animals that reacted to tuberculin and will exclude short-term nonspecific sensitization of their organism to tuberculin. The introduction of this methodology can be used to diagnose and clearly differentiate the diagnoses of “tuberculosis” and “mycobacteriosis” in cattle. This will cure part of the livestock and reduce the amount of slaughter.
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Affiliation(s)
| | | | | | - Assiya Mussaeva
- Kazakh Research Veterinary Institute, Gvardeiskiy, Kazakhstan
| | | | | | | | - Tokseiit A Yelekeyev
- Kyrgyz Research Institute of Veterinary named after A. Duysheev, Bishkek, Kyrgyzstan
| | - Elmira K Akmatova
- Kyrgyz Research Institute of Veterinary named after A. Duysheev, Bishkek, Kyrgyzstan
| | - Nazym S Syrym
- Research Institute of Biological Safety Problems, Gvardeiskiy, Kazakhstan.
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Kennedy AE, O'Mahony J, Byrne N, MacSharry J, Sayers RG. Is TB Testing Associated With Increased Blood Interferon-Gamma Levels? Front Vet Sci 2017; 4:176. [PMID: 29109952 PMCID: PMC5660059 DOI: 10.3389/fvets.2017.00176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
The Republic of Ireland reports a relatively low prevalence of Johne’s disease (JD) compared to international counterparts. Postulated reasons for this include a lower average herd size and a grass-based production system. Ireland also engages in high levels of bovine tuberculosis (bTB) testing. As interferon-gamma (IFN-γ) is believed to play a key role in protecting against JD, it is our hypothesis that administration of purified protein derivative (PPD), as part of the bTB test, is associated with a systemic increase in IFN-γ production, which may potentially limit clinical progression of the disease. We studied 265 cows (202 Friesian and 63 “Non-Friesian,” e.g., JerseyX, Norwegian Red) to assess IFN-γ levels and Mycobacterium avium subspecies paratuberculosis (MAP) antibody response before and after the bTB test. As part of the compulsory annual bTB test, avian and bovine PPD were administered at two separate cervical sites. To assess IFN-γ production, blood samples were taken before and 72 h after PPD administration. MAP antibody response was assessed before and 10 days post-PPD administration. A significant increase in MAP antibody response was identified post-bTB compared to pre-bTB response (p < 0.001). Additionally, IFN-γ production significantly increased at the post-bTB time point (p < 0.001) compared to the pre-bTB test readings. This may indicate a beneficial effect of bTB testing in controlling JD.
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Affiliation(s)
- Aideen E Kennedy
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Fermoy, Ireland.,Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | - Jim O'Mahony
- Department of Biological Sciences, Cork Institute of Technology, Cork, Ireland
| | - Noel Byrne
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Fermoy, Ireland
| | - John MacSharry
- Alimentary Pharmabiotic Centre, Biosciences Institute, University College Cork, Cork, Ireland
| | - Riona G Sayers
- Animal and Bioscience Research Department, Animal and Grassland Research and Innovation Centre, Teagasc, Fermoy, Ireland
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Korioth-Schmitz B, Perley CC, Sixsmith JD, Click EM, Lee S, Letvin NL, Frothingham R. Rhesus immune responses to SIV Gag expressed by recombinant BCG vectors are independent from pre-existing mycobacterial immunity. Vaccine 2015; 33:5715-5722. [PMID: 26192357 DOI: 10.1016/j.vaccine.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 06/02/2015] [Accepted: 07/07/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND A recombinant Mycobacterium bovis BCG (rBCG) vector expressing HIV transgenes is an attractive candidate as a dual vaccine against HIV and TB. However, pre-existing immune responses to mycobacteria may influence immune responses to rBCG. We analyzed data from a rhesus rBCG trial to determine the effect of pre-existing mycobacterial immune responses on the vaccine-induced responses to the vector and expressed transgene. METHODS Indian-origin rhesus macaques were primed with rBCG expressing simian immunodeficiency virus (SIV) Gag and boosted with attenuated vaccinia NYVAC gag-pol. Mycobacteria responses were measured by Mycobacterium tuberculosis (Mtb) purified protein derivative (PPD) interferon-γ ELISpot and Mtb whole cell lysate (WCL) ELISA. SIV Gag responses were measured by SIV Gag ELISpot and by p11C tetramer binding. RESULTS Baseline Mtb PPD ELISpot responses and Mtb WCL antibody responses in rhesus macaques overlapped those in human populations. Cellular and antibody responses boosted sharply 4 weeks after rBCG vaccination. Mtb WCL antibody titers at 4 weeks correlated with baseline titers. Primates vaccinated with rBCG developed strong SIV Gag ELISpot and p11C tetramer responses after rBCG prime and NYVAC boost. There were no correlations between the pre-existing mycobacterial immune responses and the SIV Gag T cell responses after vaccination. CONCLUSIONS Rhesus immune responses to SIV Gag expressed by rBCG vectors were independent from pre-existing anti-mycobacterial immunity. Rhesus macaques may serve as a surrogate for investigations of pre-existing anti-mycobacterial immunity in humans.
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Affiliation(s)
- Birgit Korioth-Schmitz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Casey C Perley
- Duke University School of Medicine, Durham, NC 27710, United States
| | - Jaimie D Sixsmith
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
| | - Eva M Click
- Duke University School of Medicine, Durham, NC 27710, United States
| | - Sunhee Lee
- Duke University School of Medicine, Durham, NC 27710, United States
| | - Norman L Letvin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, United States
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Mycobacterium bovis BCG Vaccination Induces Divergent Proinflammatory or Regulatory T Cell Responses in Adults. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:778-88. [PMID: 25947145 DOI: 10.1128/cvi.00162-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022]
Abstract
Mycobacterium bovis bacillus Calmette-Guérin (BCG), the only currently available vaccine against tuberculosis, induces variable protection in adults. Immune correlates of protection are lacking, and analyses on cytokine-producing T cell subsets in protected versus unprotected cohorts have yielded inconsistent results. We studied the primary T cell response, both proinflammatory and regulatory T cell responses, induced by BCG vaccination in adults. Twelve healthy adult volunteers who were tuberculin skin test (TST) negative, QuantiFERON test (QFT) negative, and BCG naive were vaccinated with BCG and followed up prospectively. BCG vaccination induced an unexpectedly dichotomous immune response in this small, BCG-naive, young-adult cohort: BCG vaccination induced either gamma interferon-positive (IFN-γ(+)) interleukin 2-positive (IL-2(+)) tumor necrosis factor α-positive (TNF-α(+)) polyfunctional CD4(+) T cells concurrent with CD4(+) IL-17A(+) and CD8(+) IFN-γ(+) T cells or, in contrast, virtually absent cytokine responses with induction of CD8(+) regulatory T cells. Significant induction of polyfunctional CD4(+) IFN-γ(+) IL-2(+) TNF-α(+) T cells and IFN-γ production by peripheral blood mononuclear cells (PBMCs) was confined to individuals with strong immunization-induced local skin inflammation and increased serum C-reactive protein (CRP). Conversely, in individuals with mild inflammation, regulatory-like CD8(+) T cells were uniquely induced. Thus, BCG vaccination either induced a broad proinflammatory T cell response with local inflammatory reactogenicity or, in contrast, a predominant CD8(+) regulatory T cell response with mild local inflammation, poor cytokine induction, and absent polyfunctional CD4(+) T cells. Further detailed fine mapping of the heterogeneous host response to BCG vaccination using classical and nonclassical immune markers will enhance our understanding of the mechanisms and determinants that underlie the induction of apparently opposite immune responses and how these impact the ability of BCG to induce protective immunity to TB.
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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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Singh S, Kumar M, Singh P. Evolution of M. bovis BCG Vaccine: Is Niacin Production Still a Valid Biomarker? Tuberc Res Treat 2015; 2015:957519. [PMID: 25694828 PMCID: PMC4324913 DOI: 10.1155/2015/957519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/15/2014] [Accepted: 01/06/2015] [Indexed: 02/07/2023] Open
Abstract
BCG vaccine is usually considered to be safe though rarely serious complications have also been reported, often incriminating contamination of the seed strain with pathogenic Mycobacterium tuberculosis. In such circumstances, it becomes prudent to rule out the contamination of the vaccine seed. M. bovis BCG can be confirmed by the absence of nitrate reductase, negative niacin test, and resistance to pyrazinamide and cycloserine. Recently in India, some stocks were found to be niacin positive which led to a national controversy and closer of a vaccine production plant. This prompted us to write this review and the comparative biochemical and genotypic studies were carried out on the these contentious vaccine stocks at the Indian vaccine plant and other seeds and it was found that some BCG vaccine strains and even some strains of M. bovis with eugenic-growth characteristics mainly old laboratory strains may give a positive niacin reaction. Most probably, the repeated subcultures lead to undefined changes at the genetic level in these seed strains. These changing biological characteristics envisage reevaluation of biochemical characters of existing BCG vaccine seeds and framing of newer guidelines for manufacturing, production, safety, and effectiveness of BCG vaccine.
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Affiliation(s)
- Sarman Singh
- 1Division of Clinical Microbiology & Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
- *Sarman Singh:
| | - Manoj Kumar
- 1Division of Clinical Microbiology & Molecular Medicine, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pragati Singh
- 2National Polio Surveillance Project, Country Office for India, World Health Organization, Mathura 281001, India
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Evaluation of gamma interferon release assays using Mycobacterium tuberculosis antigens for diagnosis of latent and active tuberculosis in Mycobacterium bovis BCG-vaccinated populations. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2010; 17:1985-90. [PMID: 20943878 DOI: 10.1128/cvi.00294-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
T-cell-based gamma interferon (IFN-γ) release assays (IGRAs) using Mycobacterium tuberculosis-specific antigens have shown higher sensitivity and specificity than the routine tuberculin skin test (TST). However, the effects of Mycobacterium bovis BCG vaccination and anti-tuberculosis (TB) treatment on dynamic T-cell responses to M. tuberculosis-specific antigens in active TB cases have rarely been investigated in regions where TB is endemic. Eighty-nine patients with active pulmonary TB (ATB) and 57 healthy controls (HC) from China were recruited and tested by sputum smear and culture, TSTs, and IGRAs with M. tuberculosis-specific antigens ESAT-6 and CFP-10 (T-SPOT.TB) as well as purified protein derivative (PPD) stimulation. All 146 participants were screened by the T-SPOT.TB assay at recruitment. T-SPOT.TB-positive rates in ATB and HC groups were 87.6% (78/89) and 21.1% (12/57), respectively. Of 38 ATB patients who were both TST and T-SPOT.TB tested, the positive rates were 73.7% (28/38) and 94.7% (36/38), respectively (P = 0.0215), and those in the HC group were 62.3% (33/53) and 18.9% (10/53), respectively (P < 0.0001). The T-SPOT.TB-positive rates declined during TB treatment and were 94.4% (51/54), 86.4% (19/22), and 61.5% (8/13) for ATB patients receiving 0- to 1-month, 1- to 3-month, and 3- to 6-month anti-TB treatment, respectively. The IGRA is a most promising test for both active TB and latent TB infection (LTBI) diagnosis due to the improvement of its specificity and convenience, especially in the Mycobacterium bovis BCG-vaccinated population. Furthermore, the T-SPOT.TB assay using ESAT-6 and CFP-10 in ATB patients during anti-TB treatment could serve as a potential predictor of therapeutic efficacy.
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Araujo Z, de Waard JH, de Larrea CF, Borges R, Convit J. The effect of Bacille Calmette-Guérin vaccine on tuberculin reactivity in indigenous children from communities with high prevalence of tuberculosis. Vaccine 2008; 26:5575-81. [PMID: 18723065 DOI: 10.1016/j.vaccine.2008.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/30/2022]
Abstract
The Bacille Calmette-Guérin (BCG) vaccine is the most widely used vaccine in the world, however it may cause problems for the appropriate interpretation of the tuberculin skin test (TST). We assessed the diagnostic value of latent infection in vaccinated and unvaccinated indigenous children from communities that have a very high prevalence of adult tuberculosis (TB). A total of 997 children under 15 years old and classified in age groups (0-1.9, 2-5, 6-9 and 10-15 years old) were randomly selected and given TSTs using the Mantoux technique. TST induration values of vaccinated children (n=724) were compared with those of children unvaccinated (n=273). BCG vaccination was not an important cause of false-positive TST, except in communities with a low prevalence of active TB. In conclusion, the results suggested that a history of BCG vaccination on TST+ response after 10 years of vaccination was statistically insignificant but whether at earlier age TST+ reflects most probably the degree of exposure to TB cases than BCG vaccination should be clarified in the future.
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Affiliation(s)
- Zaida Araujo
- Laboratorio de Inmunología de Enfermedades Infecciosas, Instituto de Biomedicina, Catedra de Inmunologia, Universidad Central de Venezuela, Apartado 4043, Caracas 1010A, Venezuela.
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