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Review 1: "Therapeutic DNA Vaccine Targeting Mycobacterium Tuberculosis Persisters Shortens Curative Tuberculosis Treatment"

In order to confirm wider applicability and improve experimental details, both reviewers suggest more research.

Published onOct 24, 2024
Review 1: "Therapeutic DNA Vaccine Targeting Mycobacterium Tuberculosis Persisters Shortens Curative Tuberculosis Treatment"
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key-enterThis Pub is a Review of
Therapeutic DNA Vaccine Targeting Mycobacterium tuberculosis Persisters Shortens Curative Tuberculosis Treatment
Therapeutic DNA Vaccine Targeting Mycobacterium tuberculosis Persisters Shortens Curative Tuberculosis Treatment
Description

Abstract Mycobacterium tuberculosis (Mtb) is one of the leading infectious causes of death worldwide. There is no available licensed therapeutic vaccine that shortens active tuberculosis (TB) disease drug treatment and prevents relapse, despite the World Health Organization’s calls. Here, we show that an intranasal DNA vaccine containing a fusion of the stringent response relMtb gene with the gene encoding the immature dendritic cell-targeting chemokine, MIP-3α/CCL20, shortens the duration of curative TB treatment in immunocompetent mice. Compared to the first-line regimen for drug-susceptible TB alone, our novel adjunctive vaccine induced greater RelMtb-specific T-cell responses associated with optimal TB control in spleen, blood, lungs, mediastinal lymph nodes, and bronchoalveolar lavage (BAL) fluid. These responses were sustained, if not augmented, over time. It also triggered more effective dendritic cell recruitment, activation, and colocalization with T cells, implying enhanced crosstalk between innate and adaptive immunity. Moreover, it potentiated a 6-month TB drug-resistant regimen, rendering it effective across treatment regimens, and also showed promising results in CD4+ knockout mice, perhaps due to enhanced Rel-specific CD8+ T-cell responses. Notably, our novel fusion vaccine was also immunogenic in nonhuman primates, the gold standard animal model for TB vaccine studies, eliciting antigen-specific T-cell responses in blood and BAL fluid analogous to those observed in protected mice. Our findings have critical implications for therapeutic TB vaccine clinical development in immunocompetent and immunocompromised populations and may serve as a model for defining immunological correlates of therapeutic vaccine-induced protection.One sentence summary A TB vaccine shortens curative drug treatment in mice by eliciting strong TB-protective immune responses and induces similar responses in macaques.

RR\ID Evidence Scale rating by reviewer:

  • Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: In this manuscript, Karanika and colleagues show that therapeutic administration of the DNA vaccine MIP-3a/relMtb shortens TB treatment in mice. It is a follow up paper from their previous publication on MIP-3a/relMtb in conjunction with Isoniazid treatment.

Here, they convincingly show that treatment duration is reduced for standard TB treatment as well as a regimen used for drug-resistant strains. Importantly, their results also show that therapeutic vaccination prevents relapse in 100% of treated mice. 

Using knockout mice for CD4, the authors demonstrate the shortened treatment is independent of CD4 T cells and their immunogenicity data implies that the success of the treatment is associated with an immune signature characterized by polyfunctional (CD8) T cells and an influx of dendritic cells that colocalize with T cells in the lung.

They observe similar immune responses when the vaccine is administered to non-human primates (NHPs). However, no CFU measurements are performed in NHPs, and as such it remains to be shown whether the treatment regimen would actually reduce TB treatment time in humans and NHPs. Hence, I believe that the title of this manuscript should be amended to reflect that the treatment has thus far only been proven successful in mice.

Nevertheless, overall, the results are very convincing and encourage further investigations into the effectiveness of this adjunct therapy in other animal species and men.

Unfortunately, the supplementary Figures were not made available as part of this review package and I have only been able to assess the content in the main Figures.

In general, most of the Figures would benefit from reformatting, as it is not always intuitive what is shown on the a-axes, particularly Figures: 3, 5, 6 and 7. Most journals require each Figure panel to have its own legend and independent x and y labels. I recommend changing to this. 

The authors should also further comment on the non-significant results obtained when using the MIP-3a/relMtb construct together with next-generation treatment against DR-TB. This is somewhat surprising, given that the regimen was highly effective against resistant TB in the spleen.

Could this be due to the IN delivery route or perhaps reflect an issue with accessibility of the drug/vaccine combination in different organ systems?

As mentioned above, I believe that the overall impact of this manuscript could be significantly enhanced if the authors obtained CFU results from this treatment regimen in NHPs and also by performing CD8 neutralization in the CD4 KO mice.

These experiments would:

  • show that the treatment is widely applicable across species and potentially humans;

  • likely show if/that the increased reduction of CFU and the prevention of relapse is due to the CD8 T cell signature hinted to by their results.

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