Allergen immunotherapy can desensitize even subjects with potentially lethal allergies, but the changes induced in T cells that underpin successful immunotherapy remain poorly understood. In a cohort of peanut-allergic participants, we used allergen-specific T-cell sorting and single-cell gene expression to trace the transcriptional "roadmap" of individual CD4+ T cells throughout immunotherapy. We found that successful immunotherapy induces allergen-specific CD4+ T cells to expand and shift toward an "anergic" Th2 T-cell phenotype largely absent in both pretreatment participants and healthy controls. These findings show that sustained success, even after immunotherapy is withdrawn, is associated with the induction, expansion, and maintenance of immunotherapy-specific memory and naive T-cell phenotypes as early as 3 mo into immunotherapy. These results suggest an approach for immune monitoring participants undergoing immunotherapy to predict the success of future treatment and could have implications for immunotherapy targets in other diseases like cancer, autoimmune disease, and transplantation.is a process in which small amounts of allergen are given over time to the allergic individual until they can safely tolerate high amounts of allergen with no signs of clinical symptoms (1-9). In the regimen of oral IT for peanut-allergic patients (identified by an allergic reaction during a standardized blinded food challenge to peanut), small amounts of peanut flour protein are ingested and escalated to a servings-worth of peanut protein (4 g of peanut protein) over a period of 2-3 y (6-7). Most patients require continuous frequent (e.g., daily) exposure to such therapy for beneficial clinical outcomes. Mechanistic studies of oral IT to food allergens, although limited to date, show that plasma markers such as IgE and IgG4 immunoglobulins, skin test markers, component testing, and basophil activation tests are only weakly predictive of long-term clinical success (10-16). T cells are critical upstream regulators of allergic sensitization that are required to help B cells to synthesize IgE/IgG4 immunoglobulins, which then can activate or inhibit basophils and mast cells (10-17). Moreover, successful IT is associated with the development of regulatory T cells (Tregs) that are thought to dampen allergic reactivity to offending allergens (7). We therefore focused on finding T-cell markers of immune tolerance that could be detected early in the peripheral blood during IT. CD4+ T cells can be relatively long-lived (compared with plasma proteins and basophils) and changes detected early in populations of T cells could perhaps predict longer-lasting successful IT. For example, in one of the first studies in peanut allergen IT to withdraw therapy for more than 10 wk, we previously showed that despite negative skin tests to peanut, and high IgG4/low specific IgE levels to peanut, and decreased basophil reactivity to the allergen, some patients who withdrew from therapy for 3-6 mo were still reactive upon rechallenge with peanut (7...
Rapidly evolving pathogens pose a challenge to vaccine design, as their mutations render previous vaccine responses obsolete. For influenza, conserved epitopes on the viral coat proteins have been identified, but mysteriously they are missed by the antibodies elicited by most vaccine recipients [1, 2]. In simulated immunizations using 263 million antibody-hemagglutinin (HA) structural docking solutions, non-conserved epitopes were immunodominant when HAs were immunized at standard concentrations. However, by vaccinating with a pool of 30 diverse and dilute HA variants, B-cells that recognize broadly-conserved epitopes across HA receive up to 30-fold higher antigen dose, with concentration being linearly correlated to conservation on a per epitope basis. If individual variants are at concentrations below the minimum threshold of immune activation, then cross-reactive B-cells will be preferentially elicited. In pig immunizations, the approach induced a broad-spectrum antibody response against a panel of 36 strains from 1918-2014, including all pandemic strains from the past century and multiple strains not in the vaccine. In further swine studies with a vaccine containing HAs from 1918-2008, we observe broad-spectrum neutralizing responses against 6 future heterologous strains, including pandemic strains, spanning H1N1 2009-2017 and H3N2 2009-2014. Our results support a greater understanding of why non-conserved epitopes are immunodominant, as well as indicate a general solution to overcome this in broad-spectrum vaccine design.
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