Probiotics, antibiotics and the immune responses to vaccines

Praharaj, Ira; John, Sushil Mathew; Bandyopadhyay, Rini; Kang, Gagandeep

doi:10.1098/rstb.2014.0144

Cited by 54 publications

(38 citation statements)

References 105 publications

(115 reference statements)

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“…Traditional probiotics have been given concomitantly with oral vaccines in children with the goal of enhancing protective immune responses but have yielded mixed results (68). Alternatively, commensals with beneficial immune-stimulating properties might be engineered to present heterologous antigen as well.…”

Section: Future Directionsmentioning

confidence: 99%

Microbiome as a tool and a target in the effort to address antimicrobial resistance

Relman

Lipsitch

2018

Proc. Natl. Acad. Sci. U.S.A.

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Reciprocal, intimate relationships between the human microbiome and the host immune system are shaped by past microbial encounters and prepare the host for future ones. Antibiotics and other antimicrobials leave their mark on both the microbiome and host immunity. Antimicrobials alter the structure of the microbiota, expand the host-specific pool of antimicrobial-resistance genes and organisms, degrade the protective effects of the microbiota against invasion by pathogens, and may impair vaccine efficacy. Through these effects on the microbiome they may affect immune responses. Vaccines that exert protective or therapeutic effects against pathogens may reduce the use of antimicrobials, the development and spread of antimicrobial resistance, and the harmful impacts of these drugs on the microbiome. Other strategies involving manipulation of the microbiome to deplete antibiotic-resistant organisms or to enhance immune responses to vaccines may prove valuable in addressing antimicrobial resistance as well. This article describes the intersections of immunity, microbiome and antimicrobial exposure, and the use of vaccines and other alternative strategies for the control and management of antimicrobial resistance.

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Section: Future Directionsmentioning

confidence: 99%

Microbiome as a tool and a target in the effort to address antimicrobial resistance

Relman

Lipsitch

2018

Proc. Natl. Acad. Sci. U.S.A.

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“…To date, the potential benefits of this approach remain equivocal, as reviewed elsewhere [158]. However, the administration of daily supplements of Lactobacillus rhamnosus GG provoked a modest improvement in Rotarix immunogenicity during a placebo-controlled trial in India [120].…”

Section: The Commensal Microbiotamentioning

confidence: 99%

Causes of Impaired Oral Vaccine Efficacy in Developing Countries

et al. 2017

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Oral vaccines are less immunogenic when given to infants in low-income compared with high-income countries, limiting their potential public health impact. Here, we review factors that might contribute to this phenomenon, including transplacental antibodies, breastfeeding, histo blood group antigens, enteric pathogens, malnutrition, microbiota dysbiosis and environmental enteropathy. We highlight several clear risk factors for vaccine failure, such as the inhibitory effect of enteroviruses on oral poliovirus vaccine. We also highlight the ambiguous and at times contradictory nature of the available evidence, which undoubtedly reflects the complex and interconnected nature of the factors involved. Mechanisms responsible for diminished immunogenicity may be specific to each oral vaccine. Interventions aiming to improve vaccine performance may need to reflect the diversity of these mechanisms. Enteric pathogens are a substantial threat to public health. This threat takes many forms, from the toxin-producing bacteria (e.g., Vibrio cholerae) and flagellated protozoa (e.g., Giardia lamblia) that colonize the mucosal surface of the small intestine to the enteroviruses that are capable of spreading via the bloodstream to the CNS, causing acute flaccid paralysis (e.g., poliovirus). Each year, enteric pathogens cause hundreds of millions of cases of diarrhea and approximately 800,000 deaths, the vast majority of which occur among children in low-income countries [1]. The most common causes of childhood diarrheal morbidity include rotavirus, Cryptosporidium, enterotoxigenic Escherichia coli and Shigella [2].Vaccines against enteric pathogens are important tools for mitigating this disease burden. Oral vaccines offer several distinct benefits compared with parenteral vaccines. They can be produced in large quantities at relatively low cost, are easy to administer and have the capacity to induce local immunity in the intestinal mucosa, thereby protecting vaccinated individuals against subsequent infection and -by blocking onward transmission -enhancing herd immunity [3,4]. Currently licensed oral vaccines include live-attenuated poliovirus vaccines containing one, two or three serotypes, live-attenuated rotavirus vaccines (Rotarix R , RotaTeq R , Lanzhou lamb rotavirus vaccine [China only] and Rotavac R [India only]), live-attenuated cholera vaccine (CVD 103-HgR or Vaxchora TM ), inactivated cholera vaccines (Dukoral R and Shanchol R ) and live-attenuated typhoid vaccine (Ty21a). Other oral vaccines are in development, including those against Shigella, enterotoxigenic E. coli, Campylobacter and Clostridium difficile, as well as several novel rotavirus vaccine candidates (including the human neonatal vaccine RV3-BB [5] and an oral bovine pentavalent vaccine [6]).Yet oral vaccines have an Achilles' heel -their immunogenicity and efficacy is impaired in low-income countries that experience the greatest burden of enteric disease (Box 1). For example, Rotarix has a 1-year protective efficacy against severe rotavirus-associated gas...

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“…18 The impact of antibiotics on the response to oral vaccination has also not previously been examined. 19 We measured the impact of azithromycin on the development of serum neutralising antibodies and poliovirus shedding after OPV, in addition to faecal and plasma biomarkers of EE and intestinal pathogens in stool. We were therefore able to determine the impact of antibiotic treatment on EE and intestinal pathogens, and whether this improved the immune response to OPV.…”

Section: Introductionmentioning

confidence: 99%