These authors contributed equally to this work.
Keywords: Ag85B, ESAT6, immunotherapy, Mycobacterium tuberculosis, recombinant Mycobacterium smegmatisThe application of immunotherapy in combination with chemotherapy is considered an effective treatment strategy against persistent Mycobacterium tuberculosis (Mtb) infection. In this study, we constructed a novel recombinant Mycobacterium smegmatis (rMs) strain that expresses ag85B and esaT6 fusion protein (ae-rMs). Immunization of c57BL/6 mice with ae-rMs generated mainly Th1-type immune responses by strongly stimulating IFN-γ-and IL-2-producing splenocytes and increasing antigen-specific cytotoxic T lymphocyte (cTL) activity. To test the immunotherapeutic efficacy of ae-rMs, a persistent tuberculosis infection (PTBI) model was established via tail-vein injection of c57BL/6 mice with 1 × 10 4 colony forming units (cFU) of Mtb strain H37Rv in combination with concurrent chemotherapy drugs isoniazid (INH) and pyrazinamide (PZa). PTBI mice immunized with ae-rMs showed high levels of IFN-γ secreted by splenocytes and decreased bacteria loads in lung. Treatment with only the anti-tuberculosis (anti-TB) drugs RFP and INH (RI), decreased bacteria loads to low levels, with the Th1-type immune response further attenuated. Moreover, ae-rMs, when combined with RI treatment, further reduced the bacteria load as well as the pathological tissue damage in lung. Together, these results demonstrated the essential roles of ae-rMs-induced Th1-type responses, providing an effective treatment strategy by combining ae-rMs and RI for persistent TB.