接种疫苗和未接种疫苗的健康志愿者接种流感病毒后黏膜相关性保护。

Mucosal correlates of protection after influenza viral challenge of vaccinated and unvaccinated healthy volunteers.

机构信息

LID Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA.

出版信息

mBio. 2024 Feb 14;15(2):e0237223. doi: 10.1128/mbio.02372-23. Epub 2024 Jan 9.

Abstract

The induction of systemic antibody titers against hemagglutinin has long been the main focus of influenza vaccination strategies, but mucosal immunity has also been shown to play a key role in the protection against respiratory viruses. By vaccinating and challenging healthy volunteers, we demonstrated that inactivated influenza vaccine (IIV) modestly reduced the rate of influenza while predominantly boosting serum antibody titers against hemagglutinin (HA) and HA stalk, a consequence of the low neuraminidase (NA) content of IIV and the intramuscular route of administration. The viral challenge induced nasal and serum responses against both HA and NA. Correlations between mucosal IgA and serum IgG against specific antigens were low, whether before or after challenge, suggesting a compartmentalization of immune responses. Even so, volunteers who developed viral shedding for multiple days had lower baseline titers across both systemic and mucosal compartments as compared to those with no shedding or a single day of shedding. Regression analysis showed that pre-challenge HA inhibition titers were the most consistent correlate of protection across clinical outcomes combining shedding and symptoms, with NA inhibition titers and HA IgG levels only predicting the duration of shedding. Despite the inclusion of data from multiple binding and functional antibody assays against HA and NA performed on both serum and nasal samples, multivariate models were unable to account for the variability in outcomes, emphasizing our imperfect understanding of immune correlates in influenza and the importance of refining models with assessments of innate and cellular immune responses.IMPORTANCEThe devastating potential of influenza has been well known for over 100 years. Despite the development of vaccines since the middle of the 20th century, influenza continues to be responsible for substantial global morbidity and mortality. To develop next-generation vaccines with enhanced effectiveness, we must synthesize our understanding of the complex immune mechanisms culminating in protection. Our study outlines the differences in immune responses to influenza vaccine and influenza infection, identifying potential gaps in vaccine-induced immunity, particularly at the level of the nasal mucosa. Furthermore, this research underscores the need to refine our imperfect models while recognizing potential pitfalls in past and future attempts to identify and measure correlates of protection.

摘要

诱导针对血凝素的系统抗体滴度一直是流感疫苗接种策略的主要重点,但黏膜免疫也已被证明在抵抗呼吸道病毒方面发挥着关键作用。通过对健康志愿者进行接种和挑战,我们证明了灭活流感疫苗(IIV)适度降低了流感的发病率,而主要增强了针对血凝素(HA)和 HA 茎的血清抗体滴度,这是由于 IIV 中的低神经氨酸酶(NA)含量和肌肉内给药途径所致。病毒挑战诱导了针对 HA 和 NA 的鼻内和血清反应。无论是在挑战之前还是之后,黏膜 IgA 与针对特定抗原的血清 IgG 之间的相关性均较低,表明免疫反应存在分隔。即便如此,与无脱落或仅脱落一天的志愿者相比,连续多天发生病毒脱落的志愿者在系统和黏膜隔室中均具有较低的基线滴度。回归分析表明,与症状结合的脱落和无症状的临床结局相比,在进行病毒挑战之前,针对 HA 的抑制滴度是最一致的保护相关指标,而针对 NA 的抑制滴度和 HA IgG 水平仅预测脱落的持续时间。尽管纳入了针对 HA 和 NA 的多个结合和功能抗体测定的血清和鼻样本数据,但多变量模型仍无法解释结局的可变性,这强调了我们对流感免疫相关性的理解不完善,以及用对先天和细胞免疫反应的评估来完善模型的重要性。

重要性

流感的破坏性潜力已被人们认识 100 多年了。尽管自 20 世纪中叶以来已经开发出了疫苗,但流感仍继续导致大量的全球发病率和死亡率。为了开发具有增强效力的下一代疫苗,我们必须综合我们对导致保护的复杂免疫机制的理解。我们的研究概述了流感疫苗和流感感染引起的免疫反应之间的差异,确定了疫苗诱导免疫中的潜在差距,特别是在鼻黏膜水平上。此外,这项研究强调了需要完善我们不完善的模型,同时认识到在过去和未来尝试识别和衡量保护相关性时可能存在的陷阱。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d53e/10865821/5b7a95452d3d/mbio.02372-23.f001.jpg

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