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Remission from HIV-1 infection: discovery of broadly neutralizing antibodies that contribute to virus control

Antibody fragments of EPCT112 bNAb (blue) discovered at the Institut Pasteur by Hugo Mouquet’s team, here forming a complex with the HIV-1 envelope protein (Env) (shown in yellow and orange

Some HIV-1 carriers who have received an early antiretroviral treatment during several years are able to control the virus for a long term after treatment interruption. However, the mechanisms enabling this post-treatment control have not been fully elucidated. For the first time, teams of scientists from the Institut Pasteur, Inserm and the Paris Public Hospital Network (AP-HP), supported by ANRS | Emerging Infectious Diseases, have investigated and revealed how neutralizing antibodies, including those described as broadly neutralizing, contribute to virus control. These key findings were published in the journal Cell Host & Microbe on July 10, 2023. A clinical trial involving the use of broadly neutralizing antibodies should begin in France before the end of 2023.

“Post-treatment controllers” is the term used to describe the rare HIV-1 carriers who, having initiated treatment early and maintained it for several years, are able to control the virus for years after that the treatment has been discontinued. These individuals were identified several years ago in part through the VISCONTI[1] study, which assembled the largest cohort of long-term post-treatment controllers in France. Although the mechanisms of viral control enabling the long-term remission from HIV-1 infection without antiretroviral therapy have not been fully elucidated, the identification of these cases provides a unique opportunity to refine our understanding of the factors associated to HIV-1 infection control.

A study conducted by the Institut Pasteur’s Humoral Immunology Unit led by Dr. Hugo Mouquet in collaboration with the team led by Dr. Asier Sáez-Cirión, Head of the Institut Pasteur’s Viral Reservoirs and Immune Control Unit, is now contributing to efforts to describe these mechanisms in more detail.

Asier Saéz-Cirión explains: “Our investigation published in 2020 on the immune response in post-treatment controllers marked a major first step in demonstrating an effective and robust antibody response to HIV-1 in some of these individuals, which may contribute to this control[2].This knowledge has now been further advanced by our new study. By investigating the role of antibodies in a specific “post-treatment controller” case with particularly high serum levels of broadly neutralizing antibodies, we discovered that remission was probably linked to the activity of this type of antibodies.

Hugo Mouquet describes the discovery: “Our study describes for the first time in a post-treatment controller a family of broadly neutralizing antibodies (bNAbs) targeting the HIV-1 envelope protein, of which the antibody EPTC112 is one of the most active member.

The antibody EPTC112 neutralizes about a third of the 200 viral variants of HIV-1[3] tested in vitro and is able to induce the elimination of infected cells in the presence of natural killer (NK) cells, the immune cells eliminating abnormal cells in the body.

This study therefore provides important insights on how neutralizing antibodies modify the course of HIV-1 infection in this individual from the VISCONTI cohort. Although the HIV-1 virus circulating in this subject was found to be resistant to EPTC112 neutralization due to mutations in the region targeted by this antibody, it was effectively neutralized by other antibody populations isolated from the blood of the individual. Hence, the study suggests that neutralizing antibodies from the EPTC112 family impose a selective pressure on the HIV-1 virus. Although the virus escaped the action of these bNAbs, it remained susceptible to the neutralization by other anti-HIV-1 antibodies produced in this individual. This observation suggests the existence of a cooperation between the various populations of neutralizing antibodies.

The fact that we discovered a potential link between the production of neutralizing antibodies, including bNAbs, and the HIV-1 control is exciting to better understand the underlying mechanisms of viral control, particularly by studying additional post-treatment controllers with similar profiles. Indeed, we wish to continue investigating on a short term whether the antibody responses in other ‘post-treatment’ controllers also contribute to long-term remission from the infection,” explains Hugo Mouquet.

This discovery paves the way for new avenues of HIV-1 therapy and fuels hopes of therapeutic approaches for increasing the chances of remission without antiretroviral treatment through the use of broadly neutralizing antibodies. To this end, a clinical trial involving the administration of broadly neutralizing antibodies[4] should begin in France before the end of 2023.

This Phase II trial conducted by the ANRS RHIVIERA consortium through a partnership between the Institut Pasteur, AP-HP, Inserm and the Rockefeller University in New York, will investigate the combination of an antiretroviral therapy in the primary infection phase with two long-acting HIV-1 bNAbs versus placebo to determine whether these antibodies contribute to establishing viral remission after antiretroviral treatment discontinuation. 69 patients in the primary HIV-1 infection[5] phase are planned to be enrolled. They will first receive a short-term antiretroviral treatment, followed by a therapy with the two bNAbs targeting two different regions of the virus envelope protein. It will be possible to stop therapy after a year of close monitoring based on a detailed set of criteria. This trial will enable us to determine whether this therapeutic strategy is able to induce a sufficient immune response to control the infection after the discontinuation of antiretroviral therapy,” concludes Hugo Mouquet.

VIH

Antibody fragments of EPCT112 bNAb (blue) discovered at the Institut Pasteur by Hugo Mouquet’s team, here forming a complex with the HIV-1 envelope protein (Env) (shown in yellow and orange) © Institut Pasteur

 

[1] HIV: The Antibodies of “Post-treatment Controllers”

[2] Transient viral exposure drives functionally coordinated humoral immune responses in HIV-1 post-treatment controllers study, Nature Communication, 11 avril 2022

[3] There are two types of HIV: HIV-1 and HIV-2 that differ from each other at molecular level. Variants occurring within these two types exhibit different levels of transmissibility, virulence and immunogenicity due to the various mutations associated with them.

[4] https://rhiviera.com/project/anrs-rhiviera-02/

[5] Primary infection: early phase of HIV-1 infection during which the viral load is high. The HIV virus invades the body, attacking the immune system and destroying its CD4 lymphocyte reservoirs.

A global overview of antibiotic resistance determinants

Proportion of third-generation cephalosporin resistance in Klebsiella pneumoniae, for blood infections, 2019 (data from ATLAS, Pfizer) © Institut Pasteur, Eve Rahbé

To understand the main determinants behind worldwide antibiotic resistance dynamics, scientists from the Institut Pasteur, Inserm, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay developed a statistical model based on a large-scale spatial-temporal analysis. Using the ATLAS antimicrobial resistance surveillance database, the model revealed significant differences in trends and associated factors depending on bacterial species and resistance to certain antibiotics. For example, countries with high quality health systems were associated with low levels of antibiotic resistance among all the gram-negative bacteria1 investigated, while high temperatures were associated with high levels of antibiotic resistance in Enterobacteriaceae. Surprisingly, national antibiotic consumption levels were not correlated with resistance for the majority of the bacteria tested. The results suggest that antibiotic resistance control measures need to be adapted to the local context and to targeted bacteria-antibiotic combinations. The results of the study were published in the journal The Lancet Planetary Health on July 10, 2023.

Antibiotic resistance (ABR) is currently one of the most urgent threats to global health. It is a natural phenomenon, but improper use of antibiotics is contributing to it by selecting resistance and complicating bacterial infection-control strategies.

Worldwide surveillance of antibiotic resistance, especially under the aegis of WHO has been set up, and several databases have been created to record ABR worldwide, with the long-term aim of improving understanding of the causes to help tackle the phenomenon.

Antibiotic resistance varies considerably depending on the bacterial species, but a recent study2 estimated that in 2019, 1.27 million deaths worldwide were attributable globally to ABR and ABR was associated with 4.95 million deaths.

To identify the main factors associated with worldwide antibiotic resistance dynamics, a multidisciplinary research team at the Institut Pasteur developed a statistical model and analyzed antibiotic resistance data from the ATLAS database, which contains data collected since 2004 in more than 60 countries on every continent. The scientists analyzed the data by testing a large number of determinants to reveal the main factors of antibiotic resistance and understand how they relate to the dynamics observed worldwide.

Research teams study how antibiotic resistance emerges in a bacterium in a Petri dish or in an individual, but we are currently lacking a population-level, global overview that can be used to investigate links between resistance and specific factors like national health system quality for different species of pathogenic bacteria. To understand the dynamics of antibiotic resistance, it needs to be studied at every level. That is what this study sets out to do,” explains Eve Rahbé, a PhD research student in the Institut Pasteur’s Epidemiology and Modeling of Bacterial Escape to Antimicrobials Unit and first author of the study.

The first stage of the study was to select relevant factors that could influence antibiotic resistance dynamics.

“Although some biological factors are known, it was also important for us to investigate hypotheses associated with socioeconomic and climate factors,” continues the scientist.

A total of eleven independent factors were selected, including health system quality (based on the GHS index3), antibiotic consumption and national wealth (GDP per capita), as well as data on travel and climate variables. Statistical models were then developed to study potential associations between the ATLAS data and the selected factors.

The analysis of global data for the period 2006-2019 initially revealed an increase in resistance to carbapenems for several species, although global trends were stable for other resistances. The study also demonstrated that the dynamics and factors associated with antibiotic resistance depend on bacteria-antibiotic combinations. Surprisingly, however, national antibiotic consumption was not significantly associated with resistance for the majority of bacteria tested (except for quinolone consumption for fluoroquinolone-resistant Escherichia coli and Pseudomonas aeruginosa and carbapenem consumption for carbapenem-resistant Acinetobacter baumannii).

Conversely, high health system quality was associated with low levels of antibiotic resistance in all the gram-negative bacteria1 tested. High temperatures were associated with high levels of antibiotic resistance, but only for Enterobacteriaceae (Escherichia coli and Klebsiella pneumoniae).

This study reveals the wide range of factors leading to antibiotic resistance among different pathogenic bacteria at global level, and the need to adapt resistance control approaches to the local context (country, transmission context) and the specific bacteria-antibiotic combination,” concludes Philippe Glaser, Head of the Institut Pasteur’s Ecology and Evolution of Antibiotic Resistance Unit and co-last author of the study.

“Our statistical model can be applied to other databases, such as the WHO database. Improving understanding of resistance determinants, which differ from one country to the next and probably even vary among regions in the same country, is crucial and will be useful in adapting public health measures,” concludes Lulla Opatowski, a Professor at Université de Versailles Saint-Quentin-en-Yvelines, scientist in the Epidemiology and Modeling of Bacterial Escape to Antimicrobials Unit and co-last author of the study.

This research was funded by the research organizations cited above, the LabEx IBEID and an independent research Pfizer Global Medical Grant. 

See the fact sheet about antibiotic resistance at pasteur.fr

1 Gram-negative bacteria are bacteria with two membranes that are more resistant to antibiotics because of the low permeability of their outer membrane.

2 Lancet, https ://doi.org/10.1016/S0140-6736(21)02724-0

3 GHS: Global Health Security Index

How Blood Stem Cells Detect Pathogens and Guide Immune Response

Cellule du système immunitaire infectée par BrucellaImmune system cell infected with Brucella (green); endocytosis compartment (blue). © CIML

Correct immune system function depends on the continuous supply of white blood cells derived from stem cells that reside in the bone marrow.  These are known as blood stem cells or hematopoietic stem cells. Researchers from Inserm, CNRS and Université d’Aix-Marseille at the Center of Immunology Marseille-Luminy have now discovered a new role played by these cells in immune response. In their article published in Journal of Experimental Medicine, they describe how they are able to recognize and directly interact with a bacterium called Brucella in the bone marrow, thanks to a receptor present on their surface. This is the first demonstration of the direct recognition of a living pathogen by the blood stem cells, which attests to their very early contribution to the immune response.

Blood stem cells, otherwise known as hematopoietic stem cells, are stem cells that reside in the bone marrow. They multiply and give rise to all blood cells, namely the red cells that transport oxygen and the white cells that participate in the immune response.

With regard to immune response, the blood stem cells had until now only been seen as the cells from which the white cells originate. However, a growing body of evidence suggests that they can also contribute directly and actively to the immune response. For example, recent data have shown that they can directly detect cytokines, which are proteins released during infection or inflammation.

In a new publication, a research team from Inserm, CNRS and Université d’Aix-Marseille led by Michael Sieweke and Jean-Pierre Gorvel[1] wanted to further the scientific knowledge in this area. The researchers succeeded in describing the mechanisms at work during the encounter between the blood stem cell and a specific pathogen: the Brucella bacterium, which is a mandatory reportable microorganism/toxin (MOT)[2].

Brucella causes an infectious disease called brucellosis (also known as Malta fever or Mediterranean fever), which is one of the most widespread zoonoses posing a significant threat to human health worldwide[3]. Brucella is an intriguing pathogen and very interesting for the scientists to study because of its ability to establish persistent and chronic infections and evade the immune response of its host[4].

The scientists found that the blood stem cells present in the bone marrow were able to detect Brucella. Their observations show that CD150, a specific receptor on the surface of the blood stem cells, interacts with Omp25, a protein present on the surface of Brucella.

bactérie BrucellaGraphic Summary of the Discovery. Thanks to the CD150 receptor on their surface, the blood stem cells in the bone marrow are able to detect Brucella. After recognizing it, they begin to produce more white blood cells. © CIML

 

“Our study reveals the mechanisms by which these blood cells are able to detect bacteria via a special receptor. We can consider this as a direct ‘handshake’ between the stem cell and the bacterium. Never had anyone imagined that the blood stem cell could recognize a living bacterium,” explains Sandrine Sarrazin, Inserm researcher and co-last author of the study.

The scientists then showed that this “handshake” leads to a rapid response by the stem cells, whereby they begin to produce more white blood cells. This is the first demonstration of the direct recognition of a living pathogen by blood stem cells and attests to a very early and unexpected contribution of these cells to the immune response.

 

How Brucella Uses Stem Cells to “Hack” the Immune System

The scientists then wondered whether this mechanism was more beneficial to the host or to the bacterium.

Thanks to meticulous observations, they found that Brucella directs the stem cells to produce the white blood cells it favors for infection. The bacterium is able to invade the white blood cells produced by the blood stem cells and use them to multiply and establish itself in the body. In this particular case, the stem cells therefore contribute to the spread of the bacterium.

“This research sheds new light on the sophisticated mechanisms that pathogens use to evade the immune system’s defenses. While the increased production of white blood cells would be beneficial if they could effectively fight infection, Brucella is able to exploit them in order to multiply,” explains Gorvel, one of the co-last authors of the study.

“This mechanism can be seen as an evasion strategy used by the bacterium to advance the infection,” summarizes Sieweke, another co-last author of the study.

The publication of this study marks an important step in understanding the complex dance between Brucella and the hematopoietic stem cells. It not only provides crucial information on the pathogenesis of brucellosis, but also opens up new avenues for the development of targeted therapeutic interventions.

“In addition to improving knowledge about how the immune response works, our study ultimately allows us to envisage the development of a targeted therapy capable of preventing the interactions between Brucella and the blood stem cell, preventing the spread of the bacteria in the body and helping patients with brucellosis,” concludes Gorvel.

 

[1] This research is the result of a collaboration between two research teams at the Center of Immunology Marseille-Luminy (CIML, CNRS/Inserm/Aix-Marseille Université): Michael Sieweke’s Stem cell and macrophage biology team and Jean-Pierre Gorvel’s Immunology and cell biology of pathogen/host cell interactions team.

[2] The Brucella experiment was therefore conducted at the Center for Immunophenomics (CIPHE) under biosafety level 3 conditions.

[3] The World Health Organization (WHO) has identified brucellosis as being one of the seven most neglected zoonoses, contributing to poverty, hindering development, and causing substantial economic losses in developing countries.

[4] Previous studies conducted at Gorvel’s laboratory had enabled crucial discoveries with the aim of elucidating the mechanisms underlying these phenomena.

Eating Broccoli to Limit Skin Allergies

brocoli

The scientists specifically focused on dietary compounds naturally present in cruciferous vegetables, such as broccoli. © Unsplash

The severity of skin allergies can vary depending on many environmental factors, including diet. However, the role of specific nutrients had not been well documented until now. In a new study, researchers from Inserm and Institut Curie at the Immunity and Cancer[1] unit have shown that the absence in the diet of compounds found in certain vegetables, particularly broccoli and cabbage, could worsen skin allergies in animal models. These findings, published in Elife, highlight the importance of a balanced diet alongside therapeutic interventions offered to patients.

Skin allergies are caused by an inappropriate immune response to compounds present in the environment, with the extent of their severity varying according to many factors, including diet. However, the impact of the different compounds present in food is still poorly understood, which complicates the use of nutrition-based strategies to alleviate patient symptoms.

In this research, the scientists focused on dietary compounds that act on a molecule present in the body called the aryl hydrocarbon receptor (AhR). Such nutrients are naturally present in cruciferous vegetables, such as broccoli.

While previous studies had already shown an association between these dietary compounds and the worsening of inflammatory bowel disease and neuroinflammation, their effect on allergic immune reactions had not been documented until now.

 

Worsening Allergies

The research team used a mouse model of skin allergy. Some of the animals were fed a diet containing no AhR-activating compounds in order to evaluate its potential impact on the severity of their allergy.

The researchers showed that the absence of these nutrients is associated with an increase in the skin’s inflammatory state and a worsening of the skin allergy, which did not occur in the mice whose diet contained those compounds.

The scientists wished to go further in order to understand the biological mechanisms of action of these nutrients. When the nutrients were absent, they observed the overproduction of a molecule called TGF-beta in the epidermis of the mice. This overproduction disrupts the normal functioning of a population of immune cells called “Langerhans cells”, which are exclusively present in the skin and act as a modulator of skin immune responses.

The scientists then validated these findings by showing that the AhR-activating compounds also control TGF-beta production in human skin cells.

“Our results suggest that an imbalanced diet could increase allergic skin reactions in humans through mechanisms that we have described precisely. In essence, we could say that our research helps to explain why eating vegetables such as broccoli and cabbage may limit the severity of skin allergies and why it is therefore important to include them in one’s diet,” emphasizes Inserm researcher Elodie Segura, who led this study at Institut Curie.

The findings of this study may also apply to other skin diseases in which inflammatory mechanisms are involved, such as psoriasis. Furthermore, they also open up interesting research avenues for improving the study of the gut-skin axis in the development of allergic diseases.

Based on these data, the research team now wishes to look at the role of AhR-activating dietary compounds in other inflammatory disease settings, such as tumors.

 

[1] Conducted at the Immunity and Cancer unit (Inserm, Institut Curie), this research was carried out with particular thanks to Institut Curie’s experimental pathology platform and new metabolomics and lipidomics platform.

Hypertension: A Mixture of Air Pollutants Could Cause Repeated High Blood Pressure Peaks

Pollution de l'airAir pollution is an acknowledged environmental factor in high blood pressure. © Adobe Stock

Air pollution is an acknowledged environmental factor in high blood pressure. It consists of a mixture of particles and gases whose combined effects on human health are not yet well known. A team from Inserm and Sorbonne Université, assisted by international collaborators, used continuous monitoring to study the daily life impact of a mixture of five air pollutants on the blood pressure of 221 MobiliSense[1] study participants in the Greater Paris area. With two models – one taking into account variations in ambient air pollutant levels, the other variations in the amounts inhaled – the researchers observed an association with acute repeated blood pressure increases. This study, published in Environmental Research, paves the way for a better understanding of the link between air pollution and hypertension.

Hypertension is a chronic disease that affects one in three adults. Linked to abnormally high pressure of the blood in the blood vessels, it can lead to cardiovascular, cerebrovascular, and even neurodegenerative complications.

Previous studies have shown that some air pollution molecules affect blood pressure and could therefore promote hypertension. However, in everyday life, the air pollution to which people are exposed generally consists of mixtures of air pollutants rather than a single component in isolation – mixtures that had been little researched until now.

An international team led by Basile Chaix, Inserm Research Director at the Pierre Louis Institute of Epidemiology and Public Health (Inserm/Sorbonne Université), wanted to characterize the effects on blood pressure of the daily-life exposure to a mixture of five air pollutants – black carbon, nitrogen dioxide (NO2), nitrogen oxide (NO), carbon monoxide (CO), and ozone (O3) – in 221 participants from the MobiliSense study.

In order to study the effects of this complex mixture, the research team developed new monitoring methods and used innovative measuring equipment. Each participant wore an ambulatory blood pressure measurement device[2], two portable sensors to continuously measure pollutants in the ambient air near the breathing zone, a GPS tracker to record mobility, and an accelerometer to measure physical activity and thus estimate the ventilation rate[3] (the volume of air inhaled or exhaled per unit of time). The measurements were taken over one day in the lives of the participants.

Their blood pressure was measured every 30 minutes in order to observe as closely as possible the time between variations in ambient air pollutant levels, the estimated amount of pollutants inhaled, and their potential impact on blood pressure.

Learn more about blood pressure and hypertension

Blood pressure results from the ejection of blood from the heart into the blood vessels and consists of the pressure it exerts on the vessel walls. It is characterized by two values:

  • the upper value or systole (systolic blood pressure), measured when the heart contracts. This pumps blood through the aorta to the peripheral arteries;
  • the lower value or diastole (diastolic blood pressure), measured when the heart relaxes. This enables the cardiac ventricles to receive the blood that enters the atria through the vena cava- and pulmonary veins.

Hypertension is when the resting systolic value is above 140 mmHg and/or the resting diastolic value is above 90 mmHg.

The researchers observed that when the levels of all the pollutants in the mixture increased within the 5 minutes prior to measuring blood pressure, there was an increase in systolic pressure (see box). A similar association was also found between an increase in the amount of pollutants inhaled within the 5 minutes prior to measuring blood pressure (related to an increase in the concentrations measured and/or physical activity and therefore in the ventilation rate) and an increase in systolic pressure.

“We chose to consider short windows of exposure (5 min, 15 min, 30 min, 1 hour) to study the time between exposure to pollution and blood pressure response, specifies Chaix. Here we see that the association is weaker when the exposure is observed over windows longer than 5 minutes, which indicates the immediacy of the blood pressure elevation in response to increased levels of air pollutants in the studied mixture,” adds the researcher. He continues: “These repeated increases in blood pressure linked to exposure to air pollutants in urban areas when out and about could contribute to a chronic rise in blood pressure, month after month, year after year. “

Another observation from these two models is that – when we consider the individual contribution of each pollutant to the effect of the mixture on blood pressure – ozone and black carbon present as being the greatest contributors to its increase.

With few existing studies having used these measurement and modeling methods to study mixtures rather than isolated pollutants, the research team clarifies that it does not currently have the possibility to compare its findings with other research, which means that they should be interpreted with caution.

However, should these findings be confirmed, it may be possible to extrapolate them to the populations of other major European cities whose pollution levels are similar to those of Greater Paris.

As for the implications of the study, Chaix concludes: “Our findings call for air pollution to be considered as a cause of hypertension and for the rollout of public policies aimed at reducing exposure to this pollution in everyday life – and particularly that of road traffic in the heart of our towns and cities. “

Next on the agenda is for the team to explore the physiological mechanisms and causes behind the associations observed in this study.

 

[1]The MobiliSense study is conducted on inhabitants of the Greater Paris area and aims to explore the effects of air and noise pollution exposure on cardiovascular and respiratory health.

[2]Unlike the blood pressure measurements taken when the individual is in a resting state, ambulatory blood pressure measurements are taken throughout the day and during the course of the individual’s activities using a wearable device.

[3]In previous studies, the team had shown that the amount of polluted air inhaled was not directly proportional to the levels of pollutants in the breathing zone but was also dependent on the ventilation rate, which varies with the intensity of physical activity. The ventilation rate was therefore estimated for each participant based on the accelerometer measurements.

COVID-19: Infection-Vaccination is the Most Protective Combination Against Reinfection

SARS-CoV-2

Electron microscopy visualization of a cell infected with SARS-CoV-2. © Philippe Roingeard, Anne Bull-Maurer, Sonia Georgeault/Inserm.licence CC-BY-NC 4.0 international

A large part of the population has developed immunity against SARS-CoV-2 following infection, vaccination – or both. In addition, some infected patients enjoy “hybrid” immunity when they are vaccinated following their infectious episode. Scientists from Inserm, CNRS, Université Claude-Bernard Lyon 1 and ENS de Lyon at the International Center for Research on Infectious Diseases (CIRI) seek to characterize the imprint left by SARS-CoV-2 exposure through vaccination or the combination of the two events on immune memory. The objective? Deepen their understanding of the mechanisms of immune response to the virus in order to improve patient care and optimize vaccine strategies. In a new study, the scientists compared the immune memory of convalescent individuals, whether or not vaccinated against SARS-CoV-2, with that induced by vaccination in individuals having never been infected with the virus. Their findings show that those who are vaccinated following an infection are the best protected from SARS-CoV-2 reinfection. The full article has been published in Science Translational Medicine.

Our body keeps a memory of the infections it has already fought in order to protect us against possible reinfection. The efficacy of vaccination is based on a strategy of simulating an infection to induce protective immunity, i.e. the production of memory cells “trained” in recognizing the pathogen, which can protect the body in the event of infection.

In the case of COVID-19, immunity is conferred either by infection (natural immunity) or by vaccination (vaccine immunity). Some people also benefit from “hybrid” immunity since they have been vaccinated following an infectious episode.

In order to better understand the precise mechanisms of the immune response to SARS-CoV-2, researchers from Inserm, CNRS, Université Claude-Bernard Lyon 1 and ENS de Lyon compared different immune memory parameters from blood samples collected from individuals with natural immunity, vaccine immunity, or hybrid immunity to SARS-CoV-2.

They focused on the adaptive immune response and more specifically on the so-called “humoral” response (see box below).

More About Adaptive Immune Response

The adaptive immune response is established a few days after contact with the pathogen, unlike the innate immune response, which is immediate.

There are two main categories of adaptive immune response.

Cell responses, which are based on the recognition and destruction of the infected cells by the cytotoxic (killer) T cells.

Humoral responses, which are based on the production of antibodies by the B cells. These antibodies recognize the pathogen and neutralize it to prevent it from infecting the target cells.

Humoral immune memory has two compartments:

– serological memory, estimated by the levels of circulating antibodies produced by the memory plasma cells. These antibodies create a barrier that can prevent reinfection.

– cell memory, consisting of memory B cells that do not secrete antibodies but which can differentiate rapidly and massively into plasma cells to generate a new amplified antibody production. These memory B cells are called upon when the barrier of antibodies produced by the memory plasma cells is deficient or insufficient.

The findings show that six months after the last vaccine injection or after infection, people with hybrid immunity are those with the highest levels of neutralizing antibodies in the blood.

In addition to this quantitative variation in serological memory, the authors also show that hybrid immunity induces a qualitative change in the cell memory constituted by the B cells. This results in a multiplication of the number of certain memory B cells carrying receptors enabling their relocation in the respiratory and intestinal mucosa. This last point suggests that hybrid immunity could provide better protection to the SARS-CoV-2 penetration sites.

“As a whole, the findings of this study demonstrate the superiority of hybrid immunity over all other forms of immunity. They emphasize the importance of including previously infected individuals in vaccination campaigns,” explains Thierry Defrance, Inserm researcher and last author of the study.

“Finally, this study serves as a reminder that while serum antibody levels are certainly an important marker of immunity, they are not the sole determinant of protective immunity. Other components of immune memory, T cells and also memory B cells, may induce a rebound in antibody secretion when stimulated by the virus,” adds the scientist.

Using Modeling to Limit Infectious Disease Transmission at Airports and Train Stations

The model concerns London Heathrow airport. © Unsplash

In crowded places, such as airports and train stations, social distancing is difficult to maintain and the risk of infectious disease transmission is increased. In order to reduce this risk, it is essential that we improve our understanding of the dynamics of disease transmission within such places and the effective mitigation measures that can be implemented at low cost. This is the objective of a mathematical model developed by teams from Inserm and Sorbonne Université at the Pierre Louis Institute of Epidemiology and Public Health with the Spanish Institute CSIC-IFISC. Taking the example of London Heathrow airport and diseases such as H1N1 influenza and COVID-19, this model makes it possible to identify zones with the highest risk of transmission within crowded places. By targeting these hotspots with measures such as air filters or the use of Far-UVC lights[1], the scientists also show that it is possible to significantly reduce contamination. Their full findings have been published in Nature Communications.

Crowds and gatherings, with their prolonged contacts between individuals, are a crucial factor in the spread of infectious diseases. While it is possible to implement certain risk reduction measures such as the wearing of masks, the maintenance of social distancing cannot always be respected, especially in transportation hubs such as airports and train stations. After all, these locations are designed to optimize logistical efficiency rather than reduce crowding. They are characterized by a constant in and outflow of visitors, with a high risk of international disease transmission.

The study by the scientists from Inserm, Sorbonne Université and CSIC-IFISC describes a mathematical model that identifies, within these places, the hotspots for the transmission of infectious diseases. It is essential to know exactly where these hotspots are in order to implement appropriate “spatial immunization” strategies, i.e. specific prevention measures that target these zones and reduce contamination.

“In the hotspots that we have identified with our model, the development of dedicated approaches such as air filtration, systematic surface disinfection, and the use of Far-UVC lights can significantly reduce the risk of pathogen spread beyond the first cases arriving at an airport or train station without having been detected,” explains Mattia Mazzoli, Inserm researcher and first author of the study.

 

A Model Built From GPS Data

In this article, the scientists studied the example of Europe’s busiest airport: London Heathrow. Their model uses anonymized data concerning the movements of over 200 000 people within the airport, derived from the GPS tracking of cell phones between February and August 2017. Using this data, the researchers were able to visualize movements with a spatial resolution of 10 meters, reconstruct the contact networks between these different people, and thereby detect the zones where contacts were the most intense, with a higher risk of contamination.

In order to provide some practical examples, the scientists fed their mathematical model with data concerning the spread of diseases such as H1N1 influenza and COVID-19 in order to study their dissemination throughout the airport.

 

A Model That Can Be Applied to the Future

The results of this modeling show that the communal areas such as bars and restaurants are where the highest number of infections occur, as these are where travelers and airport staff are brought into contact for long periods of time.

“The danger of these contagion hotspots is driven by a balance between the number of people that use them and the time they spend there. While these are not always the busiest places in the airport, they do involve more sustained contacts for longer periods of time, enabling the spread of diseases,” emphasizes Mazzoli.

Although the model has only been tested with H1N1 influenza and COVID-19, it could still be used in the future to study any new and as yet uncharacterized pathogen. In addition, the method is immediately generalizable to other modes of transport such as trains, subways, bus stations or other crowded facilities where social distancing is impossible, such as malls and convention centers.

“Using spatial immunization measures reduces the number of infections among airport users and, to a lesser extent, among airport staff. When well-targeted and implemented in zones identified as presenting the highest risk, these measures are helpful in containing and/or delaying the spread of infectious agents to the rest of the world via airports or other crowded centers. Our model could be particularly useful in the early stages of a potential future epidemic, when the first cases imported into airports and train stations have not yet been detected,” concludes Mazzoli.

Against Whooping Cough and Its Transmission, a New Safe and Effective Nasal Vaccine

coqueluche - Colonies de Bordetella pertussis

Colonies of Bordetella pertussis, the agent of whooping cough, on an agar plate. © Camille Locht/Inserm

Highly infectious and potentially life-threatening in infants, whooping cough, caused by the bacterium Bordetella pertussis, continues to circulate to a large extent throughout the world. Although the vaccines currently used protect against the onset of symptoms, they have limited durability and cannot prevent bacterial infection resulting in transmission between individuals. An international research team including Camille Locht, Inserm research director at the Center for Infection and Immunity of Lille (Inserm/Institut Pasteur de Lille/Université de Lille/Lille University Hospital/CNRS), has demonstrated, in a phase 2 clinical trial, the efficacy and safety of a nasal vaccine for whooping cough in adults. The results of their study, sponsored by ILiAD Biotechnologies and to be published in The Lancet, suggest that this new vaccine, BPZE1, which is potentially capable of preventing bacterial colonization of the respiratory tract, constitutes a valuable asset when it comes to breaking the epidemic chains of transmission of the disease.

Whooping cough is an infectious respiratory disease caused by the bacterium Bordetella pertussis. Highly contagious, it is known for causing fatal complications in infants.

Since the late 1990s, although the Tdap vaccine[1] has been used in industrialized countries mostly to fight whooping cough, the immunity it provides decreases over time, requiring the administration of boosters. In addition, although it helps to prevent the onset of symptoms, it does not prevent infection by the bacterium itself or its transmission to others. Therefore, whooping cough epidemics persist throughout the world, despite high rates of vaccination.

The development of a new whooping cough vaccine, called BPZE1, aims to make up for the shortcomings of Tdap in order to better fight these epidemics. A particularity of this “live attenuated” vaccine (containing an attenuated version of the bacterium) is that it is administered nasally, thereby mimicking the natural modes of transmission and colonization of Bordetella pertussis in the mucous membranes of the respiratory tract.

An international research team including Camille Locht, Inserm research director at the Center for Infection and Immunity of Lille (Inserm/Institut Pasteur de Lille/Université de Lille/Lille University Hospital/CNRS), in collaboration with the company ILiAD Biotechnologies, conducted a study to evaluate the efficacy and safety (non-toxicity) of BPZE1 in a phase 2 clinical trial with 300 healthy adult US participants.

In this study, the participants were divided into two groups: the first group received one nasal dose of BPZE1 and one intramuscular dose of placebo and the second group received one intramuscular injection of Tdap and one nasal dose of placebo. Three months later, half the participants from each of the two groups received one dose of BPZE1 (to simulate an attenuated natural infection), while the other half received intranasal placebo.

The research team found that, while the Tdap vaccine induced the secretion of high levels of Bordetella pertussis immunity markers in the blood, BPZE1 induced consistent immunity in both the nasal mucosa and the blood. In addition, within 28 days of the second nasal administration, 90% of the participants having initially received BPZE1 had no bacterial colonies in the nose. In the remaining 10%, colonization was low (fewer than 260 colonies per mL of mucus). In comparison, 70% of the patients vaccinated with Tdap had significant nasal bacterial colonization (nearly 14,325 colonies per mL).

Moreover, the research team did not see any serious adverse side effects from vaccination during the study.

Therefore, according to Locht, “the benefit/risk profile of BPZE1 is favorable: just one nasal administration induces safe and well-tolerated strong and long-lasting immunity, in both the blood and respiratory tract. And unlike Tdap, BPZE1 protects the mucous membranes from colonization by the bacterium”.

Indeed, given that Bordetella pertussis infects the respiratory tract and multiplies in its mucosa, immunity at this level could be essential in preventing epidemics of whooping cough.

“As this bacterium is highly infectious to humans, it is critical that a vaccine does not only target the prevention of disease but also the transmission of its causative bacterium and the speed at which the body eliminates it,” adds Locht, “which makes BPZE1 a relevant tool for preventing whooping cough infections and reducing the epidemic chains of transmission.”

Given that the participants in the aforementioned study were all adults over the age of 18, another study is ongoing to evaluate the efficacy and safety of BPZE1 in school-age children, as schools are a critical location for transmission of the disease.

More About the Development and Evaluation of BPZE1

In 2008, the European project CHILD-INNOVAC was launched under the auspices of Inserm in collaboration with 10 European partners, with the aim of developing an innovative nasal vaccine against whooping cough. This was the context for the development and patenting of the BPZE1 vaccine by a team from Inserm and Institut Pasteur de Lille led by Inserm research director and project coordinator, Camille Locht. In 2014, the research team published in PLOS ONE the first work evaluating the efficacy and safety of BPZE1 in a phase 1 clinical trial, following examination of the data by an Independent Data Monitoring Committee. An agreement was then reached between the Inserm Transfert platform, tasked with creating value from the intellectual property related to BPZE technology, and ILiAD Biotechnologies, in order to continue the development and evaluation of the vaccine. In 2020, a new phase 1 study conducted in collaboration with ILiAD Biotechnologies, and published in The Lancet Infectious Diseases, reinforced the clinical results from 2014 on the vaccine’s efficacy and safety.

[1] Tdap is an “acellular” vaccine, which does not contain whole bacteria but only certain proteins derived from Bordetella pertussis, which have the particularity of triggering a blood immune response. It combines vaccines against whooping cough, diphtheria, and tetanus, and is administered in France in three intramuscular doses to infants at 2, 4, and 11 months of age. Three boosters are recommended at around 16 months, 11 years and 26 years of age. Although better tolerated, it is more expensive and less effective than the whole cell pertussis vaccine (that contains the inactivated bacteria), which is still being used today in many low- and middle-income countries.

A New Milestone in the Development of an Effective Allergic Asthma Vaccine

asthmeMicroscopic visualization of lung sections from a mouse model of house dust mite asthma, with hematoxylin and eosin staining showing bronchial obstruction and white blood cell infiltration around the bronchi in the unvaccinated group (left) but not in the vaccinated group (right). © Dr Eva Conde.

To combat allergic asthma, which affects millions of people worldwide, scientists from Inserm, CNRS and Université Toulouse III-Paul Sabatier at the Infinity laboratory[1], Institut Pasteur and French company NEOVACS are developing and testing a new vaccine. In their previous study, the teams had shown it to be effective in producing antibodies capable of neutralizing human immune proteins that play a key role in triggering allergic asthma, cytokines IL-4 and IL-13. The results, published in Allergy, pave the way for the organization of a clinical trial.

Asthma is a chronic disease that affects around 4 million people in France and 340 million worldwide. Allergic asthma, which accounts for around 50% of asthma cases, is characterized by inflammation of the bronchial tubes and respiratory discomfort caused by the inhalation of allergens, most often dust mites.

This exposure to dust mites and other allergens triggers the overproduction of antibodies called immunoglobulin E (IgE) and proteins called type 2 cytokines (particularly interleukin-4 (IL-4) and IL-13) in the airways. This phenomenon leads to a cascade of reactions resulting in hyperresponsiveness of the respiratory tract, overproduction of mucus, and eosinophilia (when there are too many eosinophils, a type of white blood cell, in the airways).

At present, inhaled corticosteroids are the gold standard for controlling asthma. However, in the case of severe allergic asthma, this treatment is not always sufficient. Therapeutic monoclonal antibody treatments are then required in order to target the IgE or the IL-4 and IL-13 pathways. However, these are very costly and require patients to inject for years or even throughout their lives.

For several years now, Inserm research director Laurent Reber and his colleagues at the Infinity laboratory in Toulouse, along with Pierre Bruhns’ team at Institut Pasteur, have been working in collaboration with French company NEOVACS to develop a vaccine to open up new therapeutic avenues for patients with severe allergic asthma.

 

A Vaccine Effective Against Human Cytokines

In a previous study, the researchers had showed the efficacy in mice of a conjugate vaccine [2] called Kinoïde® (see box). The results suggested that this vaccine induced the sustained production of antibodies directed specifically against murine IL-4 and IL-13, as well as a reduction in the symptoms of allergic asthma in those animals.

Following these encouraging early data and in order to envisage clinical trials in humans, it was necessary to develop a vaccine that is also capable of neutralizing human IL-4 and IL-13 cytokines. In order to test the efficacy of this new vaccine, the scientists this time used a model of house dust mite allergic asthma in “humanized” mice, whose genes encoding murine cytokines IL-4 and IL-13 were replaced with the respective human genes.

Again, the results are promising: vaccination induced a major antibody response, capable of neutralizing human IL-4 and IL-13 cytokines, with no reduction in the efficacy of the vaccine, up to three months after injection (time corresponding to the total duration of this study).

A significant effect on asthma symptoms was also observed: in the animals studied, vaccination was associated with reduced IgE and eosinophilia levels as well as reduced mucus production and airway hyperreactivity.

 “This study provides proof of concept of the vaccine’s efficacy in neutralizing human proteins that play a key role in allergic asthma, bringing us closer to its testing in humans. We are currently in discussion with the various project partners regarding the set-up of these clinical trials,” concludes Reber.

“Vaccination against allergic asthma represents the hope of a long-term treatment for this chronic disease and the prospect of reducing allergy symptoms related to other factors, since this vaccine targets molecules involved in different allergies,” points out Pierre Bruhns, head of the Antibodies in Therapy and Pathology unit at Institut Pasteur.

 

 How Does This Vaccine Work?

Kinoïde® uses a technology that combines the recombinant cytokines IL-4 and IL-13 with a carrier protein called CRM197 (the non-pathogenic mutated form of the diphtheria toxin, used in many conjugated vaccines).

This protein is highly immunogenic, in that it is capable of provoking a major immune response. When exposed to the CRM197 contained in the vaccine, the immune system starts to produce antibodies directed not just against this protein, but also against the cytokines IL-4 and IL-13. This helps control the overproduction of these proteins, which are key in allergic asthma, and more generally in any allergic reaction.

In addition to allergic asthma, IL-4 and IL-13 are involved in many other allergic conditions, including atopic dermatitis and food allergy. Ongoing preclinical studies in the laboratories of the various partners aim to demonstrate that this vaccine can also induce a protective response against these major allergies. 

 

[1] Toulouse Institute for Infectious and Inflammatory Diseases (Inserm/CNRS/Université Toulouse III)

[2]conjugate vaccine  is a vaccine containing an antigen associated with a protein to increase its efficacy

New data of efficacy of a Meningococcal B Vaccine and a Preventive Antibiotic in Reducing the Risk of Sexually Transmitted Bacterial Infections and proven efficacy of the MVA-BN Vaccine Against Mpox

This study, sponsored and funded by ANRS | Emerging Infectious Diseases in partnership with Roche[1], was conducted by a research team from the Paris Public Hospitals Group AP-HP, Université Paris Cité, Inserm, and Sorbonne Université in collaboration with the associations AIDES and Coalition PLUS. It demonstrates the efficacy of both a meningococcal B vaccine in reducing the risk of gonorrhea infection and the use of the antibiotic doxycycline as a preventive treatment against sexually transmitted infections, when taken within 72h after sex. Following the first mpox cases in France, the study scope was expanded, adding the possibility to observe the efficacy of the Modified Vaccinia Ankara (MVA-BN) vaccine against the mpox virus responsible for the epidemic that emerged in 2022.

In recent years, France has seen an increase in sexually transmitted infections (STIs), including bacterial infections such as syphilis, chlamydia and gonorrhea, which particularly affect men who have sex with men (MSM). It was this population which has been mainly affected by the mpox epidemic, which emerged in France in May 2022.

The ANRS DOXYVAC trial was designed to evaluate interventions aimed at preventing these infections. It has been ongoing since January 2021 in MSM using PrEP to prevent HIV infection and highly exposed to the risk of STIs and having presented at least one STI during the year prior to their participation in it[2].

 

The ANRS DOXYVAC trial aims to measure the efficacy of an antibiotic and a vaccine in preventing bacterial STIs in MSM.

Enrollment was stopped early and the two interventions were proposed to all participants following the promising results with doxycycline in the U.S. study DOXYPEP and at the recommendation of the data and safety monitoring board following an interim analysis requested by them.

The study is evaluating the efficacy of post-exposure prophylaxis (PEP)[3] for bacterial STIs that combines the antibiotic doxycycline and vaccination with Bexsero® against meningococcus B[4]. Between January 2021 and July 2022, 502 MSM volunteers living in the Paris region were randomly assigned to into four groups: the first receiving doxycycline PEP to be taken within 72h after condomless sex; the second receiving vaccination with Bexsero®; the third a combination of these two interventions; and the fourth none of the two interventions.

The volunteers had a median age of 39 years, a median of 10 sexual partners in the last 3 months and received a median follow-up of 9 months. They were monitored and tested every 3 months for symptoms of gonorrhea, chlamydia and syphilis infections.

The researchers compared the incidence of a first episode of chlamydia or syphilis infection between the group that received doxycycline and the group that did not and found it to be 5.6 and 35.4 per 100 person-years[5], respectively (84% reduction in the risk of chlamydia or syphilis infection). As for the incidence of a first episode of gonorrhea infection in these same groups, this was found to be 20.5 and 41.3 per 100 person-years (51% reduction). After 3 months, the incidence of a first episode of gonorrhea infection in the Bexsero®-vaccinated group and the unvaccinated group was 9.8 and 19.7 per 100 person-years (51% reduction). No severe adverse effects relating to these two procedures were observed.

“The use of doxycycline for post-exposure prophylaxis has shown itself to be effective in reducing the incidence of both chlamydia and syphilis infection. This antibiotic has also had a significant impact, just like the meningococcal B vaccine, on the incidence of gonorrhea infections. This is the first time that a vaccine has shown an effect on a sexually transmitted bacterial infection,” concludes Prof. Jean-Michel Molina (Université Paris Cité and Department of Infectious Diseases at Hôpital Saint-Louis and Lariboisière, AP-HP, and Université Paris Cité), the study’s coordinating investigator.

Follow-up of the participants will continue until the end of 2023 to ensure that these prevention strategies, which have now been offered to all the participants, are effective in the medium term.

This study, which forms part of a global prevention effort, combines several risk reduction measures (repeated screening for HIV and STIs, vaccination against hepatitis A and B, distribution of condoms and gels). The participants also have the possibility to benefit from community support, therapeutic education, or both.

 

Beyond bacterial STIs, DOXYVAC has made it possible to analyze the impact of the MVA-BN vaccine on the incidence of the mpox virus rapidly after the appearance of the first cases.

In France, the first cases of infection with the mpox virus appeared in May 2022. For the first time, the risk of human-to-human transmission of this virus through sexual contact has been observed. It has therefore been recommended since July 11, 2022 that the vaccine be used as a protective measure for multi-partner MSM.

In view of this observation, the research teams considered it necessary to include in DOXYVAC a component dedicated to studying the vaccine impact on the incidence of mpox virus in MSM taking PrEP, given that these volunteers are at risk of developing mpox. Among the 502 participants in DOXYVAC, the researchers analyzed, in this specific component, the information regarding 472 people whose data were available before and after May 8, 2022. These participants had reported having a median of 10 partners in the previous 3 months, and 20% had received a smallpox vaccine in childhood.

The researchers compared the pre-epidemic (i.e. until May 8, 2022) characteristics of the 77 volunteers having contracted mpox to the “control” volunteers who had not had the virus. They found that the cases of mpox affected younger people (37 vs. 40 years) who had had more sexual partners in the previous 3 months (7 vs. 5), and among whom fewer had been vaccinated against smallpox in childhood (4% vs. 23%). In people who did not have mpox infection, the proportion having had more than 10 partners over a 3-month period had decreased between the pre-epidemic and epidemic periods (up to and after May 8, 2022).

The incidence of mpox virus infection was 67.4 per 1 000 person-months between May 9 and July 10. It fell to 24.4 per 1 000 person-months between July 11 (date from which it was possible to get vaccinated) and September 20. The research team found that simply being vaccinated against the mpox virus in 2022 was associated with a reduced risk of developing the disease with an efficacy of 99%; the impact of behavioral change was limited in this highly vaccinated population (87%).

“This vaccine provides a high level of protection against the mpox virus,” explains Prof. Jade Ghosn (Université Paris Cité, Department of Infectious and Tropical Diseases of Bichat-Claude-Bernard Hospital AP-HP), DOXYVAC co-investigator and the researcher behind the implementation of the study’s “mpox” component.

AIDES, which has developed numerous risk reduction tools during the mpox crisis and participated in providing community support in these studies, welcomes these results.

For Camille Spire, president of the association, the emergence of new effective tools to add to the existing prevention arsenal is to be welcomed, especially since during the mpox crisis we have noted a high level of vaccine uptake by the people exposed to the virus. We will work to ensure that the effective accessibility of these tools is supported by public policies in terms of the fight against STIs”.

Vincent Leclercq, managing director of Coalition PLUS adds: “in order to achieve their full potential, these prevention tools must reach all the populations at which they are targeted. However, access to vaccines and medicines is too often restricted to the richest countries. We have seen it with the mpox epidemic: only the countries of the North have been able to set up vaccination campaigns”.

 

[1] Roche Molecular System and Roche Diagnostics France provided – free of charge – the kits, consumables and reagents needed to detect Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium.

[2] These men are participants in the HIV infection prevention cohort ANRS PREVENIR.

[3] Post-exposure prophylaxis (PEP) is the use of preventive treatment in people who have recently been exposed to a risk of disease transmission to prevent them from developing it.

[4] Meningococcus B (Neisseria meningitidis) is a bacterium that can cause meningitis. It is close to gonococcus (Neisseria gonorrhoeae).

[5] X per 100 person-years: this means that out of 100 patients followed up for one year, there is a probability of observing X events (in this case an STI).

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