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Cutaneous leishmaniasis is an infectious disease that is endemic especially in tropical and desert regions with an incidence of 1.5 million cases per year and a prevalence of 12 million people infected worldwide. The infection can be caused by the intracellular parasite Leishmania major. The disease has been studied extensively in the murine model. It has become apparent that the induction of a class of interferon (IFN)--producing CD4+ T helper cells (TH1 cells) that activate macrophages to kill the parasites they harbor is desicive for the establishment of immunity. The redirection of the host’s immune response towards a protective TH1 phenotype will also be the key to an effective vaccine. Dendritic cells (DC) loaded with leishmanial antigens ex vivo were lately described as vaccines against L. major infections. One single recombinant Leishmania antigen, LeIF (Leishmania homologue of eukaryotic ribosomal initiation factor 4a), which was identified as a protein that stimulates DC to secrete interleukin (IL)-12 and discussed as a pattern-associated molecular pattern (PAMP), was found to mediate a protective TH1-dependent effect when used for pulsing of DC. The application of recombinant proteins is tied to many disadvantages, which is why other methods of antigen administration have been developed. RNA electroporation of DC has recently emerged from tumor research as a safe and versatile method of antigen delivery, by which a large number of RNA molecules encoding a specific antigen gains access to the cytosol of DC by an electrical impulse. The present study describes, for the first time, transfection of DC with RNA encoding a molecularly defined parasite antigen. Initially, a standardized protocol for RNA transfection was established, using the enhanced green fluorescent protein (EGFP) as reporter antigen. EGFP-RNA was well translatable in an in vitro translation system, and both a DC cell line (fetal skin-derived DC; FSDC) and murine primary bone marrow-derived DC (BMDC) could be transfected efficiently, with a yield of up to 90% and 75%, respectively. In both cell types, maximal transfection efficiency was attained with 20 µg RNA and could not be further increased with larger amounts of RNA. The level of antigen expression, measured as the mean fluorescence intensity (MFI) by flow cytometry, was directly proportional to the amount of RNA used for transfection. In FSDC, transfection efficiency and MFI were generally higher than in BMDC when the same amounts of RNA were used. Furthermore, the kinetics was shown to be sensitive to treatment with lipopolysaccharide (LPS): the expression peak was higher and was reached sooner, followed by a more rapid decline. In transfection experiments with LeIF, two variants of LeIF-RNA were used: LeIF(fl)-RNA, encoding the complete LeIF sequence, and LeIF(226)-RNA, encoding only the aminoterminal half of the LeIF sequence (226 amino acids), the immunogenic part of LeIF. Only LeIF(fl) was detectable by Western Blot in whole cell lysates of BMDC after LeIF(fl)-RNA transfection, whereas LeIF(226) could never be detected in LeIF(226)-transfected BMDC. However, as both constructs were well translatable in a cell-free system, the failure to detect LeIF(226) in BMDC lysates did not represent a failure in RNA translation, but rather a rapid antigen degradation. It was therefore expected that LeIF(226)-transfected BMDC should nevertheless be able to present LeIF(226)-derived antigenic peptides to T cells from BALB/c mice primed with recombinant LeIF (rLeIF). This hypothesis was confirmed by measuring IFN- production in BMDC-T cell co-incubation assays, showing that rLeIF-pulsed, LeIF(226)- and LeIF(fl)-transfected day 7 BMDC did indeed activate T cells from LeIF-immunized mice in an antigen-specific manner. In contrast, IL-4 was not produced, which was consistent with the fact that T cells found in lymph nodes from LeIF-primed mice are primarily of the TH1 type. In the supernatants of LeIF-transfected BMDC cultures, in contrast to rLeIF-pulsed BMDC, the proinflammatory cytokines IL-1β, IL-6, IL-10 and IL-12 were not detected. This effect was not due to the electroporation procedure, as cytokine production by BMDC electroporated with rLeIF was only partially impaired. Also, the expression levels of CD86 were lower upon LeIF transfection than after pulsing with rLeIF. Thus, LeIF transfection did not induce maturation of DC. In conclusion, LeIF-transfected BMDC may have acted as semi-mature antigen-specific tolerance inducers, with regulatory T cells as responders. The effect of LeIF transfection on the immunostimulatory capacity of BMDC was not significantly increased when day 8 or 9 BMDC were used. However, day 8, and even more day 9 BMDC pulsed with rLeIF mounted a vigorous T cell response. Day 9 BMDC were able to activate naïve T cells. In conclusion, before a strong T cell response against LeIF can be induced, DC need to – besides presenting antigen and expressing co-stimulatory molecules – exhibit a susceptibility to the innate signaling molecule LeIF which is linked to their maturation age. This third signal is provided by extracellular rLeIF, but it is not conveyed – or is suppressed – by intracellular LeIF after LeIF-RNA transfection. Furthermore, electroporation of rLeIF abrogated IL-12 production by BMDC completely, the production of IL-1 was reduced with higher antigen doses, and the production of IL-10 was partially increased. The IL-6 production was unaffected. This altered cytokine profile suggests that LeIF as a PAMP might have a bipartite nature: besides exhibiting the capacity to stimulate IL-12 production upon extracellular presence, thereby enhancing host resistance against L. major, LeIF could also contribute to parasitic host evasion mechanisms from intracellular compartments of DC, possibly by interfering with mitogen-activated protein (MAP) kinase signaling pathways. Thus, the adjuvant properties of LeIF depend both on its mode of delivery (transfection with RNA vs. pulsing with the recombinant protein) and the targeted compartment (extra- vs. intracellular). From this work, it can be summarized that BMDC are well transfectable with a parasite antigen. The antigen is processed and presented, but it is not recognized as a PAMP by DC. Hence, transfection with antigen-encoding mRNA by itself does not convey all necessary signals for the elicitation of a potent immune response.
Diarrheal diseases are a major cause of death in developing countries. Vaccinating against the causative pathogens could reduce mortality and morbidity in these countries. Unfortunately, only for some of the most common enteral pathogens are vaccines available. Some of these available vaccines have limitations in terms of effectiveness and duration of protection. There is therefore an urgent need to develop new vaccine strategies that can generate protection against enteral pathogens.
The presence of all-trans retinoic acid (ATRA) during lymphocyte maturation is known to imprint a phenotype on lymphocytes that enables them to home to the intestines. Additionally, ATRA is known to play a role in B cell class switch to IgA, which is the dominant immunoglobulin in the intestines.
The aim of this study was therefore to investigate whether the addition of all-trans retinoic acid (ATRA) or a retinoic acid receptor agonist (AM80) to a parenteral vaccination could provide protection at the intestinal mucosa against enteric pathogens.
C57BL/6 mice received s.c. priming and boosting immunizations with Ovalbumin followed by several s.c. injections with either ATRA, AM80 or the respective solvent as control substance. Feces, serum, saliva and vaginal lavage samples were collected and analyzed by ELISA for detection and relative quantification of antigen-specific antibodies. B cell populations in the draining lymph nodes were investigated after immunization using flow-cytometry. Antigen-specific antibodies producing cells were visualized in the small intestine of vaccinated animals using two-photon microscopy.
Animals that were vaccinated and were exposed to AM80, and to a lesser extent ATRA exposed mice, had higher serum, fecal, saliva and vaginal lavage antigen-specific IgA titers when compared to animals that were vaccinated but did not receive ATRA/AM80. Antigen-specific IgG titers were not altered in any of the investigated tissues. In the draining lymph nodes, IgA+ and IgG+ B cells were increased after vaccination and AM80 exposure at several time points within 14 days after vaccination. Antigen-specific IgA+ cells were found in the small intestine of immunized and AM80-exposed but not control substance-exposed mice.
These results suggest that the addition of ATRA or AM80 to parenteral vaccine formulations increases the abundance of antigen-specific antibodies at mucosal surfaces, and therefore have the potential to generate protective antibody titers at those mucosal surfaces.
Measles, mumps and rubella are viral infectious diseases that may cause severe and devastating complications among affected individuals. The disease burden of all three diseases is high, but could be reduced entirely through successful vaccination strategies. As such, the WHO has established the goal of globally eliminating measles and rubella and concomitantly controlling the frequently co-vaccinated mumps.
In 2010, the WHO European Region member states agreed to strengthen efforts to eliminate measles and rubella from Europe by the end of 2015. As this date draws closer, progress analyses become increasingly relevant. In this systematic literature review, the immunization strategies, vaccination coverages and disease incidences of eleven European nations were assessed and their progress towards disease elimination evaluated.
Successful prevention of the endemic transmission of measles, mumps, or rubella could be achieved in several nations, including Sweden, Croatia, Greece and Spain. Austria, France, Germany, Italy, Poland, Turkey and the United Kingdom of Great Britain and Northern Ireland, though having improved their overall immunization rates, have not yet been able to reach the elimination goals. In Turkey, Italy and Poland, sharp increases in case numbers during recent years are potentially threatening the successful measles, mumps and rubella control in Europe.
Pockets of susceptible population groups that may contribute to the perpetuation of the diseases have been identified. They include infants and young children, adolescents and young adults, adolescent and adult males, recent immigrants and refugees,and traveling ethnic minority groups. Reasons for the increased risk of infection among these groups are manifold and a result of various historic and current vaccination practices, cultural, political and religious differences, as well as individual believes and concerns. Travel and migration of infected individuals to and between the various European nations also play an essential role in the continual transmission of measles, mumps and rubella in Europe. Only an adequate population-wide immunity can prevent the occurrence of major outbreaks due to viral importation. Efforts should therefore be made to immunize all population members able to receive vaccinations and to offer additional immunization opportunities to those susceptible population subgroups that are difficult to reach through routine vaccination programs.
In countries struggling to meet the WHO elimination goals, alternative immunization practices may be necessary. A uniform, European-wide MMR vaccination schedule based on the successful immunization methods of countries that have eliminated measles, mumps and rubella may be an effective tool for improving the overall population-wide immunity and controlling the three diseases. A model for such a schedule was created and includes strategies for reaching population members regardless of age, gender or migratory background. The implementation of uniform immunization recommendations is challenging, but the advantages in terms of improved vaccination, surveillance and disease control methods may be worth at least considering such a strategy in Europe.
Measles, mumps and rubella elimination may be attainable in the WHO European Region. The current epidemiological situation suggests that the goal is unlikely to be reached by the end of 2015, but through continued international efforts and collaboration, effective disease control could be achieved in the near future. In the meantime, improvements in immunization strategies, vaccination coverages, supplementary campaigns as well as disease notification systems and confirmations should be made on a national and international level, so that an adequate population-wide immunity can be established and the disease elimination progresses effectively monitored within the entire European region.
Dendritic cell-based vaccination is a well established technique for preventive and therapeutic instruction of the immune system where conservative vaccine formulations fail to cure or prevent diseases, respectively. Efficiency of this technique already was demonstrated in infectious diseases as well as for cancer in animal or human studies. Well controlled manipulation and antigen-loading of immature DC is most beneficial to this technique. But, time-consuming and cost-extensive procedures for preparation of DC precursors, expansion and stimulation of DC and inpatient administration are big disadvantages regarding vaccine development for pandemic infectious diseases that occur mainly in underdeveloped countries. Therefore vaccines are needed that are pathogen-tailored and able to induce equal immune responses as their DC-based vaccine models. For vaccination against Leishmania parasites such a DC-based vaccine is feasible and its efficacy to induce protective Th1-based immune responses was already demonstrated in several animal studies. But, one of our own studies indicated supportive activity of host cells exceeding the allocation of T cells to become activated by transferred DC. IL-12, an important cytokine for the induction of Th1-related immune responses, has to be produced by host cells. Therefore, the aim of this study was to investigate the mechanism of BMDC-based vaccination with regard to simplification of the vaccine formulation. Key questions that have been addressed are: Which cells process the information that is transferred by the injected DC and what are the key components of this information? Further more, it was looked at whether altered vaccine formulations are able to induce protective immunity and whether they share equal molecular mechanisms. The current paradigm of BMDC-based vaccination proposes direct interaction of transferred BMDC with host T cells. These BMDC have to be antigen-loaded for stimulation via antigen-peptide-MHC molecule-complexes and they have to be activated for proper co-stimulation of T cells. Here, this study demonstrates that neither activation for co-stimulation nor direct interaction with adequate MHC molecules is needed for the induction of protective immunity against infection with Leishmania-parasites. Disrupted antigen-loaded BMDC are able to induce protective immunity in BALB/c mice without pre-stimulation via CpG ODN. Beyond, if BMDC were used with a different MHC-background than recipient mice then the vaccine still would be efficient in terms of reduction of footpad swelling and parasite load in draining lymph nodes. Even more, DC-specific features are no key component that leads to protective immunity as vaccination with disrupted antigen-loaded MΦ shows equal properties than before mentioned vaccine formulations. Further more, it was found that host DC play a major role in transforming the incoming signal, received from transferred antigen-loaded DC, into Th1-related stimuli and Leishmania-antigen-specific T cell activation. Suspensions of disrupted antigen-loaded DC resemble a combination of laid off soluble molecules together with exosome-like vesicles that formed after disruption of membranes. Here it was shown that separation of the membranous and soluble fractions and subsequent transfer into BALB/c mice will lead to protection of these mice against infection with L. major promastigotes only if the membranous fraction is used as vaccine. More, this vaccine formulation takes advantage of easy storage at -80°C with no need of fresh production. This clearly demonstrates that the immunity-inducing principle of disrupted DC-based vaccination lies within the membrane enclosed fraction. On a molecular level, disrupted antigen-loaded DC induce Th1-related cytokines during vaccination and as response on pathogen encounter. In vivo assays revealed IL-12 production and antigen-specific T cell proliferation among splenocytes that were stimulated with disrupted antigen-loaded DC. Splenocytes of accordingly vaccinated mice produce tremendous amounts of IFNγ after stimulation with Leishmania parasites. In summary, disrupted antigen-loaded BMDC fulfil all characteristics of DC-based vaccination against Leishmania major. But, while purification of membranes of antigen-loaded DC and subsequent transfer to BALB/c mice leads to control of the disease in the animal model, only slight levels of Th1-related cytokines are seen in the in vivo assays. Whether this points towards a loss of vaccine activity on unseen levels or unknown sites where Th1-related immunity is induced by both, complete solution and purified membranes, still has to be determined.