Tuberculosis vaccines: developmental work and the future

Preclinical testing of new vaccines for tuberculosis: A comprehensive review

The past decade has seen an explosive increase in the development of potential new tuberculosis vaccine candidates, as well as the establishment of at least two testing centers. Various animal models, but particularly the mouse and guinea pig models, have provided a lot information about how new vaccines can reduce disease progression and how this influences the pathology of the disease, but there is still much to learn at the immunological level, particularly in terms of the nature of the T cell response that is needed to confer long lived resistance. Several categories of vaccine candidates have been tried to date, and there are at least five individual vaccines moving towards clinical evaluation. There are still areas of the field that are poorly developed however. These include the fact that we have no models of post- exposure vaccination, or any models of latent disease. In addition, no standardized models of safety/toxicology exist as yet, which will be needed before extensive clinical development of the new vaccines.

Controversies in BCG immunization

Despite controversies BCG vaccination has stood the test of time. World Health Organization continues to recommend its use in infant immunization programme in countries with heavy endemicity and where threatening HIV epidemic in an emerging problem > 85% efficacy have been established in recent years against hematogenous spread of the disease and > or = 50% efficacy even against pulmonary tuberculosis. Host related factors, agent related factors, vaccine related factors and inadequacy of evaluation tests determine the BCG vaccine efficacy. Identification of complete BCG genome in 1998 has opened new vistas in newer BCG vaccine development. Adoption of a '5C' concept viz. Case detection, Chemotherapy short course, Contact elimination, Chemoprophylaxis and lastly control in BCG vaccine will be a desirable national approach in combating adult and childhood TB.

Tuberculosis vaccine development

If the end of the 20th century saw the flowering of genomics, the beginning of the 21st century is witnessing an equally rapid blossoming of proteomics. These twin technologies have had a dramatic influence on the study of tuberculosis (TB), and nowhere more so than in the development of new TB vaccines. Only a few years ago, it was generally accepted that clinical trials of new TB vaccines would not take place for at least a decade. However, the first trials are now scheduled to start within months. Much TB vaccine research has thus shifted from developing new vaccines, to selecting the best vaccines for human use from the increasing number of effective new candidates becoming available. This selection is being eased by the improved animal models that have been developed over the past few years and by our increasing understanding of immunity to TB.

Failure of the Mycobacterium bovis BCG vaccine: some species of environmental mycobacteria block multiplication of BCG and induction of protective immunity to tuberculosis

The efficacy of Mycobacterium bovis bacillus Calmette-Guérin (BCG) vaccine against pulmonary tuberculosis (TB) varies enormously in different populations. The prevailing hypothesis attributes this variation to interactions between the vaccine and mycobacteria common in the environment, but the precise mechanism has so far not been clarified. Our study demonstrates that prior exposure to live environmental mycobacteria can result in a broad immune response that is recalled rapidly after BCG vaccination and controls the multiplication of the vaccine. In these sensitized mice, BCG elicits only a transient immune response with a low frequency of mycobacterium-specific cells and no protective immunity against TB. In contrast, the efficacy of TB subunit vaccines was unaffected by prior exposure to environmental mycobacteria. Six different isolates from soil and sputum samples from Karonga district in Northern Malawi (a region in which BCG vaccination has no effect against pulmonary TB) were investigated in the mouse model, and two strains of the Mycobacterium avium complex were found to block BCG activity completely.

Reverse vaccinology

Biochemical, serological and microbiological methods have been used to dissect pathogens and identify the components useful for vaccine development. Although successful in many cases, this approach is time-consuming and fails when the pathogens cannot be cultivated in vitro, or when the most abundant antigens are variable in sequence. Now genomic approaches allow prediction of all antigens, independent of their abundance and immunogenicity during infection, without the need to grow the pathogen in vitro. This allows vaccine development using non-conventional antigens and exploiting non-conventional arms of the immune system. Many vaccines impossible to develop so far will become a reality. Since the process of vaccine discovery starts in silico using the genetic information rather than the pathogen itself, this novel process can be named reverse vaccinology.