BACKGROUND. Bacille Calmette-Guérin (BCG) vaccine is protective against Tuberculosis (TB) in children, but its efficacy wanes with age. Consequently, determining if BCG revaccination augments anti-TB immunity in young adults in TB endemic regions is vital. METHODS. Two hundred healthy adults, BCG vaccinated at birth, were tested for their IFN-γ release assay (IGRA) status. Of these, 28 IGRA + and 30 IGRAwere BCG revaccinated, and 24 IGRA + and 23 IGRAsubjects served as unvaccinated controls. T and innate cell responses to mycobacterial antigens were analyzed by 14-color flow cytometry over 34 weeks. RESULTS. IFN-γ and/or IL-2 Ag85A-and BCG-specific CD4 + and CD8 + T cell responses were boosted by revacciantion at 4 and 34 weeks, respectively, and were > 2-fold higher in IGRA + compared with IGRAvaccinees. Polyfunctional Ag85A, BCG, and mycobacterium tuberculosis (Mtb) latency Agspecific (LTAg-specific) CD4 + T cells expressing up to 8 cytokines were also significantly enhanced in both IGRA + and IGRAvaccinees relative to unvaccinated controls, most markedly in IGRA + vaccinees. A focused analysis of Th17 responses revealed expansion of Ag85A-, BCG-, and LTAgspecific total IL-17A + ,IL-17F + ,IL-22 + , and IL-10 + CD4 + T cell effectors in both IGRA + and IGRAsubjects. Also, innate IFN-γ + NK/γδ/NKT cell responses were higher in both IGRA + and IGRAvaccinees compared with controls. This is the first evidence to our knowledge that BCG revaccination significantly boosts antimycobacterial Th1/Th17 responses in IGRA + and IGRAsubjects. CONCLUSION. These data show that BCG revaccination is immunogenic in IGRAand IGRA + subjects, implying that Mtb preinfection in IGRA + subjects does not impact immunogenicity. This has implications for public health and vaccine development strategies.

The functional heterogeneity of T cell responses to diverse antigens expressed at different stages of Mycobacterium tuberculosis (Mtb) infection, in particular early secreted versus dormancy related latency antigens expressed later, that distinguish subjects with latent (LTBI), pulmonary (PTB) or extrapulmonary (EPTB) tuberculosis remains unclear. Here we show blood central memory CD4 T-cell responses specific to Mtb dormancy related (DosR) latency, but not classical immunodominant secretory antigens, to clearly differentiate LTBI from EPTB and PTB. The polyfunctionality score integrating up to 31 DosR-specific CD4 T-cell functional profiles was significantly higher in LTBI than EPTB or PTB subjects. Further analysis of 256 DosR-specific T-cell functional profiles identified regulatory IL10 + Th17 cells (IL10+IL17A+IL17F+IL22+) to be significantly enriched in LTBI; in contrast to pro-inflammatory Th17 cells (IFNγ+IL17A+/IL10−) in the blood and lung of EPTB and PTB subjects respectively. A blood polyfunctional, Mtb DosR latency antigen specific, regulatory, central memory response is therefore a novel functional component of T-cell immunity in latent TB and potential correlate of protection.

Chronic T cell activation is a hallmark of pulmonary tuberculosis (PTB). The mechanisms underpinning this important phenomenon are however, poorly elucidated, though known to rely on control of T effector cells (Teff) by regulatory T cells (Treg). Our studies show that circulating natural Treg cells in adults with PTB preserve their suppressive potential but Teff cells from such subjects are resistant to Treg-mediated suppression. We found this to be due to expansion of an activated Teff subset identified by Human Leukocyte Antigen (HLA)-DR expression. Sensitivity to suppression was restored to control levels by depletion of this subset. Comparative transcriptome analysis of Teff cells that contain HLA-DR+ cells versus the fraction depleted of this population identified putative resistance mechanisms linked to IFNG, IL17A, IL22, PD-L1 and β-chemokines CCL3L3, CCL4 expression. Antibody blocking experiments confirmed HLA-DR+ Teff cells, but not the fraction depleted of HLA-DR+ effectors, to be resistant to Treg suppression mediated via CCR5 and PD-L1 associated pathways. In the presence of HLA-DR+ Teff cells, activation of NFκB downstream of CCR5 and PD-L1 was perturbed. In addition, HLA-DR+ Teff cells expressed significantly higher levels of Th1/Th17 cytokines that may regulate Treg function through a reciprocal counter-balancing relationship. Taken together, our study provides novel insight on how activated HLA-DR+CD4+ T cells may contribute to disease associated inflammation by compromising Treg-mediated suppression in PTB.

IntroductionHuman APOBEC3G/F (hA3G/F) restricts retroviral replication through G-to-A hypermutations, which can generate drug-resistant progenies in vitro. The clinical relevance is still inconclusive. To bridge this gap, we aim to study the role of these hypermutations in evolution of drug resistance; we characterised hA3G/F-mediated hypermutations in the RT region of the pol gene of patients with or without antiretroviral therapy (ART).MethodsIn 88 HIV-1-positive individuals, drug resistance genotyping was carried out in plasma virus and provirus by population sequencing. Hypermutations were determined by three different approaches using Hypermut 2.0 software, cluster analysis and APOBEC3G-mediated defectives indices. Clinical and demographic characteristics of these individuals were studied in relation to these hypermutations.ResultshA3G/F-mediated hypermutated sequences in proviral DNA, but not in plasma virus, were identified in 11.4% (10/88) subjects. Proviral hypermutations were observed more frequently in patients with ART failure than in ART-naïve individuals (p=0.03). In therapy failure patients, proviral hypermutation were associated with greater intra-compartmental genetic diversity (p<0.001). In therapy-naïve individuals, hypermutated proviral DNA with M184I and M230I mutations due to the editing of hA3G, had stop codons in the open reading frames and the same mutations were absent in the plasma virus. Only a limited concordance was found between the drug resistance mutations in plasma RNA and proviral DNA.ConclusionshA3G lethal hypermutation was significantly associated with ART failure in Indian HIV-1 subtype C patients. It is unlikely that viral variants, which exhibit hypermutated sequences and M184I and/or M230I, will mature and expand in vivo.

The trans-activator of transcription (Tat) of HIV-1 plays an important role in viral infection and pathogenesis. We examined the genetic characteristics of exon 1 of the tat gene derived from 102 seropositive subjects from southern India. Database-derived Indian (n = 105) and global (n = 413) HIV-1C sequences were also used for viral epidemiological signature pattern analysis in the Tat open reading frame (ORF). We identified HIV-1C as the most predominant genetic subtype (99%) and the presence of a novel A1C recombinant strain in one study participant. After examining all the available HIV-1C Indian sequences from primary clinical isolates and database-derived sequences, we found a high level of sequence conservation (92.6 -12%) within Tat amino acid residues. Furthermore, signature pattern analysis identified five amino acid positions in Tat that contained signature residues unique for Indian HIV-1C consisting of 21A, 24N, 29K, 40K, and 60Q. Our data have direct relevance for subunit-based Tat HIV-1 vaccine development.