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January 14, 2020
Old TB vaccine may work better when delivered intravenously
At a Glance
- Delivering the only approved tuberculosis vaccine intravenously greatly enhanced its ability to protect rhesus monkeys from infection.
- The study provides a new model for understanding the mechanisms underlying vaccine protection against tuberculosis.
Tuberculosis (TB), the world’s leading cause of death from infection, is caused by Mycobacterium tuberculosis bacteria. It’s spread through the air, often through coughing, by people with TB disease of the lungs. Others can breathe in these bacteria and become infected. TB most commonly affects the lungs (pulmonary TB), but it can also spread to other parts of the body, including the kidney, spine, and brain (disseminated TB).
The world’s only licensed TB vaccine, Bacille Calmette-Guerin (BCG), was developed a century ago. Given to infants intradermally (ID), in which the vaccine is placed just under the skin with a needle, it protects them from disseminated TB. However, BCG given this way is far less effective at preventing pulmonary TB, which is the major cause of illness and deaths in teens or adults.
To control TB infection and prevent clinical disease, a vaccine must elicit strong, sustained responses from the immune system’s T cells. The standard ID delivery route may not generate enough of these critical cells in the lung to immediately control infection and protect against pulmonary TB.
To determine if a different dose or route of administration of this vaccine could be more effective at preventing pulmonary TB, a team led by Drs. Robert A. Seder and Mario Roederer at NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and Dr. JoAnne L. Flynn of the University of Pittsburgh carried out a study in rhesus monkeys. The results were published on January 2, 2020, in Nature.
Five groups of monkeys were given the BGC vaccine in different ways: standard ID, higher dose ID, via aerosol to the lungs, a combination standard-dose ID and aerosol, or as an intravenous, or IV, injection. The scientists assessed immune responses in blood and in fluid drawn from the lining of the lungs for a 24-week period following vaccination. IV administration of the BCG vaccine resulted in 10- to 100-fold higher levels of T cells in the lungs compared with the other routes.
Six months after vaccination, the researchers exposed the groups of vaccinated monkeys and a group of unvaccinated monkeys to TB-causing bacteria. They then tracked the infection and disease development over three months. Nine out of 10 animals vaccinated by IV were highly protected; six showed no detectable infection in any tissue tested, and three had only very low counts of M. tuberculosis bacteria in lung tissue. All unvaccinated animals and those immunized via aerosol or ID showed signs of significantly greater infection.
“This study provides a new framework to understand the immune correlates and mechanisms of protection against TB, and should guide the field of TB vaccine research,” Seder says.
- Early Sentinels of Multidrug-Resistant TB
- Predicting Effective Drug Combinations for TB
- Development of Antibiotics to Treat Tuberculosis
- New Vaccine Offers Better Protection Against Tuberculosis
References: Prevention of tuberculosis in macaques after intravenous BCG immunization. Darrah PA, Zeppa JJ, Maiello P, Hackney JA, Wadsworth MH 2nd, Hughes TK, Pokkali S, Swanson PA 2nd, Grant NL, Rodgers MA, Kamath M, Causgrove CM, Laddy DJ, Bonavia A, Casimiro D, Lin PL, Klein E, White AG, Scanga CA, Shalek AK, Roederer M, Flynn JL, Seder RA. Nature. 2020 Jan;577(7788):95-102. doi: 10.1038/s41586-019-1817-8. Epub 2020 Jan 1. PMID: 31894150.
Funding: NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and National Human Genome Research Institute (NHGRI); Bill and Melinda Gates Foundation; Searle Scholars Program; Beckman Foundation; Alfred P. Sloan Foundation.