In vitro control of Mycobacterium bovis by macrophages.

Mycobacterium bovis is frequently seen inside macrophages in vivo. The outcome of M. bovis infection depends on T cell interactions with macrophages, however mycobacteria are thought to be relatively resistant to macrophage killing. Little is known about the immunological mechanisms which control intracellular growth of M. bovis, and in the absence of T cell help the organism is capable of intracellular survival and replication. We have investigated the role of macrophages in controlling growth of virulent M. bovis or M. bovis BCG in vitro. At a multiplicity of infection of 5:1, macrophages from a range of animal species including cattle, deer, possums, ferrets and mice restricted growth of BCG while M. bovis grew progressively. Inter-species variation in controlling growth of M. bovis by alveolar macrophages was observed. Pre-treatment of macrophages with interferon-gamma and lipopolysaccharide inhibited intracellular growth of M. bovis. Addition of freshly recruited macrophages further inhibited M. bovis, and intracellular growth was arrested by activated fresh macrophages. Our observations suggest that na?ve macrophages can prevent BCG growth, while T cell activation in conjunction with freshly recruited macrophages is required for preventing growth of M. bovis.     

Oral delivery of BCG Moreau Rio de Janeiro gives equivalent protection against tuberculosis but with reduced pathology compared to parenteral BCG Danish vaccination

There is a need for an improved vaccine to better control human tuberculosis (TB), as the only currently available TB vaccine, bacillus Calmette–Guerin (BCG) delivered parenterally, offers variable levels of efficacy. Therefore, recombinant strains expressing additional antigens are being developed alongside alternative routes to parenteral delivery. There is strong evidence that BCG Moreau (RdJ) is a safe and effective vaccine in humans when given by the oral route. This study compared the efficacy of a single oral dose of wild type BCG Moreau Rio de Janeiro (RdJ), or a recombinant RdJ strain expressing Ag85B-ESAT6 fusion protein, formulated with and without lipid to enhance oral delivery, with subcutaneous BCG Danish 1331 and saline control groups in a guinea pig aerosol infection model of pulmonary tuberculosis. Protection was measured as survival at 30 weeks post-challenge and reduced bacterial load and histopathology in lungs and spleen. Results showed that a single oral dose of BCG Moreau (RdJ) or recombinant BCG Moreau (RdJ)-Ag85B-ESAT6, formulated with or without lipid, gave protection equivalent to subcutaneously delivered BCG Danish in the 30 weeks post-challenge survival study. The orally delivered vaccines gave reduced pathology scores in the lungs (three of the four formulations) and spleens (all four formulations) compared to subcutaneously delivered BCG Danish. The oral wild type BCG Moreau (RdJ) in lipid and the unformulated oral wild type BCG Moreau (RdJ) vaccine also gave statistically lower bacterial loads in the lungs and spleens, respectively, compared to subcutaneously delivered BCG Danish. This study provides further evidence to show that lipid formulation does not impair vaccine efficacy and may enhance the delivery and stability of oral vaccines intended for use in countries with poor health infrastructure. Oral delivery also avoids needles (and associated cross-infection risks) and immunisation without the need for specially trained medical professional staff.     

Influence of sensitisation to environmental mycobacteria on subsequent vaccination against bovine tuberculosis.

Bacille Calmette-Guerin (BCG) is the world's most widely used vaccine, but there are concerns that it provides little protection against pulmonary tuberculosis of humans in countries that have a high prevalence of environmental mycobacteria. Experiments in cattle provide a model to investigate this situation and to develop an improved tuberculosis vaccine. In the third of a series of BCG vaccination trials, calves had high interferon-gamma (IFN-gamma) responses to purified protein derivative (PPD) from Mycobacterium avium prior to vaccination, indicating that infection with environmental mycobacteria had occurred. The calves vaccinated with BCG had minimal protection against an experimental intratracheal challenge with virulent Mycobacterium bovis. In comparison, calves vaccinated with either of two newly-derived attenuated M. bovis strains had significantly better but not complete protection against the development of tuberculous lesions compared to both BCG-vaccinated and non-vaccinated animals. Vaccination with the newly-derived attenuated M. bovis strains induced strong IFN-gamma and interleukin-2 (IL-2) responses to PPD from M. bovis at 2 weeks after vaccination, while BCG vaccination induced only a weak response at this time. In association with the previous two trials, the results suggest that sensitisation of the calves to environmental mycobacteria adversely affected subsequent protective efficacy of BCG. However, the results of vaccination with the other two attenuated M. bovis strains indicated that improved tuberculosis vaccines could be developed for such sensitised animals.     

Oral vaccination of mice with lipid-encapsulated Mycobacterium bovis BCG: Effect of reducing or eliminating BCG load on cell-mediated immunity

Oral delivery of lipid-encapsulated BCG represents an effective method for vaccination against tuberculosis (Tb). This method establishes live, replicating BCG in the lymphatic tissues of the alimentary tract, and promotes systemic-level cell-mediated immunity (CMI) and consequent protection against virulent mycobacterial challenge. Here, we investigated the effects of reducing or eliminating the BCG load on CMI responses in mice. Mice receiving a standard immunising dose of approximately 10(7) BCG (range, 1-5 x 10(7)) developed mycobacterial antigen-specific lymphocyte transformation (LT) responses, as well as interleukin-2 (IL-2) and gamma-interferon (IFN-gamma) secretion, at 8 and 18 weeks post-oral vaccination. These responses were concurrent with establishment of viable, replicating BCG in the alimentary tract lymphatics in over 90% of cases. Reducing the immunising dose by 10-fold reduced the magnitude of CMI, concurrent with abridged establishment of BCG in the lymphatics; reducing the dose 100-fold ablated BCG establishment, and diminished the production of IFN-gamma by antigen-stimulated lymphocytes of these mice. In mice immunised using the standard dose, replicating BCG were eliminated from the alimentary tract lymphatics using selective antibiotics. Interestingly, while lymphocyte transformation and interleukin-2 responses remained largely unaltered in these mice, levels of IFN-gamma produced by antigen-stimulated lymphocytes were shown to be reduced significantly. This study identifies a dosage threshold for effective oral vaccination using lipid-encapsulated BCG, and furthermore highlights the requirement of on-going intra-lymphatic BCG replication for the maintenance of strong IFN-gamma production, above other indicator CMI responses.     

Oral delivery of lipid-encapsulated Mycobacterium bovis BCG extends survival of the bacillus in vivo and induces a long-term protective immune response against tuberculosis

The success of oral-route vaccination using Mycobacterium bovis bacille Calmette-Guérin (BCG) relies on delivery of live, actively metabolising bacilli to confer protection. Here, we describe that lipid-microencapsulation can extend the in vivo survival of bacilli when fed to mice, and can induce a long-lasting protective immune response. Feeding mice with lipid-encapsulated BCG (L-BCG) resulted in greater recovery of viable BCG bacilli from the mesenteric lymph nodes (MLN) compared to mice fed non-encapsulated BCG. A time-course study indicated persistence of viable BCG bacilli in MLN up to 30 weeks post-vaccination, similar to the duration of viable BCG recovery from the spleen following subcutaneous vaccination. The persistence of viable bacilli in the MLN of L-BCG mice invoked long-lasting systemic cell-mediated immune reactivity, with responses similar to those observed in subcutaneously-vaccinated mice. Further, L-BCG-vaccinated mice showed a high degree of protection against aerogenic challenge with virulent M. bovis at 30 weeks post-vaccination, with significant reductions in lung and spleen pathogen burdens. This study identifies that lipid-encapsulation of live BCG bacilli can facilitate increased in vivo survival and immunogenicity of the vaccine in orally-vaccinated mice, and highlights protection via this route for up to 7 months post-immunisation.     

Low oral BCG doses fail to protect cattle against an experimental challenge with Mycobacterium bovis

Studies were undertaken to determine whether a dose of oral Mycobacterium bovis bacillus Calmette–Guérin (BCG) which did not induce skin test reactivity could protect cattle against bovine tuberculosis (TB). Groups of calves (n = 9) were vaccinated by administering 10⁸, 10⁷ or 10⁶ colony forming units (CFU) of BCG orally or 10⁶ CFU subcutaneous (s.c.) BCG. A control group (n = 10) was not vaccinated. All animals were challenged with M. bovis 18 weeks after vaccination and euthanized and necropsied at 16 weeks following challenge. Positive responses in the single cervical tuberculin skin test (severe interpretation) at 15 weeks post-vaccination were only observed in the s.c. BCG and 10⁸ CFU oral BCG groups (four of nine animals/group). Following experimental challenge with M. bovis, both these BCG-vaccinated groups had significant reductions in lesion scores and bacterial counts whereas there was no protection in calves vaccinated with oral doses of 10⁶ or 10⁷ CFU of BCG. In conclusion, low oral doses of BCG did not induce skin test responses, IFN-γ responses or protection against TB, however, in the BCG vaccine groups where protection was observed, there was no correlation between protection and skin test responses or IFN-γ responses.     

Oral immunization with a novel lipid-based adjuvant protects against genital Chlamydia infection

Oral immunization is attractive as a delivery route because it is needle-free and useful for rapid mass vaccination programs to target pandemics or bioterrorism. This potential has not been realized for human vaccination, due to the requirement of large antigen doses and toxic (to humans) adjuvants to overcome the induction of oral tolerance and potential degradation of antigens in the stomach. To date, only oral vaccines based on live attenuated organisms have been approved for human use. In this study we describe the use of a lipid-based delivery system/adjuvant, Lipid C, for oral immunization to protect mice against genital tract chlamydial infection. Lipid C is formulated from food-grade purified and fractionated triglycerides. Bacterial shedding following vaginal challenge with Chlamydia muridarum was reduced by 50% in female mice orally immunized with the chlamydial major outer membrane protein (MOMP) formulated in Lipid C, protection equivalent to that seen in animals immunized with MOMP admixed with both cholera toxin (CT) and CpG oligodeoxynucleotides (CpG-ODN). Protection was further enhanced when MOMP, CT and CpG were all combined in the Lipid C matrix. Protection correlated with production of gamma interferon (IFN) by splenic T cells, a serum MOMP-specific IgG response and low but detectable levels of MOMP-specific IgA in vaginal lavage.     

Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines

This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first‐line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low‐energy diet (n = 4), protein‐sparing modified fast (n = 2), and very low‐carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.     

Mycobacterium bovis-infected cervine alveolar macrophages secrete lymphoreactive lipid antigens

Tuberculosis is caused by intracellular bacteria belonging to the genus Mycobacterium, including M. tuberculosis and M. bovis. Alveolar macrophages (AMs) are the primary host cell for inhaled mycobacteria. However, little is known about the mechanisms by which infected AMs can process and present mycobacterial antigens to primed lymphocytes and how these responses may affect ensuing protection in the host. In the present study, we sought to determine whether AMs from a naturally susceptible host for Mycobacterium bovis (red deer) could produce and secrete soluble immunoreactive antigens following mycobacterial infection in vitro. Confluent monolayers of deer AMs were infected with either heat-killed or live virulent M. bovis or M. bovis BCG at a multiplicity of infection of 5:1 and cultured for 48 h. Culture supernatants were collected, concentrated, and tested for the presence of mycobacterial antigens in a lymphocyte proliferation assay by using peripheral blood mononuclear cells from M. bovis-sensitized or naive deer. Supernatants derived from macrophages which had been infected with live bacilli stimulated the proliferation of antigen-sensitized, but not naive, lymphocytes. Supernatants derived from uninoculated AMs or AMs inoculated with heat-killed bacilli failed to stimulate lymphocyte proliferation. The lymphoproliferative activity was retained following lipid extraction of the supernatants, which were free of amino groups as determined by thin-layer chromatography. These results demonstrate that mycobacteria which are actively growing within AMs produce lipids which are secreted into the extracellular milieu and that these lipids are recognized by lymphocytes from mycobacterium-primed hosts. We suggest that mycobacterial lipids are released from AMs following aerosol infection in vivo and that they play an important role in the early immune response to tuberculosis.     

Mice fed lipid-encapsulated Mycobacterium bovis BCG are protected against aerosol challenge with Mycobacterium tuberculosis

Mice that consumed a single dose of 10(7) lipid-encapsulated Mycobacterium bovis BCG bacilli showed significant pulmonary and systemic protection against aerosol challenge with M. tuberculosis H37Rv. As an extension of previous challenge studies with virulent strains of M. bovis, this report describes a reduction in M. tuberculosis infection in mice vaccinated orally with lipid-encapsulated BCG comparable to that observed in mice vaccinated subcutaneously with BCG. These results are consistent with the induction of tuberculin-specific cell-mediated immune responses.