title: Oral Tolerance to Environmental Mycobacteria Interferes with Intradermal, but Not Pulmonary, Immunization against Tuberculosis.
abstract: Bacille Calmette-Guérin (BCG) is currently the only approved vaccine against tuberculosis (TB) and is administered in over 150 countries worldwide. Despite its widespread use, the vaccine has a variable protective efficacy of 0-80%, with the lowest efficacy rates in tropical regions where TB is most prevalent. This variability is partially due to ubiquitous environmental mycobacteria (EM) found in soil and water sources, with high EM prevalence coinciding with areas of poor vaccine efficacy. In an effort to elucidate the mechanisms underlying EM interference with BCG vaccine efficacy, we exposed mice chronically to Mycobacterium avium (M. avium), a specific EM, by two different routes, the oral and intradermal route, to mimic human exposure. After intradermal BCG immunization in mice exposed to oral M. avium, we saw a significant decrease in the pro-inflammatory cytokine IFN-γ, and an increase in T regulatory cells and the immunosuppressive cytokine IL-10 compared to naïve BCG-vaccinated animals. To circumvent the immunosuppressive effect of oral M. avium exposure, we vaccinated mice by the pulmonary route with BCG. Inhaled BCG immunization rescued IFN-γ levels and increased CD4 and CD8 T cell recruitment into airways in M. avium-presensitized mice. In contrast, intradermal BCG vaccination was ineffective at T cell recruitment into the airway. Pulmonary BCG vaccination proved protective against Mtb infection regardless of previous oral M. avium exposure, compared to intradermal BCG immunization. In conclusion, our data indicate that vaccination against TB by the pulmonary route increases BCG vaccine efficacy by avoiding the immunosuppressive interference generated by chronic oral exposure to EM. This has implications in TB-burdened countries where drug resistance is on the rise and health care options are limited due to economic considerations. A successful vaccine against TB is necessary in these areas as it is both effective and economical.
authors.affiliation: Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, United States of America.|Biomedical Sciences Graduate Program, University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Dominique N
authors.initials: DN
authors.lastname: Price
authors.affiliation: Department of Pathology, University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Donna F
authors.initials: DF
authors.lastname: Kusewitt
authors.affiliation: Department of Molecular Genetics and Microbiology, University of New Mexico, Albuquerque, New Mexico, United States of America.|Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Lino
authors.affiliation: Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, United States of America.|Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors.forename: Amber A
authors.initials: AA
authors.lastname: McBride
authors.affiliation: Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, United States of America.
authors.forename: Pavan
authors.initials: P
authors.lastname: Muttil
mesh_terms: D000818:Animals; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000276:immunology; D004195:Disease Models, Animal; D004781:Environmental Exposure / Q000009:adverse effects*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D007108:Immune Tolerance / Q000276:immunology*; D016130:Immunophenotyping; D051379:Mice; D008810:Mice, Inbred C57BL; D009162:Mycobacterium avium / Q000276:immunology*; D014397:Tuberculosis, Pulmonary / Q000276:immunology*
chemical_list: D001500:BCG Vaccine