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Andualem H, Hollams E, Kollmann TR, Amenyogbe N. BCG-Induced Immune Training: Interplay between Trained Immunity and Emergency Granulopoiesis. J Mol Biol 2023; 435:168169. [PMID: 37263392 DOI: 10.1016/j.jmb.2023.168169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
Bacille Calmette-Guérin (BCG) is the most commonly administered vaccine in human history. The medical application of BCG extends far beyond the fight against tuberculosis. Despite its stellar medical record over 100 years, insight into how BCG provides this vast range of benefits is largely limited, both for its pathogen-specific (tuberculosis) as well as pathogen-agnostic (other infections, autoimmunity, allergies, and cancer) effects. Trained immunity and emergency granulopoiesis have been identified as mediating BCG's pathogen-agnostic effects, for which some of the molecular mechanisms have been delineated. Upon review of the existing evidence, we postulate that emergency granulopoiesis and trained immunity are a continuum of the same effect cascade. In this context, we highlight that BCG's pathogen-agnostic benefits could be optimized by taking advantage of the age of the recipient and route of BCG administration.
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Affiliation(s)
- Henok Andualem
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Ethiopia.
| | - Elysia Hollams
- Telethon Kids Institute, Perth, Western Australia, Australia
| | | | - Nelly Amenyogbe
- Telethon Kids Institute, Perth, Western Australia, Australia
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Jensen KJ, Hansen MS, Skovgaard K, Svensson E, Larsen LE, Heegaard PMH, Benn CS, Jungersen G. Immunogenicity of Bacillus Calmette-Guérin in pigs: potential as a translational model of non-specific effects of BCG. Front Immunol 2023; 14:1219006. [PMID: 37520542 PMCID: PMC10374211 DOI: 10.3389/fimmu.2023.1219006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Clinical and immunological studies in humans show that the live attenuated Bacillus Calmette-Guérin (BCG) vaccine has beneficial non-specific effects, increasing resistance against diseases other than tuberculosis. The underlying mechanisms are currently being explored. The pig exhibits considerable physiological similarity to humans in anatomy and physiology, suggesting that similar responses to BCG could be expected. Studies of the non-specific effects of BCG in pigs are scarce. We investigated the feasibility of using pigs as a large animal model to investigate the non-specific immunological effects of BCG. Methods In a series of experiments, we randomized newborn or young piglets from conventional farms to receiving BCG or placebo and investigated the persistence of live BCG bacteria in various tissues, the immunogenicity of BCG in ex vivo blood and in vitro stimulation assays, and the acute phase protein and clinical responses to heterologous infectious challenge with influenza A virus or Actinobacillus pleuropneumoniae. Results The BCG vaccine was generally well tolerated. In contrast to humans, no skin reaction in the form of abscesses, ulcers, or scars was observed. Live BCG was recovered from draining lymph nodes in 2/13 animals 20 weeks after vaccination. Specific in vitro responses of IFN-γ to antigen-specific re-stimulation with mycobacterial antigen were increased but not TNF-responses to TLR2 or TLR4 agonists. A few genes were differentially expressed in blood after vaccination, including the antiviral genes RIG-I and CSF1, although the effect disappeared after correction for multiple testing. Clinical symptoms after heterologous bacterial or viral respiratory infections did not differ, nor did virus copies in nasopharyngeal samples after the challenge. However, the acute phase protein response was significantly reduced in BCG-vaccinated animals after influenza challenge but not after A. pleuropneumoniae challenge. Discussion BCG was safe in pigs, inducing specific immunological responses, but our model did not corroborate the innate immunological responsiveness to BCG seen in humans. The dose of BCG or the bacterial and viral challenges may have been sub-optimal. Even so, the acute phase protein response to influenza infection was significantly reduced in BCG-vaccinated animals.
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Affiliation(s)
- Kristoffer Jarlov Jensen
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
- Copenhagen Phase IV Unit, Center for Clinical Research and Prevention and Department of Clinical Pharmacology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Frederiksberg, Denmark
| | - Mette Sif Hansen
- Institute for Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
- Center for Diagnostics, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Kerstin Skovgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Erik Svensson
- Department of Tuberculosis and Mycobacteria, Statens Serum Institut, Copenhagen, Denmark
| | - Lars Erik Larsen
- Institute for Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Peter M. H. Heegaard
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, University of Southern Denmark, Copenhagen, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Gregers Jungersen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kgs. Lyngby, Denmark
- Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
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Strandmark J, Darboe A, Diray-Arce J, Ben-Othman R, Vignolo SM, Rao S, Smolen KK, Leroux-Roels G, Idoko OT, Sanchez-Schmitz G, Ozonoff A, Levy O, Kollmann TR, Marchant A, Kampmann B. A single birth dose of Hepatitis B vaccine induces polyfunctional CD4 + T helper cells. Front Immunol 2022; 13:1043375. [PMID: 36426360 PMCID: PMC9681035 DOI: 10.3389/fimmu.2022.1043375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 04/13/2024] Open
Abstract
A single birth-dose of Hepatitis B vaccine (HepB) can protect newborns from acquiring Hepatitis B infection through vertical transmission, though several follow-up doses are required to induce long-lived protection. In addition to stimulating antibodies, a birth-dose of HepB might also induce polyfunctional CD4+ T-cells, which may contribute to initial protection. We investigated whether vaccination with HepB in the first week of life induced detectable antigen-specific CD4+ T-cells after only a single dose and following completion of the entire HepB vaccine schedule (3 doses). Using HBsAg- stimulated peripheral blood mononuclear cells from 344 infants, we detected increased populations of antigen-specific polyfunctional CD154+IL-2+TNFα+ CD4+ T-cells following a single birth-dose of HepB in a proportion of infants. Frequencies of polyfunctional T-cells increased following the completion of the HepB schedule but increases in the proportion of responders as compared to following only one dose was marginal. Polyfunctional T-cells correlated positively with serum antibody titres following the birth dose (day30) and completion of the 3-dose primary HepB vaccine series (day 128). These data indicate that a single birth dose of HepB provides immune priming for both antigen-specific B- and T cells.
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Affiliation(s)
- Julia Strandmark
- Vaccines & Immunity Theme, Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine (LSHTM), Fajara, Gambia
| | - Alansana Darboe
- Vaccines & Immunity Theme, Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine (LSHTM), Fajara, Gambia
| | - Joann Diray-Arce
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Rym Ben-Othman
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sofia M. Vignolo
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
| | - Shun Rao
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
| | - Kinga K. Smolen
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | | | - Olubukola T. Idoko
- Vaccines & Immunity Theme, Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine (LSHTM), Fajara, Gambia
| | - Guzmán Sanchez-Schmitz
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Al Ozonoff
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Klarman Cell Observatory & Global Health Initiative, Broad Institute of the Massachusetts Institute of Technology (MIT) & Harvard, Cambridge, MA, United States
| | - Ofer Levy
- Precision Vaccines Program, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Klarman Cell Observatory & Global Health Initiative, Broad Institute of the Massachusetts Institute of Technology (MIT) & Harvard, Cambridge, MA, United States
| | - Tobias R. Kollmann
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
| | - Beate Kampmann
- Vaccines & Immunity Theme, Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine (LSHTM), Fajara, Gambia
- The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fish EN, Benn CS, Klein SL. Introduction. Vaccine 2022; 40:1513-1515. [DOI: 10.1016/j.vaccine.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hupert N, Marín-Hernández D, Gao B, Águas R, Nixon DF. Heterologous vaccination interventions to reduce pandemic morbidity and mortality: Modeling the US winter 2020 COVID-19 wave. Proc Natl Acad Sci U S A 2022; 119:e2025448119. [PMID: 35012976 PMCID: PMC8784160 DOI: 10.1073/pnas.2025448119] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 remains a stark health threat worldwide, in part because of minimal levels of targeted vaccination outside high-income countries and highly transmissible variants causing infection in vaccinated individuals. Decades of theoretical and experimental data suggest that nonspecific effects of non-COVID-19 vaccines may help bolster population immunological resilience to new pathogens. These routine vaccinations can stimulate heterologous cross-protective effects, which modulate nontargeted infections. For example, immunization with Bacillus Calmette-Guérin, inactivated influenza vaccine, oral polio vaccine, and other vaccines have been associated with some protection from SARS-CoV-2 infection and amelioration of COVID-19 disease. If heterologous vaccine interventions (HVIs) are to be seriously considered by policy makers as bridging or boosting interventions in pandemic settings to augment nonpharmaceutical interventions and specific vaccination efforts, evidence is needed to determine their optimal implementation. Using the COVID-19 International Modeling Consortium mathematical model, we show that logistically realistic HVIs with low (5 to 15%) effectiveness could have reduced COVID-19 cases, hospitalization, and mortality in the United States fall/winter 2020 wave. Similar to other mass drug administration campaigns (e.g., for malaria), HVI impact is highly dependent on both age targeting and intervention timing in relation to incidence, with maximal benefit accruing from implementation across the widest age cohort when the pandemic reproduction number is >1.0. Optimal HVI logistics therefore differ from optimal rollout parameters for specific COVID-19 immunizations. These results may be generalizable beyond COVID-19 and the US to indicate how even minimally effective heterologous immunization campaigns could reduce the burden of future viral pandemics.
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Affiliation(s)
- Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065;
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
- Cornell Institute for Disease and Disaster Preparedness, Cornell University, New York, NY 10065
| | - Daniela Marín-Hernández
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
| | - Bo Gao
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Ricardo Águas
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, United Kingdom
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY 10065
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Marín-Hernández D, Nixon DF, Hupert N. Heterologous vaccine interventions: boosting immunity against future pandemics. Mol Med 2021; 27:54. [PMID: 34058986 PMCID: PMC8165337 DOI: 10.1186/s10020-021-00317-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/20/2021] [Indexed: 12/14/2022] Open
Abstract
While vaccines traditionally have been designed and used for protection against infection or disease caused by one specific pathogen, there are known off-target effects from vaccines that can impact infection from unrelated pathogens. The best-known non-specific effects from an unrelated or heterologous vaccine are from the use of the Bacillus Calmette-Guérin (BCG) vaccine, mediated partly through trained immunity. Other vaccines have similar heterologous effects. This review covers molecular mechanisms behind the heterologous effects, and the potential use of heterologous vaccination in the current COVID-19 pandemic. We then discuss novel pandemic response strategies based on rapidly deployed, widespread heterologous vaccination to boost population-level immunity for initial, partial protection against infection and/or clinical disease, while specific vaccines are developed.
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Affiliation(s)
- Daniela Marín-Hernández
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, Belfer Research Building, Room 530, 413 E. 69th street, New York, NY 10065 USA
| | - Douglas F. Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, Belfer Research Building, Room 530, 413 E. 69th street, New York, NY 10065 USA
| | - Nathaniel Hupert
- Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th Street, New York, NY 10065 USA
- Cornell Institute for Disease and Disaster Preparedness, Weill Cornell Medicine, 402 E. 67th Street, New York, NY 10065 USA
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