Despite the widespread use of Mycobacterium bovis BCG, the only licensed vaccine against tuberculosis (TB), TB remains a global epidemic. To assess whether more direct targeting of the lung mucosa by respiratory immunization would enhance the potency and longevity of BCG-induced anti-TB protective immunity, the long-term impact of intranasal (i.n.) BCG vaccination was compared to conventional subcutaneous (s.c.) immunization by using a mouse model of pulmonary tuberculosis. Although significantly improved protection in the lung was seen at early time points (2 and 4 months postvaccination) in i.n. BCG-immunized mice, no differences in pulmonary protection were seen 8 and 10 months postvaccination. In contrast, in all of the study periods, i.n. BCG vaccination induced significantly elevated protective splenic responses relative to s.c. immunization. At five of nine time points, we observed a splenic protective response exceeding 1.9 log 10 protection relative to the s.c. route. Furthermore, higher frequencies of CD4 T cells expressing gamma interferon (IFN-␥) and IFN-␥/tumor necrosis factor alpha, as well as CD8 T cells expressing IFN-␥, were detected in the spleens of i.n. vaccinated mice. Using PCR arrays, significantly elevated levels of IFN-␥, interleukin-9 (IL-9), IL-11, and IL-21 expression were also seen in the spleen at 8 months after respiratory BCG immunization. Overall, while i.n. BCG vaccination provided short-term enhancement of protection in the lung relative to s.c. immunization, potent and extremely persistent splenic protective responses were seen for at least 10 months following respiratory immunization.
More than a century after Robert Koch first described how to culture tubercle bacilli, Mycobacterium tuberculosis remains one of the most successful human pathogens and a major global public health threat. According to the recent WHO global tuberculosis (TB) report, 1.3 million people died from TB in 2012 and 8.6 million new cases of the disease were detected (1). Next to HIV, TB is the most important cause of death from an infectious agent in low-income countries. Recommended by the WHO, live, attenuated Mycobacterium bovis BCG is the only TB vaccine approved for human use, being administered intradermally (i.d.) to more than 70% of children worldwide (2). Although i.d. BCG vaccination has been shown to be effective in preventing severe forms of extrapulmonary TB, its ability to protect against pulmonary TB in controlled clinical trials has been highly variable (0 to 80%) (3-5). Importantly, it has been estimated that i.d. BCG immunization prevents only about 5% of vaccine-preventable deaths (6). Clearly, novel, more effective TB immunization strategies are needed.Despite 9 decades of BCG vaccine use, the optimal vaccine dose and route of administration have not been fully defined. Since TB is primarily a pulmonary infection, respiratory BCG immunization has long been considered an attractive alternative to i.d. vaccination. With immune lymphoid mucosal and bronchial tissues being targeted by r...