Mycobacterium vaccae vaccine(Immune Network Ltd.)

Immunotherapy of tuberculosis (TB) to shorten treatment duration represents an unmet medical need. Orally delivered, tableted TB vaccine (V7) containing heat-killed Mycobacterium vaccae (NCTC 11659) has been demonstrated in prior clinical studies to be safe and fast-acting immune adjunct.

The outcome of Phase III trial of V7 containing 10 µg of hydrolyzed M. vaccae was evaluated in 152 patients randomized at 2:1 ratio: V7 (N = 100), placebo (N = 52). Both arms received conventional 1st or 2nd line TB drugs co-administered with daily pill of V7 or placebo.

After one month mycobacterial clearance was observed in 68% (P < 0.0001) and 23.1% (P = 0.04) of patients on V7 and placebo. Stratified conversion rates in V7 recipients with drug-sensitive and multidrug-resistant TB were 86.7% and 55.6% vs 27.2% and 15% in placebo. Patients on V7 gained on average 2.4 kg (P < 0.0001) vs 0.3 kg (P = 0.18) in placebo. Improvements in hemoglobin levels, erythrocyte sedimentation rate and leukocyte counts were significantly better than in controls. Liver function tests revealed that V7 can prevent chemotherapy-induced hepatic damage.

Oral M. vaccae is safe, can overcome TB-associated weight loss and inflammation, reduce hepatotoxicity of TB drugs, improve sputum conversion three-fold OR 3.15; 95%CI (2.3,4.6), and cut treatment length by at least six-fold. Longer follow-up studies might be needed to further substantiate our findings (Clinicaltrials.gov: NCT01977768).

In this study, the Mycobacterium tuberculosis (MTB) latency-associated antigens Rv2660c, Rv1733c, Rv1813c, Rv2628, Rv2029c, and Rv2659c were compared regarding their immunogenicity and potential therapeutic effects in an MTB reactivation mouse model. Normal mice or MTB reactivation mice were immunized intramuscularly three times at 2-week intervals with saline, plasmid vector pVAX1, Mycobacterium vaccae vaccine (a commercial inactivated vaccine), rv1813c DNA, rv2628 DNA, rv2029c DNA, rv2659c DNA, rv1733c DNA, or rv2660c DNA. The normal mice immunized with rv2628 DNA or rv2659c DNA had low numbers of Th1 cells and a lower ratio of Th1:Th2 immune cells in whole blood (p < 0.05). Compared to the saline group, Tc1 cells in the rv2029c DNA group and Tc1:Tc2 cell ratio in the rv1813c DNA, rv2628 DNA, and rv2029c DNA groups were significantly decreased (p < 0.05). The proportion of Foxp3⁺CD4⁺ T cells in the rv2628 DNA and rv2659c DNA groups and the proportion of CD4⁺CD25⁺ T cells in the rv2029c DNA group were significantly increased (p < 0.05). The level of anti-Rv1813c-immunoglobulin G (IgG) in the rv1813c DNA group was significantly increased (p < 0.01). The levels of specific IgG, IgG1, and IgG2a in the rv2628 DNA, rv2029c DNA, and rv2659c DNA groups were significantly increased (p < 0.05). Lung colony-forming units in M. vaccae and the six DNA groups decreased to different degrees in the MTB reactivation mouse model, but only the lung colony-forming units in the rv2628 DNA group (4.38 ± 0.70 log₁₀) significantly decreased compared to the vector group (5.90 ± 0.42 log₁₀; p < 0.05). The MTB rv1813c DNA, rv2628 DNA, rv2029c DNA, and rv2659c DNA could elicit a strong humoral immune response and a higher proportion of CD4⁺CD25⁺or CD4⁺Foxp3⁺ T cells but could not increase the proportions of Th1 and Tc1 cells. These results suggest that latency-associated DNA vaccines, especially rv2628 DNA, had some therapeutic effect on the endogenous resurgence mouse tuberculosis model.