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Pittet LF, Messina NL, Gardiner K, Freyne B, Abruzzo V, Francis KL, Morrison C, Zufferey C, Vuillermin P, Allen KJ, Ponsonby A, Robins‐Browne R, Shann F, Flanagan KL, Phillips R, Donath S, Casalaz D, Curtis N. Prevention of infant eczema by neonatal Bacillus Calmette-Guérin vaccination: The MIS BAIR randomized controlled trial. Allergy 2022; 77:956-965. [PMID: 34309859 DOI: 10.1111/all.15022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/13/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) vaccine could play a role in counteracting the rising prevalence of atopic diseases, through its beneficial off-target effects. We aimed to determine whether neonatal BCG vaccination reduces the incidence of eczema in infants. METHODS Randomized controlled trial with 1272 infants allocated to receive BCG-Denmark or no BCG at birth. The primary outcome was the 12-month incidence of eczema based on 3-monthly questionnaires. Eczema was also assessed at a 12-month clinic visit. ClinicalTrial.gov: NCT01906853. RESULTS The 12-month eczema incidence was 32.2% in the BCG group compared with 36.6% in the control group (adjusted risk difference (aRD) -4.3%, 95% CI -9.9% to 1.3%, multiple imputation model). In addition, comparing infants in the BCG group with the control group, 15.7% vs. 19.2% had eczema lesions at the 12-month visit (aRD -3.5%, 95% CI -8.0% to 1.0%); 35.7% vs. 39.0% reported using topical steroids (aRD -3.3, 95% CI -9.2 to 2.7); and 7.3% vs. 10.2% had severe eczema scores (aRD -3.0%, 95% CI -8.8% to 2.7%). In 344 high-risk infants (two atopic parents), the 12-month eczema incidence was 35.3% in the BCG group compared with 46.8% in the control group (aRD -11.5%, 95% CI -21.9% to -1.2%; number needed to treat 8.7, 95% CI 4.6 to 83.3). CONCLUSION There is insufficient evidence to recommend neonatal BCG vaccination in all infants for the prevention of eczema in the first year of life; however, a modest beneficial effect was observed among high-risk infants. A single dose of BCG-Denmark soon after birth could reduce the incidence of eczema in infants with two atopic parents.
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Affiliation(s)
- Laure F. Pittet
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Infectious Diseases The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Nicole L. Messina
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
| | - Kaya Gardiner
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Research Operations The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Bridget Freyne
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics College of Medicine University of MalawiQueen Elizabeth Central Hospital Blantyre Malawi
- Institute of Infection, Veterinary and Ecological Sciences University of Liverpool and Malawi‐Liverpool Wellcome Trust Research Programme Blantyre Malawi
| | - Veronica Abruzzo
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Kate L. Francis
- Clinical Epidemiology & Biostatistics Unit Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Clare Morrison
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Christel Zufferey
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Peter Vuillermin
- School of Medicine Deakin University Geelong Victoria Australia
- Child Health Research Unit Barwon Health Geelong Victoria Australia
| | - Katrina J. Allen
- Formerly Centre for Food and Allergy Research Murdoch Children's Research Institute Parkville Victoria Australia
| | - Anne‐Louise Ponsonby
- Population Allergy Murdoch Children's Research Institute Parkville Victoria Australia
- The Florey Institute for Neuroscience and Mental Health University of Melbourne Melbourne Victoria Australia
| | - Roy Robins‐Browne
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Microbiology and Immunology Peter Doherty Institute for Infection and Immunity The University of Melbourne Melbourne Victoria Australia
| | - Frank Shann
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
| | - Katie L. Flanagan
- School of Health Sciences University of Tasmania Hobart Tasmania Australia
- School of Health and Biomedical Science RMIT University Melbourne Victoria Australia
- Department of Immunology and Pathology Monash University Melbourne Victoria Australia
| | - Rod Phillips
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Dermatology Unit The Royal Children’s Hospital Melbourne Parkville Victoria Australia
| | - Susan Donath
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Clinical Epidemiology & Biostatistics Unit Murdoch Children’s Research Institute Parkville Victoria Australia
| | - Dan Casalaz
- Neonatal Intensive Care Unit Mercy Hospital for Women Heidelberg Victoria Australia
| | - Nigel Curtis
- Infectious Diseases Group Murdoch Children’s Research Institute Parkville Victoria Australia
- Department of Paediatrics The University of Melbourne Parkville Victoria Australia
- Infectious Diseases The Royal Children’s Hospital Melbourne Parkville Victoria Australia
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Tanner R, Villarreal-Ramos B, Vordermeier HM, McShane H. The Humoral Immune Response to BCG Vaccination. Front Immunol 2019; 10:1317. [PMID: 31244856 PMCID: PMC6579862 DOI: 10.3389/fimmu.2019.01317] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
Bacillus Calmette Guérin (BCG) is the only currently available vaccine against tuberculosis (TB), but it confers incomplete and variable protection against pulmonary TB in humans and bovine TB (bTB) in cattle. Insights into the immune response induced by BCG offer an underexploited opportunity to gain knowledge that may inform the design of a more efficacious vaccine, which is urgently needed to control these major global epidemics. Humoral immunity in TB and bTB has been neglected, but recent studies supporting a role for antibodies in protection against TB has driven a growing interest in determining their relevance to vaccine development. In this manuscript we review what is known about the humoral immune response to BCG vaccination and re-vaccination across species, including evidence for the induction of specific B cells and antibodies; and how these may relate to protection from TB or bTB. We discuss potential explanations for often conflicting findings and consider how factors such as BCG strain, manufacturing methodology and route of administration influence the humoral response. As novel vaccination strategies include BCG prime-boost regimens, the literature regarding off-target immunomodulatory effects of BCG vaccination on non-specific humoral immunity is also reviewed. Overall, reported outcomes to date are inconsistent, but indicate that humoral responses are heterogeneous and may play different roles in different species, populations, or individual hosts. Further study is warranted to determine whether a new TB vaccine could benefit from the targeting of humoral as well as cell-mediated immunity.
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Affiliation(s)
- Rachel Tanner
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bernardo Villarreal-Ramos
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, United Kingdom
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - H. Martin Vordermeier
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Bacteriology, Animal and Plant Health Agency, Addlestone, United Kingdom
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Helen McShane
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Kandasamy R, Voysey M, McQuaid F, de Nie K, Ryan R, Orr O, Uhlig U, Sande C, O'Connor D, Pollard AJ. Non-specific immunological effects of selected routine childhood immunisations: systematic review. BMJ 2016; 355:i5225. [PMID: 27737830 PMCID: PMC5063033 DOI: 10.1136/bmj.i5225] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify and characterise non-specific immunological effects after routine childhood vaccines against BCG, measles, diphtheria, pertussis, and tetanus. DESIGN Systematic review of randomised controlled trials, cohort studies, and case-control studies. DATA SOURCES Embase, PubMed, Cochrane library, and Trip searched between 1947 and January 2014. Publications submitted by a panel of experts in the specialty were also included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES All human studies reporting non-specific immunological effects after vaccination with standard childhood immunisations. Studies using recombinant vaccines, no vaccine at all, or reporting only vaccine specific outcomes were excluded. The primary aim was to systematically identify, assemble, and review all available studies and data on the possible non-specific or heterologous immunological effects of BCG; measles; mumps, measles, and rubella (MMR); diphtheria; tetanus; and pertussis vaccines. RESULTS The initial search yielded 11 168 references; 77 manuscripts met the inclusion criteria for data analysis. In most included studies (48%) BCG was the vaccine intervention. The final time point of outcome measurement was primarily performed (70%) between one and 12 months after vaccination. There was a high risk of bias in the included studies, with no single study rated low risk across all assessment criteria. A total of 143 different immunological variables were reported, which, in conjunction with differences in measurement units and summary statistics, created a high number of combinations thus precluding any meta-analysis. Studies that compared BCG vaccinated with unvaccinated groups showed a trend towards increased IFN-γ production in vitro in the vaccinated groups. Increases were also observed for IFN-γ measured after BCG vaccination in response to in vitro stimulation with microbial antigens from Candida albicans, tetanus toxoid, Staphylococcus aureas, lipopolysaccharide, and hepatitis B. Cohort studies of measles vaccination showed an increase in lymphoproliferation to microbial antigens from tetanus toxoid and C albicans Increases in immunogenicity to heterologous antigens were noted after diphtheria-tetanus (herpes simplex virus and polio antibody titres) and diphtheria-tetanus-pertussis (pneumococcus serotype 14 and polio neutralising responses) vaccination. CONCLUSIONS The papers reporting non-specific immunological effects had heterogeneous study designs and could not be conventionally meta-analysed, providing a low level of evidence quality. Some studies, such as BCG vaccine studies examining in vitro IFN-γ responses and measles vaccine studies examining lymphoproliferation to microbial antigen stimulation, showed a consistent direction of effect suggestive of non-specific immunological effects. The quality of the evidence, however, does not provide confidence in the nature, magnitude, or timing of non-specific immunological effects after vaccination with BCG, diphtheria, pertussis, tetanus, or measles containing vaccines nor the clinical importance of the findings.
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Affiliation(s)
- Rama Kandasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Fiona McQuaid
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Karlijn de Nie
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Rebecca Ryan
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Olivia Orr
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Ulrike Uhlig
- Department of Paediatrics, Children's Hospital Oxford, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - Charles Sande
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Daniel O'Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE, UK
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Park SS, Heo EY, Kim DK, Chung HS, Lee CH. The Association of BCG Vaccination with Atopy and Asthma in Adults. Int J Med Sci 2015; 12:668-73. [PMID: 26283887 PMCID: PMC4532975 DOI: 10.7150/ijms.12233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/18/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There are few studies investigating the association between BCG vaccination and atopy or asthma in adults. OBJECTIVE We investigated the association between BCG scar and the occurrence of atopy and asthma in Korean adults. METHODS We carried out a retrospective study of Korean adults who underwent skin prick testing, and, in some cases, spirometry and bronchial provocation tests in a secondary care hospital from April 2010 to February 2011. Atopy status was classified according to allergen/histamine (A/H) ratio of wheal (A/H ratio ≥ 1, atopy; 0 < A/H ratio < 1, intermediate; A/H ratio = 0, non-atopy). A patient with asthma was defined as one who has symptoms compatible with asthma and showed either a positive provocation testing or bronchodilator reversibility. RESULTS Among 200 participants, neither the presence (intermediate vs. non-atopy: adjusted odds ratio (aOR) 0.83; 95% CI 0.26, 2.60; p = 0.75, atopy vs. non-atopy: aOR 0.89; 95% CI 0.33, 2.37; p = 0.81, respectively). nor the size of BCG scar was significantly associated with atopy status. However, among those patients who underwent either bronchodilator response testing or bronchial provocation testing, the presence of BCG scar (aOR 0.33; CI 0.14, 0.77; p = 0.01) and the size of BCG scar were inversely associated with asthma. (p = 0.01) CONCLUSIONS: We found a significant association between BCG scar and asthmatic status in Korean adults, although there was no significant association between either the presence or size of BCG scar and atopy.
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Affiliation(s)
- Sung Soo Park
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Eun Young Heo
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Hee Soon Chung
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea ; 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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5
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Zhang G, Wang P, Qiu Z, Qin X, Lin X, Li N, Huang H, Liu H, Hua W, Chen Z, Zhao H, Li W, Shen H. Distant lymph nodes serve as pools of Th1 cells induced by neonatal BCG vaccination for the prevention of asthma in mice. Allergy 2013; 68:330-8. [PMID: 23346957 DOI: 10.1111/all.12099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neonatal Bacillus Calmette-Guérin (BCG) vaccination induces vigorous T-helper type 1 (Th1) responses and inhibits allergy-related airway dysfunction, but the exact mechanisms remain unclear. The objective of this study was to address where the Th1 cells induced by neonatal BCG vaccination are generated and stored, and how they are recruited into the inflamed airway for the prevention of allergen-induced airway inflammation. METHODS We vaccinated neonatal C57BL/6 mice with BCG in a mouse model of asthma and analyzed the expression and function of Th1 cells in vivo and in vitro. RESULTS BCG vaccination-induced Th1 cells in the local inguinal lymph nodes (ILN) migrated into the lungs upon inhaled ovalbumin (OVA) challenge in OVA-sensitized mice. These CD4(+) T cells in the ILN exhibited potentials of activation, proliferation and cytokine secretion and expressed high levels of CXCR3. Adoptive transfer of CD4(+) T cells from BCG-treated ILN significantly decreased allergic airway responses. In addition, the protective effect of BCG vaccination against allergic airway inflammation was lost upon the excision of the ILN. CONCLUSIONS These data demonstrate that ILN serves as a 'weapon' pool of Th1 cells following BCG vaccination, and these cells are ready for the migration into the inflamed lungs upon the allergen challenge, thereby inhibiting allergen-induced airway disorder.
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Affiliation(s)
- G. Zhang
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - P. Wang
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - Z. Qiu
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - X. Qin
- Department of Respiratory Disease; People's Hospital of Guangxi Zhuang Autonomous Region; Nanning; China
| | - X. Lin
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - N. Li
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - H. Huang
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - H. Liu
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - W. Hua
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - Z. Chen
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
| | - H. Zhao
- Pulmonary & Critical Care Unit; Massachusetts General Hospital; Harvard Medical School; Boston; MA; USA
| | - W. Li
- Department of Respiratory and Critical Care Medicine; Second Affiliated Hospital; Zhejiang University School of Medicine; Hangzhou
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6
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Deng Y, Chen W, Zang N, Li S, Luo Y, Ni K, Wang L, Xie X, Liu W, Yang X, Fu Z, Liu E. The antiasthma effect of neonatal BCG vaccination does not depend on the Th17/Th1 but IL-17/IFN-γ balance in a BALB/c mouse asthma model. J Clin Immunol 2011; 31:419-29. [PMID: 21340706 DOI: 10.1007/s10875-010-9503-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/27/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to determine whether the protective effects of the Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination on allergic asthma are associated with the T helper (Th) 17/Th1 balance in a murine asthma model. METHODS BALB/c neonates were vaccinated with BCG on the first day after birth, sensitized with ovalbumin, and then challenged with allergen. The resulting airway inflammation and responsiveness were measured. The levels of IL-17 and interferon (IFN)-γ in BALF and ratio of Th17/Th1 were investigated. RESULTS We found that although BCG neonatal vaccination inhibited airway hyperresponsiveness and inflammation following allergen challenge in a BALB/c mouse asthma model, reduced levels of Th2 cytokines were not observed. However, BCG neonatal vaccination reduced IL-17 production and increased IFN-γ production in both the bronchoalveolar lavage fluid and the lung lymphocytes in asthmatic mice. CONCLUSION The antiasthma effects of neonatal BCG vaccination reversed the IL-17/IFN-γ imbalance in a murine asthma model but did not depend on modifying the Th17/Th1 balance.
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Affiliation(s)
- Yu Deng
- Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Chongqing, 400014, People's Republic of China
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Thorburn AN, Hansbro PM. Harnessing regulatory T cells to suppress asthma: from potential to therapy. Am J Respir Cell Mol Biol 2010; 43:511-9. [PMID: 20097830 DOI: 10.1165/rcmb.2009-0342tr] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Regulatory T cells (Tregs) play an essential role in maintaining the homeostatic balance of immune responses. Asthma is an inflammatory condition of the airways that is driven by dysregulated immune responses toward normally innocuous antigens. Individuals with asthma have fewer and less functional Tregs, which may lead to uncontrolled effector cell responses and promote proasthmatic responses of T helper type 2, T helper 17, natural killer T, antigen-presenting, and B cells. Tregs have the capacity to either directly or indirectly suppress these responses. Hence, the induced expansion of functional Tregs in predisposed or individuals with asthma is a potential approach for the prevention and treatment of asthma. Infection by a number of micro-organisms has been associated with reduced prevalence of asthma, and many infectious agents have been shown to induce Tregs and reduce allergic airways disease in mouse models. The translation of the regulatory and therapeutic properties of infectious agents for use in asthma requires the identification of key modulatory components and the development and trial of effective immunoregulatory therapies. Further translational and clinical research is required for the induction of Tregs to be harnessed as a therapeutic strategy for asthma.
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Affiliation(s)
- Alison N Thorburn
- Centre for Asthma and Respiratory Disease and Hunter Medical Research Institute, the University of Newcastle, Newcastle, Australia
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Choi IS, Lin XH, Koh YA, Cui Y. BCG-induced dendritic cell responses and suppression of interleukin-5 production from T cells in atopic asthmatics. J Korean Med Sci 2008; 23:628-34. [PMID: 18756049 PMCID: PMC2526385 DOI: 10.3346/jkms.2008.23.4.628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacille Calmette-Guérin (BCG) induces potent Th1 responses with the help of interleukin (IL)-10 and IL-12 released from dendritic cells (DCs), and suppresses Th2- associated allergic reactions. However, there are still some controversies on therapeutic effects of BCG in asthmatics. This study investigated whether BCG administration to DCs suppresses IL-5 production from T cells in atopic asthmatics. DCs derived from peripheral blood of subjects were cultured with or without BCG and Dermatophagoides farinae extract. Some DCs were co-cultured with T cells in the presence of BCG or the above culture supernatants. In the atopic asthmatics, BCG significantly increased IL-10 and IL-12 production from DCs. In the presence of D. farinae extract, BCG further increased IL-10 production. BCG-induced IL-10 production was significantly higher in the atopics (n=14) than in the non-atopics (n=9). Both BCG and the BCG-treated DCs culture supernatant significantly increased IFN-gamma production from T cells. Both BCG and the supernatant from DCs+BCG+D. farinae co-cultures significantly decreased IL-5 production (all p<0.05), but the supernatant from DCs+BCG co-cultures did not. In conclusion, administration of BCG together with D. farinae extract effectively decreased IL-5 production from T cells, probably through the action of IL-10 and IL-12 released from DCs in D. farinae-sensitive asthmatics.
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Affiliation(s)
- Inseon S Choi
- Department of Allergy, Chonnam National University Medical School, Dong-gu, Gwangju, Korea.
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Sánchez-Solis M, García-Marcos L. Do vaccines modify the prevalence of asthma and allergies? Expert Rev Vaccines 2007; 5:631-40. [PMID: 17181437 DOI: 10.1586/14760584.5.5.631] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epidemiological studies suggest the hypothesis that the increase in asthma and allergies in the industrialized world can be explained by a decline in the number of infectious diseases occurring during childhood. In the context of this 'hygiene hypothesis', is immunization in early life a risk factor for promoting allergic diseases? The majority of studies, especially those conducted with more extensive populations, have not found an increased risk, and although 'not finding an increased risk' is not the same as 'the non-existence of any risk at all', it seems that the evidence is tipped in favor of the absence of risk. Conversely, although some surveys have described a protective effect of vaccination, the majority refuted this result. If there is any effect, it is probably a weak one.
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Affiliation(s)
- Manuel Sánchez-Solis
- Institute of Respiratory Health, University of Murcia, Pediatrics Pneumology Unit, Universitary Hospital Virgen de la Arrixaca, Murcia, Spain.
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Harada M, Magara-Koyanagi K, Watarai H, Nagata Y, Ishii Y, Kojo S, Horiguchi S, Okamoto Y, Nakayama T, Suzuki N, Yeh WC, Akira S, Kitamura H, Ohara O, Seino KI, Taniguchi M. IL-21-induced Bepsilon cell apoptosis mediated by natural killer T cells suppresses IgE responses. ACTA ACUST UNITED AC 2006; 203:2929-37. [PMID: 17178921 PMCID: PMC2118181 DOI: 10.1084/jem.20062206] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Epidemiological studies have suggested that the recent increase in the incidence and severity of immunoglobulin (Ig)E-mediated allergic disorders is inversely correlated with Mycobacterium bovis bacillus Calmette Guerin (BCG) vaccination; however, the underlying mechanisms remain uncertain. Here, we demonstrate that natural killer T (NKT) cells in mice and humans play a crucial role in the BCG-induced suppression of IgE responses. BCG-activated murine Vα14 NKT cells, but not conventional CD4 T cells, selectively express high levels of interleukin (IL)-21, which preferentially induces apoptosis in Bɛ cells. Signaling from the IL-21 receptor increases the formation of a complex between Bcl-2 and the proapoptotic molecule Bcl-2–modifying factor, resulting in Bɛ cell apoptosis. Similarly, BCG vaccination induces IL-21 expression by human peripheral blood mononuclear cells (PBMCs) in a partially NKT cell–dependent fashion. BCG-activated PBMCs significantly reduce IgE production by human B cells. These findings provide new insight into the therapeutic effect of BCG in allergic diseases.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/metabolism
- Animals
- Antibodies, Monoclonal/pharmacology
- Antibody Formation/immunology
- Antigens, CD1/immunology
- Antigens, CD1d
- Apoptosis/immunology
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Female
- Gene Expression
- Humans
- Immunoglobulin E/blood
- Immunoglobulin E/immunology
- Interleukin-12/genetics
- Interleukin-12/metabolism
- Interleukin-12/pharmacology
- Interleukins/physiology
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Liver/immunology
- Liver/metabolism
- Mice
- Mice, Inbred BALB C
- Mice, Knockout
- Monocytes, Activated Killer/immunology
- Mycobacterium bovis/immunology
- Ovalbumin/immunology
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
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Affiliation(s)
- Michishige Harada
- Laboratory for Immune Regulation, RIKEN Research Center for Allergy and Immunology, Yokohama, Kanagawa 230-0045, Japan
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Vuitton DA, Dalphin JC. Hygiène et allergie : les micro-organismes des fermes sont-ils protecteurs ? J Mycol Med 2006. [DOI: 10.1016/j.mycmed.2006.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Feleszko W, Jaworska J, Hamelmann E. Toll-like receptors—novel targets in allergic airway disease (probiotics, friends and relatives). Eur J Pharmacol 2006; 533:308-18. [PMID: 16436277 DOI: 10.1016/j.ejphar.2005.12.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2005] [Indexed: 02/04/2023]
Abstract
Experimental and epidemiological studies enabled to hypothesize that stimulation of the immune system by selected microbial products may prevent or treat allergic diseases. According to recent advances in molecular immunology, this stimulation acts via group of conserved receptors present on antigen presenting cells, known as toll-like receptors (TLRs). These receptors play an essential role in antigen presentation and latter development of immune response into pro-allergic (Th2), cellular (Th1) or regulatory (Tr1) responses. Since toll-like receptors govern decisive points in immune regulation, an extensive research focuses on agents interfering with their immunomodulatory activities. In this report, we review information on the potential use of microbial products in allergy prevention and therapy, which are believed to target toll-like receptor network. Current toll-like receptor-based approaches, as well as potential use of lipopolysaccharide (and derivates), oligonucleotides, mycobacteria, bacterial extracts, and probiotics are discussed herein.
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Affiliation(s)
- Wojciech Feleszko
- Department of Pediatric Pneumology and Allergy, The Medical University Children's Hospital, The Medical University of Warsaw, Warsaw, Poland.
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Chen W, KuoLee R, Patel GB. Therapeutic potential of microbes and microbial products in the management of human allergic asthma. Expert Opin Ther Pat 2005. [DOI: 10.1517/13543776.15.7.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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García-Marcos L, Suárez-Varela MM, Canflanca IM, Garrido JB, Quirós AB, López-Silvarrey Varela A, Hernández GG, Guillén-Grima F, Díaz CG, González IH, Pena AA, Monge RB. BCG immunization at birth and atopic diseases in a homogeneous population of Spanish schoolchildren. Int Arch Allergy Immunol 2005; 137:303-9. [PMID: 15970638 DOI: 10.1159/000086461] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 03/24/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The role of immunization with bacillus Calmette-Guérin (BCG) in the prevalence of asthma, hay fever and atopic dermatitis is not definitely established and seems to be influenced by ethnic background. The aim of this study was to analyze the relationship between this immunization and the prevalence of those diseases in a homogeneous population of Spanish schoolchildren. METHODS The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in four different centers of the Spanish North Atlantic coast. Bilbao, San Sebastián and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruña discontinued this practice in 1989. Except for this center, immunization coverage was above 90%. A random sample of schools of Asturias or all schools in the city district (rest of centers) with children 6 and 7 years old was surveyed. RESULTS The participation rate was above 70%. After excluding those children born outside Spain, the numbers were 6,762 immunized and 2,828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, older and younger siblings and having a cat or a dog during the first year of the child's life, the adjusted ORs of the BCG-immunized children suffering from asthma, hay fever and atopic dermatitis were respectively 0.87 (95% CI 0.76-1.00), 0.87 (0.75-1.01) and 0.89 (0.76-1.05). CONCLUSIONS BCG immunization offers a weak but significant protection against asthma and hay fever in Spanish schoolchildren.
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Affiliation(s)
- L García-Marcos
- Cartagena Clinical and Research Unit and Department of Pediatrics, University of Murcia, Spain
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Vargas MH. Ecological association between scarlet fever and asthma. Respir Med 2005; 100:363-6. [PMID: 15946835 DOI: 10.1016/j.rmed.2005.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
One plausible explanation for the worldwide epidemic increase of asthma prevalence is the hygiene hypothesis, which suggests that better control of infections shifts the immune response toward an allergic phenotype. However, studies demonstrating an inverse association between asthma and infectious diseases are scarce and possess conflicting results. To explore the relationship between asthma and scarlet fever, an ecological analysis of their national trends was carried out. Association of both diseases in their annual (1996-2003), seasonal (by month) and geographic (by state) trends was evaluated using the Spearman's correlation coefficient (r(S)). Results showed a strong inverse association between asthma and scarlet fever in all settings. Thus, annual incidence rates of both diseases showed an r(S)=-0.93 (P=0.0009). Seasonal patterns showed a higher proportion of new asthma cases from September to January, while the number of scarlet fever cases increased from March to June (r(S)=-0.84, P=0.0006, 1-month lag). Among the 32 Mexican states, the higher the incidence of scarlet fever the lower the incidence of asthma (r(S)=-0.47, P=0.007). These results suggest that Streptococcus pyogenes, the causative agent of scarlet fever, might be one of the major protagonists of the hygiene hypothesis, a possibility deserving of further investigation.
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Affiliation(s)
- Mario H Vargas
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330, CP 06720, México DF, México.
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