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      MTBVAC vaccination protects rhesus macaques against aerosol challenge with M. tuberculosis and induces immune signatures analogous to those observed in clinical studies

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          Abstract

          A single intradermal vaccination with MTBVAC given to adult rhesus macaques was well tolerated and conferred a significant improvement in outcome following aerosol exposure to M. tuberculosis compared to that provided by a single BCG vaccination. Vaccination with MTBVAC resulted in a significant reduction in M. tuberculosis infection-induced disease pathology measured using in vivo medical imaging, in gross pathology lesion counts and pathology scores recorded at necropsy, the frequency and severity of pulmonary granulomas and the frequency of recovery of viable M. tuberculosis from extrapulmonary tissues following challenge. The immune profiles induced following immunisation with MTBVAC reflect those identified in human clinical trials of MTBVAC. Evaluation of MTBVAC- and TB peptide-pool-specific T-cell cytokine production revealed a predominantly Th1 response from poly- (IFN-γ +TNF-α +IL2 +) and multi-(IFN-γ +TNF-α +) functional CD4 T cells, while only low levels of Th22, Th17 and cytokine-producing CD8 T-cell populations were detected together with low-level, but significant, increases in CFP10-specific IFN-γ secreting cells. In this report, we describe concordance between immune profiles measured in clinical trials and a macaque pre-clinical study demonstrating significantly improved outcome after M. tuberculosis challenge as evidence to support the continued development of MTBVAC as an effective prophylactic vaccine for TB vaccination campaigns.

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          Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature.

          To quantify the efficacy of BCG vaccine against tuberculosis (TB). MEDLINE with index terms BCG vaccine, tuberculosis, and human. Experts from the Centers for Disease Control and Prevention and the World Health Organization, among others, provided lists of all known studies. A total of 1264 articles or abstracts were reviewed for details on BCG vaccination, concurrent vaccinated and unvaccinated groups, and TB outcome; 70 articles were reviewed in depth for method of vaccine allocation used to create comparable groups, equal surveillance and follow-up for recipient and concurrent control groups, and outcome measures of TB cases and/or deaths. Fourteen prospective trials and 12 case-control studies were included in the analysis. We recorded study design, age range of study population, number of patients enrolled, efficacy of vaccine, and items to assess the potential for bias in study design and diagnosis. At least two readers independently extracted data and evaluated validity. The relative risk (RR) or odds ratio (OR) of TB provided the measure of vaccine efficacy that we analyzed. The protective effect was then computed by 1-RR or 1-OR. A random-effects model estimated a weighted average RR or OR from those provided by the trials or case-control studies. In the trials, the RR of TB was 0.49 (95% confidence interval [CI], 0.34 to 0.70) for vaccine recipients compared with nonrecipients (protective effect of 51%). In the case-control studies, the OR for TB was 0.50 (95% CI, 0.39 to 0.64), or a 50% protective effect. Seven trials reporting tuberculous deaths showed a protective effect from BCG vaccine of 71% (RR, 0.29; 95% CI, 0.16 to 0.53), and five studies reporting on meningitis showed a protective effect from BCG vaccine of 64% (OR, 0.36; 95% CI, 0.18 to 0.70). Geographic latitude of the study site and study validity score explained 66% of the heterogeneity among trials in a random-effects regression model. On average, BCG vaccine significantly reduces the risk of TB by 50%. Protection is observed across many populations, study designs, and forms of TB. Age at vaccination did not enhance predictiveness of BCG efficacy. Protection against tuberculous death, meningitis, and disseminated disease is higher than for total TB cases, although this result may reflect reduced error in disease classification rather than greater BCG efficacy.
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            Prevention of tuberculosis in macaques after intravenous BCG immunization

            Mycobacterium tuberculosis (Mtb) is the leading cause of death from infection worldwide 1 . The only available vaccine, BCG (Bacillus Calmette–Guérin), is given intradermally and has variable efficacy against pulmonary tuberculosis, the major cause of mortality and disease transmission 1,2 . Here we show that intravenous administration of BCG profoundly alters the protective outcome of Mtb challenge in non-human primates (Macaca mulatta). Compared with intradermal or aerosol delivery, intravenous immunization induced substantially more antigen-responsive CD4 and CD8 T cell responses in blood, spleen, bronchoalveolar lavage and lung lymph nodes. Moreover, intravenous immunization induced a high frequency of antigen-responsive T cells across all lung parenchymal tissues. Six months after BCG vaccination, macaques were challenged with virulent Mtb. Notably, nine out of ten macaques that received intravenous BCG vaccination were highly protected, with six macaques showing no detectable levels of infection, as determined by positron emission tomography–computed tomography imaging, mycobacterial growth, pathology and granuloma formation. The finding that intravenous BCG prevents or substantially limits Mtb infection in highly susceptible rhesus macaques has important implications for vaccine delivery and clinical development, and provides a model for defining immune correlates and mechanisms of vaccine-elicited protection against tuberculosis.
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              Prevention of tuberculosis in rhesus macaques by a cytomegalovirus-based vaccine

              Despite widespread use of the Bacille Calmette-Guérin (BCG) vaccine, tuberculosis (TB) remains a leading cause of global mortality from a single infectious agent ( Mycobacterium tuberculosis or Mtb ). Here, over two independent Mtb challenge studies, we demonstrate that subcutaneous vaccination of rhesus macaques (RM) with Rhesus Cytomegalovirus vectors encoding Mtb antigen (Ag) inserts (RhCMV/TB), which elicit and maintain highly effector-differentiated, circulating and tissue-resident Mtb -specific CD4 + and CD8 + memory T cell responses, can reduce the overall (pulmonary and extra-pulmonary) extent of Mtb infection and disease by 68% compared to unvaccinated controls after intra-bronchial Erdman strain Mtb challenge, with challenge occurring at ~1 year after first vaccination. Fourteen of 34 RhCMV/TB-vaccinated RM (41%) across both studies showed no TB disease by computed tomography (CT) scan or at necropsy after challenge (compared with 0 of 17 unvaccinated controls) and 10 of these RM were Mtb culture-negative in all tissues, an exceptional long-term vaccine effect in the Erdman strain Mtb RM challenge model. These results suggest that complete vaccine-mediated immune control of highly pathogenic Mtb is possible if immune effector responses can intercept Mtb infection at its earliest stages.
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                Author and article information

                Contributors
                Andrew.white@phe.gov.uk
                Journal
                NPJ Vaccines
                NPJ Vaccines
                NPJ Vaccines
                Nature Publishing Group UK (London )
                2059-0105
                4 January 2021
                4 January 2021
                2021
                : 6
                : 4
                Affiliations
                [1 ]GRID grid.271308.f, ISNI 0000 0004 5909 016X, Public Health England, National Infection Service, Porton Down, ; Salisbury, SP4 0JG UK
                [2 ]GRID grid.415719.f, ISNI 0000 0004 0488 9484, The Churchill Hospital, Headington, ; Oxford, UK
                [3 ]GRID grid.185006.a, ISNI 0000 0004 0461 3162, La Jolla Institute for Allergy and Immunology, ; La Jolla, CA USA
                [4 ]Biofabri, Ponteverdra, Spain
                [5 ]GRID grid.432518.9, Aeras, ; Rockvile, MD 20850 USA
                [6 ]GRID grid.11205.37, ISNI 0000 0001 2152 8769, Grupo de Genética de Micobacterias, Departamento Microbiología, Universidad de Zaragoza, IIS-Aragón, CIBERES, ; Zaragoza, Spain
                Author information
                http://orcid.org/0000-0001-9481-0079
                http://orcid.org/0000-0001-9868-6183
                http://orcid.org/0000-0001-7302-8002
                http://orcid.org/0000-0002-5315-3882
                http://orcid.org/0000-0003-2993-5478
                Article
                262
                10.1038/s41541-020-00262-8
                7782851
                33397991
                8a331a13-7c83-4a7a-8738-9a6363ec6483
                © Crown 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 July 2020
                : 13 November 2020
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                © The Author(s) 2021

                tuberculosis,live attenuated vaccines
                tuberculosis, live attenuated vaccines

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