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Shin D, Shin Y, Kim E, Nam H, Nan H, Lee J. Immunological characteristics of MAV/06 strain of varicella-zoster virus vaccine in an animal model. BMC Immunol 2022; 23:27. [PMID: 35658899 PMCID: PMC9166591 DOI: 10.1186/s12865-022-00503-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Varicella-zoster virus (VZV) is a pathogen that causes chickenpox and shingles in humans. Different types of the varicella vaccines derived from the Oka and MAV/06 strains are commercially available worldwide. Although the MAV/06 vaccine was introduced in 1990s, little was known about immunological characteristics. RESULTS Here, we evaluated B and T cell immune response in animals inoculated with the Oka and MAV/06 vaccines as well as a new formulation of the MAV/06 vaccine. A variety of test methods were applied to evaluate T and B cell immune response. Plaque reduction neutralization test (PRNT) and fluorescent antibody to membrane antigen (FAMA) assay were conducted to measure the MAV/06 vaccine-induced antibody activity against various VZVs. Glycoprotein enzyme-linked immunosorbent assay (gpELISA) was used to compare the degree of the antibody responses induced by the two available commercial VZV vaccines and the MAV/06 vaccine. Interferon-gamma enzyme-linked immunosorbent spot (IFN-γ ELISpot) assays and cytokine bead array (CBA) assays were conducted to investigate T cell immune responses. Antibodies induced by MAV/06 vaccination showed immunogenicity against a variety of varicella-zoster virus and cross-reactivity among the virus clades. CONCLUSIONS It is indicating the similarity of the antibody responses induced by commercial varicella vaccines and the MAV/06 vaccine. Moreover, VZV-specific T cell immune response from MAV/06 vaccination was increased via Th1 cell response. MAV/06 varicella vaccine induced both humoral and cellular immune response via Th1 cell mediated response.
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Affiliation(s)
- Duckhyang Shin
- GC Biopharma Corp., 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Younchul Shin
- GC Biopharma Corp., 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Eunmi Kim
- MOGAM Institute for Biomedical Research, 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Hyojung Nam
- GC Biopharma Corp., 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Haiyan Nan
- GC Biopharma Corp., 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Jaewoo Lee
- GC Biopharma Corp., 107, Ihyeon-ro 30beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
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Levin MJ, Weinberg A. Immune Responses to Varicella-Zoster Virus Vaccines. Curr Top Microbiol Immunol 2022; 438:223-246. [PMID: 35102438 DOI: 10.1007/82_2021_245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The live attenuated varicella vaccine is intended to mimic the tempo and nature of the humoral and cell-mediated immune responses to varicella infection. To date, two doses of varicella vaccine administered in childhood have been very effective in generating varicella-zoster virus (VZV) immune responses that prevent natural infection for at least several decades. After primary infection, the infecting VZV establishes latency in sensory and cranial nerve ganglia with the potential to reactivate and cause herpes zoster. Although, the immune responses developed during varicella are important for preventing herpes zoster they wane with increasing age (immune senescence) or with the advent of immune suppression. Protection can be restored by increasing cell-mediated immune responses with two doses of an adjuvanted recombinant VZV glycoprotein E vaccine that stimulates both VZV-and gE-specific immunity. This vaccine provides ~85-90% protection against herpes zoster for 7-8 years (to date).
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Affiliation(s)
- Myron J Levin
- Departments of Pediatrics and Medicine, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Adriana Weinberg
- Departments of Pediatrics, Medicine, and Pathology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
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Gershon AA, Brooks D, Stevenson DD, Chin WK, Oldstone MBA, Gershon MD. High Constitutive Interleukin 10 Level Interferes With the Immune Response to Varicella-Zoster Virus in Elderly Recipients of Live Attenuated Zoster Vaccine. J Infect Dis 2020; 219:1338-1346. [PMID: 30445431 DOI: 10.1093/infdis/jiy660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/12/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Live attenuated zoster vaccine (Zostavax) was used to test the hypothesis that constitutive level of interleukin 10 (IL-10), which may be high in elderly subjects, impairs vaccine efficacy. If constitutive IL-10 impairs vaccine efficacy, the effectiveness of viral vaccines might be improved by transient inhibition of IL-10 before vaccination. METHODS Zostavax was given to 26 patients (age, 60-80 years). IL-10 and immunity to varicella zoster virus (VZV) were measured at baseline and after vaccination. Fluorescent antibody to membrane antigen (FAMA) assays and glycoprotein enzyme-linked immunosorbent assays (gpELISAs) were used to assess humoral immunity; anti-varicella virus T-cell responses were studied in a subset of subjects. In a prospective animal model, T-cell responses to chimeric vaccines against lymphocytic choriomeningitis virus (LCMV) were assessed in mice that express or lack IL-10. RESULTS FAMA assays revealed significant boosting (by 4-fold) of humoral immunity, which occurred only in subjects (10 of 26) with a low constitutive IL-10 level (ie, <20 pg/mL); moreover, the Zostavax-induced FAMA and gpELISA responses were inversely related to the constitutive IL-10 level. Significant VZV-specific T-cell responses followed vaccination only in subjects with a low constitutive IL-10 level. Vaccine-induced LCMV-specific T-cell responses in mice lacking IL-10 were greater than in wild-type animals. CONCLUSIONS A high constitutive IL-10 level adversely affects vaccine efficacy.
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Affiliation(s)
- Anne A Gershon
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - David Brooks
- Princess Margaret Cancer Center, University of Toronto Medical School, Canada
| | - Donald D Stevenson
- Viral-Immunobiology Laboratory, Department of Immunology and Microbiology, Scripps Research Institute, La Jolla, California
| | - William K Chin
- Allergy, Asthma, Clinical Immunology Clinic, Naval Medical Center Portsmouth, Virginia
| | - Michael B A Oldstone
- Division of Allergy and Immunology, Scripps Clinic Medical Group, La Jolla, California
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Tovar Salazar A, McKhann A, Chen H, Bosch RJ, Weinberg A. Immune Correlates of Herpes Zoster in People Living with HIV on Effective Antiretroviral Therapy. AIDS Res Hum Retroviruses 2019; 35:890-895. [PMID: 31179712 DOI: 10.1089/aid.2019.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Herpes zoster (HZ) has high morbidity in people living with HIV (PLHIV). We investigated immunological factors that correlated with the development of HZ in PLHIV with controlled HIV replication on antiretroviral therapy (ART). PLHIV who developed HZ on ART (cases), with undetectable plasma HIV RNA, and CD4 counts ≥200 cells/μL were matched 1:1 to controls by CD4 count, age, gender, race, and duration of ART. Varicella-zoster virus (VZV)-specific T cells and circulating regulatory T cells (Treg) were measured by flow cytometry before and after HZ. Differences between cases and controls were assessed by paired t-tests and longitudinal changes by Wilcoxon signed rank test. HZ cases (N = 31) had higher CD4+FOXP3+CD25+% Treg before HZ compared with 31 controls. After VZV ex vivo restimulation, cases had lower T cell responses, including CD8+perforin+% cytotoxic T lymphocytes (CTLs), CD4+IL10+%, and CD4+TGFβ+% compared with controls. Overall, Treg negatively correlated with VZV-specific Th1 responses. Moreover, Treg decreased over time on ART in HZ cases, VZV-CTLs were stable and did not increase even after HZ. Increased circulating Treg and decreased VZV-specific T cell immune responses were associated with the risk of HZ in PLHIV. The kinetics of Treg over time, but not of VZV-CTLs, paralleled the natural history of HZ, whose incidence decreases over time on effective ART.
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Affiliation(s)
- Adriana Tovar Salazar
- Department of Pediatrics, Anschutz Medical Center University of Colorado Denver, Aurora, Colorado
| | - Ashley McKhann
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Huichao Chen
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Ronald J. Bosch
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Adriana Weinberg
- Department of Pediatrics, Anschutz Medical Center University of Colorado Denver, Aurora, Colorado
- Department of Medicine, Anschutz Medical Center University of Colorado Denver, Aurora, Colorado
- Department of Pathology, Anschutz Medical Center University of Colorado Denver, Aurora, Colorado
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The Effect of Age on the Immunogenicity of the Live Attenuated Zoster Vaccine Is Predicted by Baseline Regulatory T Cells and Varicella-Zoster Virus-Specific T Cell Immunity. J Virol 2019; 93:JVI.00305-19. [PMID: 31092579 DOI: 10.1128/jvi.00305-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/30/2022] Open
Abstract
Older age is associated with increased infectious morbidity and decreased immune responses to vaccines, but the mechanisms that mediate this effect are incompletely understood. The efficacy and immunogenicity of the live attenuated zoster vaccine (ZVL) have a very-well-described negative association with the age of the vaccinee. In a study of 600 ZVL recipients 50 to >80 years of age, we investigated immunological factors that might explain the effect of age on the immunogenicity of ZVL. Using FluoroSpot assays and flow cytometry, we determined that varicella-zoster virus (VZV)-specific peak T helper 1 (VZV-Th1) responses to ZVL were independently predicted by prevaccination VZV-Th1 responses, regulatory T cells (Treg), and PD1-expressing immune checkpoint T cells (Tcheck) but not by the age of the vaccinee. Persistence of VZV-Th1 1 year after vaccination was independently predicted by the factors mentioned above, by peak VZV-Th1 responses to ZVL, and by the age of the vaccinee. We further demonstrated by ex vivo blocking experiments the mechanistic role of PD1 and CTLA4 as modulators of decreased VZV-Th1 responses in the study participants. VZV-specific cytotoxic T cell (VZV-CTL) and T follicular helper responses to ZVL did not correlate with age, but similar to other Th1 responses, VZV-CTL peak and baseline responses were independently correlated. These data expand our understanding of the factors affecting the magnitude and kinetics of T cell responses to ZVL in older adults and show the importance of prevaccination Treg and Tcheck in modulating the immunogenicity of ZVL. This presents new potential interventions to increase vaccine responses in older adults.IMPORTANCE Vaccination is the most effective method to protect older adults against viral infections. However, the immunogenicity of viral vaccines in older adults is notoriously poor. The live attenuated zoster vaccine (ZVL) provides the best example of a gradual decrease of vaccine immunogenicity with every 10-year age increase above 50 years. Here we show that the abundance of regulatory T cells before vaccine administration to older adults has a significant inhibitory effect on immune responses to ZVL and, together with baseline immunity to varicella-zoster virus, explains the effect of age on the immunogenicity of ZVL. Moreover, in vitro blockade of regulatory T cell mechanisms of action with biologic modulators restores immune responses to varicella-zoster virus in vaccinees. Collectively, these observations suggest that immune modulators that block regulatory T cell activity may increase responses to viral attenuated vaccines in older adults.
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Pedromonico Arrym M, Martins Alves PC, Virginello Castelhano M, Nitsch Mazzola T, Muller Banzato Pinto de Lemos R, Zaccariotto TR, Levy CE, Guimarães F, Nolasco da Silva MT. Preservation of cytotoxic granule production in response to mycobacterial antigens by T-lymphocytes from vertically HIV-infected Brazilian youth on effective combined antiretroviral therapy. Braz J Infect Dis 2019; 23:151-159. [PMID: 31271732 PMCID: PMC9428219 DOI: 10.1016/j.bjid.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background HIV infection harms adaptive cellular immunity mechanisms. Long-term virological control by combined antiretroviral therapy (cART) reduces the risk of mycobacterial infections. Thus, we aimed to study cellular responses to mycobacterial antigens in 20 HIV-infected adolescents with at least one year of virological control (HIV-RNA <40 copies/mL) and 20 healthy adolescents. Methods We evaluated CD8 and γδ T-cell degranulation by measurement of CD107a membrane expression after stimulation with lysates from BCG (10 μg/mL) and H37RA Mycobacterium tuberculosis (Mtb, 10 μg/mL). Immune activation and antigen-presenting ability were also assessed by determination of HLA-DR, CD80, and CD86 markers. Results TCR γδ T-cell CD107a expression was similar between groups in response to mycobacterial antigens, and lower in the HIV-infected group in response to mitogen. Higher baseline HLA-DR expression and lower mycobacterial-stimulated expression was found within the HIV-infected group. Conclusions Similar degranulation in stimulated CD8+ and TCR γδ T-cells from HIV-infected adolescents, when compared to healthy controls suggests long-term immunological preservation with immune reconstitution under successful cART. However, differences in HLA-DR expression may represent ongoing inflammation and lower specific responses in HIV-infected youth. These features may be relevant in the context of the precocity and severity of vertically acquired HIV infection.
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Affiliation(s)
- Mauro Pedromonico Arrym
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Paulo César Martins Alves
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Mariana Virginello Castelhano
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil
| | - Taís Nitsch Mazzola
- State University of Campinas, Center for Molecular Biology and Genetical Engineering, Campinas, SP, Brazil
| | | | - Tânia Regina Zaccariotto
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Carlos Emilio Levy
- State University of Campinas Clinics Hospital, Clinical Pathology Laboratory, Campinas, SP, Brazil
| | - Fernando Guimarães
- State University of Campinas, Center for Integral Attention to Women's Health, SP, Brazil
| | - Marcos Tadeu Nolasco da Silva
- State University of Campinas, Faculty of Medical Sciences, Laboratory of Translational Research in Child and Adolescent Health, Center for Investigation in Pediatrics, Campinas, SP, Brazil.
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Erdmann NB, Prentice HA, Bansal A, Wiener HW, Burkholder G, Shrestha S, Tang J. Herpes Zoster in Persons Living with HIV-1 Infection: Viremia and Immunological Defects Are Strong Risk Factors in the Era of Combination Antiretroviral Therapy. Front Public Health 2018; 6:70. [PMID: 29594092 PMCID: PMC5857573 DOI: 10.3389/fpubh.2018.00070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/20/2018] [Indexed: 12/30/2022] Open
Abstract
In a cohort of 4,225 persons living with human immunodeficiency virus type 1 (HIV-1) infection (PLWH) enrolled at a southeastern US clinic, the overall rate of incident herpes zoster (HZ) was 101 per 10,000 person-years (PY) between January 1999 and 2017, which nearly quadruples the rate reported for the general US population. In the same cohort, the median age of HZ diagnosis was 39.5 years [interquartile range (IQR) 31.5–49.2] in African American (AA) and 39.1 years (IQR 34.9–45.2) in European American (EA) PLWH, with the highest incidence seen in PLWH who were over 50 years old (144 and 93 per 10,000 PY in AA and EA, respectively, P = 0.18), showing no bias between men (100 per 10,000 PY) and women (101 per 10,000 PY). In multivariable models that were applicable to 245 HZ cases and 3,713 controls, age, nadir CD4+ T-cell (CD4) count, plasma viral load (VL), and duration of combination antiretroviral therapy were independent correlates of incident HZ (adjusted P ≤ 0.006 for all). Regardless of other factors, viremic PLWH (VL > 50 copies/mL) was at the highest risk of HZ [adjusted odds ratio (OR) > 3.0, P < 0.0001]. PLWH with a nadir CD4 count of ≥500 cells/μL showed a relatively low risk (adjusted OR = 0.48, P = 0.003). By contrast, similar risk estimates were observed with three advancing age groups (30–39, 40–49, and ≥50) when compared with age <30 (adjusted OR = 1.86–2.17, P ≤ 0.010). These findings indicate that efforts for HZ diagnosis and prophylaxis should target viremic PLWH who are over 30 years old and with CD4 count <500 cells/μL.
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Affiliation(s)
- Nathaniel B Erdmann
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Heather A Prentice
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anju Bansal
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Howard W Wiener
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jianming Tang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Weinberg A, Lindsey J, Bosch R, Persaud D, Sato P, Ogwu A, Asmelash A, Bwakura-Dangarambezi M, Chi BH, Canniff J, Lockman S, Gaseitsiwe S, Moyo S, Smith CE, Moraka NO, Levin MJ. B and T Cell Phenotypic Profiles of African HIV-Infected and HIV-Exposed Uninfected Infants: Associations with Antibody Responses to the Pentavalent Rotavirus Vaccine. Front Immunol 2018; 8:2002. [PMID: 29403482 PMCID: PMC5780413 DOI: 10.3389/fimmu.2017.02002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022] Open
Abstract
We examined associations between B and T cell phenotypic profiles and antibody responses to the pentavalent rotavirus vaccine (RV5) in perinatally HIV-infected (PHIV) infants on antiretroviral therapy and in HIV-exposed uninfected (PHEU) infants enrolled in International Maternal Pediatric Adolescent AIDS Clinical Trials P1072 study (NCT00880698). Of 17 B and T cell subsets analyzed, PHIV and PHEU differed only in the number of CD4+ T cells and frequency of naive B cells, which were higher in PHEU than in PHIV. In contrast, the B and T cell phenotypic profiles of PHIV and PHEU markedly differed from those of geographically matched contemporary HIV-unexposed infants. The frequency of regulatory T and B cells (Treg, Breg) of PHIV and PHEU displayed two patterns of associations: FOXP3+ CD25+ Treg positively correlated with CD4+ T cell numbers; while TGFβ+ Treg and IL10+ Treg and Breg positively correlated with the frequencies of inflammatory and activated T cells. Moreover, the frequencies of activated and inflammatory T cells of PHIV and PHEU positively correlated with the frequency of immature B cells. Correlations were not affected by HIV status and persisted over time. PHIV and PHEU antibody responses to RV5 positively correlated with CD4+ T cell counts and negatively with the proportion of immature B cells, similarly to what has been previously described in chronic HIV infection. Unique to PHIV and PHEU, anti-RV5 antibodies positively correlated with CD4+/CD8+FOXP3+CD25+% and negatively with CD4+IL10+% Tregs. In conclusion, PHEU shared with PHIV abnormal B and T cell phenotypic profiles. PHIV and PHEU antibody responses to RV5 were modulated by typical HIV-associated immune response modifiers except for the association between CD4+/CD8+FOXP3+CD25+Treg and increased antibody production.
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Affiliation(s)
- Adriana Weinberg
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Medicine, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pathology, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jane Lindsey
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, United States
| | - Ronald Bosch
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, United States
| | - Deborah Persaud
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Paul Sato
- Maternal Adolescent and Pediatric Research Branch, NIAID, NIH, Bethesda, MD, United States
| | | | | | - Mutsa Bwakura-Dangarambezi
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer Canniff
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Shahin Lockman
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Simani Gaseitsiwe
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Christiana Elizabeth Smith
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Myron J Levin
- Department of Pediatrics, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Medicine, Section of Pediatric Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Borkowsky W, Gershon AA. Varicella Zoster Vaccine Experience in HIV-Infected Children and Adolescents. Immunology 2018. [DOI: 10.1016/b978-0-12-809819-6.00010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Levin MJ, Bresnitz E, Popmihajlov Z, Weinberg A, Liaw KL, Willis E, Curtis JR. Studies with herpes zoster vaccines in immune compromised patients. Expert Rev Vaccines 2017; 16:1217-1230. [PMID: 29053937 DOI: 10.1080/14760584.2017.1395703] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The active component of the herpes zoster vaccine (ZVL), licensed for people ≥50 years of age, is a live attenuated varicella-zoster virus. ZVL is contraindicated for immune compromised individuals, with limited regard to the degree of immunosuppression. Areas covered: This review evaluates phase I and II and observational studies for ZVL, and published reports of the off-label use of ZVL, for conditions and therapies for which investigators considered the risk-benefit for using ZVL to be favorable. It also discusses exploratory trials of ZVL for additional immune compromising conditions, and summarizes clinical guidelines from many countries and professional societies that are based upon recent investigations. Studies in immune compromised patients of investigational vaccines that do not contain live virus are reviewed. Expert commentary: It is likely that past and ongoing research with ZVL will define immune compromising diseases and/or therapies for which the risk-benefit for using ZVL vaccine is favorable. The main variables to consider in this assessment in immune compromised patients are safety, immunogenicity, protection against herpes zoster, and persistence of protection. Vaccination against herpes zoster prior to suppressing immunity is an important clinical strategy, although efficacy of this approach has not been evaluated in a clinical trial.
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Affiliation(s)
- Myron J Levin
- a Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | | | | | - Adriana Weinberg
- a Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | | | | | - Jeffrey R Curtis
- c Division of Clinical Immunology and Rheumatology , University of Alabama , Birmingham , AL , USA
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Kim MS, Kim DJ, Na CH, Shin BS. A Study of the Changes of T Helper 17 Cells and Regulatory T Cells in Herpes Zoster. Ann Dermatol 2017; 29:578-585. [PMID: 28966514 PMCID: PMC5597651 DOI: 10.5021/ad.2017.29.5.578] [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: 10/17/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Immunosuppression and age-related deficiencies in cell-mediated immunity are important factors for the reactivation of latent varicella-zoster virus (VZV). CD4+CD25+Foxp3+ regulatory T (Treg) cells and T helper 17 (Th17) cells are closely associated with various viral infections. OBJECTIVE We analyzed Treg cells and Th17 cells in patients with herpes zoster and investigated their relationship with the reactivation of latent VZV. METHODS Treg and Th17 cells in peripheral blood and the ratio of Th17 to Treg cells were examined in patients with herpes zoster and healthy controls. Changes between pre-treatment and post-treatment estimates of Treg and Th17 cells and clinical parameters in patients with herpes zoster were also analyzed. RESULTS The proportion of circulating Th17 cells and the Th17/Treg cell ratio were significantly higher in patients with herpes zoster than controls (p=0.012, 0.013), but there was no significant difference in the proportion of Treg cells between groups. There was no significant difference in the proportions of Treg and Th17 cells and the Th17/Treg cell ratio before and after treatment and between the non-postherpetic neuralgia and postherpetic neuralgia groups. Changes in Treg and Th17 cells and the Th17/Treg cell ratio were not significantly correlated with changes in the visual analog scale. Body surface area was significantly correlated with Treg cells, Th17 cells, and the Th17/Treg cell ratio (p=0.022, 0.002, 0.004). CONCLUSION An imbalance between Th17 and Treg cells is associated with the reactivation of VZV, which may contribute to pathogenesis of herpes zoster.
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Affiliation(s)
- Min Sung Kim
- Department of Dermatology, Chosun University School of Medicine, Gwangju, Korea
| | - Dong Jin Kim
- Department of Dermatology, Chosun University School of Medicine, Gwangju, Korea
| | - Chan Ho Na
- Department of Dermatology, Chosun University School of Medicine, Gwangju, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University School of Medicine, Gwangju, Korea
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Weinberg A, Canniff J, Rouphael N, Mehta A, Mulligan M, Whitaker JA, Levin MJ. Varicella-Zoster Virus-Specific Cellular Immune Responses to the Live Attenuated Zoster Vaccine in Young and Older Adults. THE JOURNAL OF IMMUNOLOGY 2017; 199:604-612. [PMID: 28607114 DOI: 10.4049/jimmunol.1700290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/09/2017] [Indexed: 12/11/2022]
Abstract
The incidence and severity of herpes zoster (HZ) increases with age. The live attenuated zoster vaccine generates immune responses similar to HZ. We compared the immune responses to zoster vaccine in young and older to adults to increase our understanding of the immune characteristics that may contribute to the increased susceptibility to HZ in older adults. Young (25-40 y; n = 25) and older (60-80 y; n = 33) adults had similar magnitude memory responses to varicella-zoster virus (VZV) ex vivo restimulation measured by responder cell-frequency and flow cytometry, but the responses were delayed in older compared with young adults. Only young adults had an increase in dual-function VZV-specific CD4+ and CD8+ T cell effectors defined by coexpression of IFN-γ, IL-2, and CD107a after vaccination. In contrast, older adults showed marginal increases in VZV-specific CD8+CD57+ senescent T cells after vaccination, which were already higher than those of young adults before vaccination. An increase in VZV-stimulated CD4+CD69+CD57+PD1+ and CD8+CD69+CD57+PD1+ T cells from baseline to postvaccination was associated with concurrent decreased VZV-memory and CD8+ effector responses, respectively, in older adults. Blocking the PD1 pathway during ex vivo VZV restimulation increased the CD4+ and CD8+ proliferation, but not the effector cytokine production, which modestly increased with TIM-3 blockade. We conclude that high proportions of senescent and exhausted VZV-specific T cells in the older adults contribute to their poor effector responses to a VZV challenge. This may underlie their inability to contain VZV reactivation and prevent the development of HZ.
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Affiliation(s)
- Adriana Weinberg
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045; .,Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Jennifer Canniff
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Nadine Rouphael
- Hope Clinic of the Emory Vaccine Center and Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA 30030; and
| | - Aneesh Mehta
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30307
| | - Mark Mulligan
- Hope Clinic of the Emory Vaccine Center and Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA 30030; and
| | - Jennifer A Whitaker
- Hope Clinic of the Emory Vaccine Center and Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Decatur, GA 30030; and
| | - Myron J Levin
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.,Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
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Gershon AA. Is chickenpox so bad, what do we know about immunity to varicella zoster virus, and what does it tell us about the future? J Infect 2017; 74 Suppl 1:S27-S33. [PMID: 28646959 PMCID: PMC5726865 DOI: 10.1016/s0163-4453(17)30188-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Varicella and zoster continue to cause significant morbidity and even mortality in children and adults. Complications include bacterial superinfection, central nervous system manifestations such as meningitis, encephalitis, and cerebellar ataxia, and pain syndromes especially post herpetic neuralgia. Many developed countries but not all, are now administering live attenuated varicella vaccine routinely, with a decrease in the incidence of disease, providing personal and herd immunity. There is some controversy, however, in some countries concerning whether a decrease in the circulation of wild type virus will result in loss of immunity to VZV in persons who have already had varicella. This manuscript reviews the complications of varicella and zoster in detail, the reasons for development of vaccines against these diseases, complications of vaccinations, and mechanisms by which immunity to this virus develops and is maintained. There are strong indications that the best way to control disease and spread of this virus is by vaccination against both.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
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Exuberant varicella-zoster exanthema and pneumonia as clinical clue for HIV infection. J Pediatr 2015; 166:199. [PMID: 25444005 DOI: 10.1016/j.jpeds.2014.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/24/2014] [Indexed: 11/23/2022]
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Influence of frequent infectious exposures on general and varicella-zoster virus-specific immune responses in pediatricians. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:417-26. [PMID: 24429070 DOI: 10.1128/cvi.00818-13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Reexposure to viruses is assumed to strengthen humoral and cellular immunity via the secondary immune response. We studied the effects of frequent exposure to viral infectious challenges on immunity. Furthermore, we assessed whether repetitive exposures to varicella-zoster virus (VZV) elicited persistently high immune responses. Blood samples from 11 pediatricians and matched controls were assessed at 3 time points and 1 time point, respectively. Besides the assessment of general immunity by means of measuring T-cell subset percentages, antibody titers and gamma interferon (IFN-γ)/interleukin 2 (IL-2)-producing T-cell percentages against adenovirus type 5 (AdV-5), cytomegalovirus (CMV), tetanus toxin (TT), and VZV were determined. Pediatricians had lower levels of circulating CD4(+)-naive T cells and showed boosting of CD8(+) effector memory T cells. Although no effect on humoral immunity was seen, repetitive exposures to VZV induced persistently higher percentages of IFN-γ-positive T cells against all VZV antigens tested (VZV glycoprotein E [gE], VZV intermediate-early protein 62 [IE62], and VZV IE63) than in controls. T cells directed against latency-associated VZV IE63 benefitted the most from natural exogenous boosting. Although no differences in cellular or humoral immunity were found between the pediatricians and controls for AdV-5 or TT, we did find larger immune responses against CMV antigens in pediatricians. Despite the high infectious burden, we detected a robust and diverse immune system in pediatricians. Repetitive exposures to VZV have been shown to induce a stable increased level of VZV-specific cellular but not humoral immunity. Based on our observations, VZV IE63 can be considered a candidate for a zoster vaccine.
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van Besouw NM, Verjans GMGM, Zuijderwijk JM, Litjens NHR, Osterhaus ADME, Weimar W. Systemic varicella zoster virus reactive effector memory T-cells impaired in the elderly and in kidney transplant recipients. J Med Virol 2013; 84:2018-25. [PMID: 23080511 DOI: 10.1002/jmv.23427] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Varicella zoster virus (VZV) infections cause varicella and subsequently herpes zoster upon reactivation. Immune-compromised individuals and the elderly are at high risk of developing herpes zoster due to waning of VZV-specific T-cell immunity. In the present study, a novel functional T-cell assay was developed to test the correlation between age and VZV-specific T-cell responses in peripheral blood from healthy individuals. Secondly, VZV-specific T-cell responses from renal transplant recipients were compared with healthy individuals. Monocytes were differentiated into mature monocyte-derived dendritic cells (moDCs) and were infected with VZV. T-cells were co-cultured with autologous moDCs infected with VZV and subjected to flowcytometric analysis to identify the phenotype (i.e., naïve [NA: CCR7(+) CD45RO(-) ], central [CM: CCR7(+) CD45RO(+) ] and effector memory [EM: CCR7(-) CD45RO(+) ] T-cells) and the frequency of VZV-reactive T-cell subsets by intra-cellular IFN-γ flowcytometry. In contrast to NA and CM T-cells, the frequency of VZV-reactive CD4 and CD8 EM T-cells was inversely correlated with age (P = 0.0007 and P = 0.01). No difference was found in the percentage of VZV-reactive CD4 NA, CM and EM T-cells between transplant recipients and controls. However, the percentage of VZV-reactive CD8 EM T-cells was significantly lower in transplant recipients compared to controls (P = 0.02). In conclusion, moDCs infected with VZV are efficient antigen presenting cells applicable to enumerate and characterize the phenotype and differentiation status of the systemic VZV-specific T-cell response ex-vivo. The data suggest that VZV-reactive EM T-cells are impaired in the elderly and renal transplant recipients.
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Affiliation(s)
- Nicole M van Besouw
- Department of Internal Medicine-Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Levin MJ. Immune senescence and vaccines to prevent herpes zoster in older persons. Curr Opin Immunol 2012; 24:494-500. [PMID: 22857823 DOI: 10.1016/j.coi.2012.06.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/01/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
Varicella-zoster virus (VZV) T-cell-mediated immunity (VZV-CMI) in older persons prevents latent VZV in sensory neurons from reactivating to cause herpes zoster. VZV-CMI declines greatly with aging, but can be restored by the licensed zoster vaccine. However, the vaccine-induced boost in VZV-CMI (which determines the efficacy of the vaccine) is a function of the age of the vaccinee, and the duration of this boost wanes with time. Both factors influence the value of this vaccine. To understand these aging effects, limited information about the phenotypic and functional differences in VZV-CMI in old and young persons are reviewed, as well as the reversal of these differences by vaccination. Based on information from these studies some potential approaches to improving prevention of herpes zoster are discussed.
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Affiliation(s)
- Myron J Levin
- Section of Pediatric Infectious Diseases, University of Colorado Denver School of Medicine and Health Sciences Center, C227, Building 401, 1784 Racine Street, Aurora, CO 80045, USA.
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