结核分枝杆菌抗原检测研究进展

结核病仍然是一个严重的全球性公共卫生问题,有效控制结核病的障碍在于缺乏早期、准确的诊断方法。机体受到结核分枝杆菌感染后,体内首先出现的是结核分枝杆菌特异性抗原。因此,结核分枝杆菌抗原检测作为结核病早期诊断的方法可能具有很高的诊断价值。我们简要综述了结核分枝杆菌抗原检测的相关研究进展。     

治疗性结核病疫苗研究进展

治疗性结核病疫苗主要用于接种已感染结核分枝杆菌的个体,包括化学药物治疗的患者和潜伏感染者。治疗性疫苗可逆转发生在疾病进展期的非保护性免疫反应,使其向Th1型反应发展;能打破机体的免疫耐受,有效激发宿主针对结核分枝杆菌的以抗原为基础的细胞免疫反应,诱发抗原特异性的细胞毒性T淋巴细胞免疫反应,来清除胞内寄生的结核分枝杆菌。治疗性疫苗将有助于防止潜伏结核病的复发;与药物联合使用以提高药物的治疗效果,尤其是针对耐药结核病的治疗。     

黏膜免疫与结核疫苗研发CSCD

结核病是全球重要的传染性疾病之一,在全球范围内保持着较高的发病率和死亡率。卡介苗是目前临床上唯一应用的结核疫苗,虽然对儿童有较好的保护作用,但对成人的免疫保护效果并不明显。研发新的结核疫苗对于结核病的防控具有重要的意义。由于结核病的致病菌结核分枝杆菌主要通过呼吸道传播,机体的黏膜成为抵御结核分枝杆菌的第一道防线。设计稳定高效的抗结核黏膜免疫疫苗是目前结核疫苗研究的新方向之一。选择合适的黏膜免疫途径、佐剂及抗原递送系统是黏膜疫苗研发成功的关键。本文对抗结核分枝杆菌的黏膜免疫应答作简短的概述,并重点阐明黏膜免疫在结核疫苗研发中的研究进展。     

黏膜免疫与结核疫苗研发

结核病是全球重要的传染性疾病之一,在全球范围内保持着较高的发病率和死亡率。卡介苗是目前临床上唯一应用的结核疫苗,虽然对儿童有较好的保护作用,但对成人的免疫保护效果并不明显。研发新的结核疫苗对于结核病的防控具有重要的意义。由于结核病的致病菌结核分枝杆菌主要通过呼吸道传播,机体的黏膜成为抵御结核分枝杆菌的第一道防线。设计稳定高效的抗结核黏膜免疫疫苗是目前结核疫苗研究的新方向之一。选择合适的黏膜免疫途径、佐剂及抗原递送系统是黏膜疫苗研发成功的关键。本文对抗结核分枝杆菌的黏膜免疫应答作简短的概述,并重点阐明黏膜免疫在结核疫苗研发中的研究进展。     

蛋白质组学在结核分枝杆菌研究中的应用

蛋白质组学是在基因组学基础上发展起来的新兴学科, 其基本技术包括样品制备、蛋白质分离和蛋白质鉴定分析, 其中的核心技术是双向凝胶电泳技术(2-Dimensional Electrophoresis, 2-DE)和质谱技术(Mass Spectrometry, MS)。近年来, 蛋白质组学技术已应用于结核分枝杆菌的研究领域。应用蛋白质组学技术分离、鉴定、检测结核分枝杆菌致病株的全菌蛋白及分泌蛋白, 分析其蛋白组成, 可深入解析结核分枝杆菌的致病机理和耐药机制。通过对结核分枝杆菌致病株抗原的分析, 为研制预防结核病的新型疫苗拓展了空间。通过对结核分枝杆菌临床分离株的蛋白组成分析还发现了一些有意义的结核病早期诊断标志物。蛋白质组学技术还应用于寻找新的药物靶标, 在研制和筛选新的抗结核药物等方面展示了一些有价值的研究成果, 为更好地开展结核病的预防、早期诊断及治疗打下了基础。     

结核分枝杆菌与巨噬细胞相互作用的研究进展

结核分枝杆菌是一种胞内感染菌,巨噬细胞是其寄生场所。结核分枝杆菌通过阻止吞噬溶酶体的融合、减少巨噬细胞凋亡、降低巨噬细胞对刺激应答的敏感性等途径逃避巨噬细胞的免疫监视和攻击,并在细胞内存活、增殖;而巨噬细胞又是抗菌免疫的主要效应细胞,通过直接杀伤和分泌多种细胞因子,对结核分枝杆菌具有免疫调节、呈递抗原等作用。深入研究结核分枝杆菌对巨噬细胞的免疫逃逸机制及巨噬细胞抗结核免疫作用,对研究宿主抗结核免疫机制及设计新型结核病疫苗有重要意义。     

保护HLA—DR3转基因鼠抗结核杆菌感染的复合期多表位疫苗

结核分枝杆菌（Mtb）每年导致近200万人死亡。BCG是当前唯一使用的结核病疫苗,能够诱导不恒定的保护力,不能防止潜伏性结核病的复活。因此,急切需要有效的疫苗来补充BCG。由于在细菌的繁殖阶段与休眠阶段结核分枝杆菌的蛋白质组在性质和数量上不同,所以改良的结核病疫苗应该能够诱导产生对感染各个阶段表达的结核分枝杆菌抗原的免疫应答。因此,这种“复合期”疫苗应该由结核分枝杆菌感染不同阶段表达的（免疫决定簇）抗原组成。作为一个概念性多级疫苗,我们通过融合五种HLA—DR3限制性T细胞表位构建了一个多表位肽（polyepitope）,这些限制性表位来源于不同的结核分枝杆菌蛋白,有繁殖期高表达产物（Ag85B,hsp65,19kDa脂蛋白）,有休眠菌富表达而且经结核菌素皮下测试阳性（TST＋）个体验证的产物（hspl6,Rvl733c）。在体外试验中,结核病治愈后HIA-DR3＋而非HLA-DR3-病人和结核菌素皮下测试阳性个体的外周血单核细胞对复合期多表位肽反应良好。使用缺乏内源性鼠Ⅱ类基因的HIA—DR3转基因小鼠模型,在体内分析了复合期多表位肽的免疫原性和保护效力。用CpG做佐剂的复合期多表位肽免疫动物产生了高水平的IgG以及多功能CD4’T细胞,它们能够产生HLA-DR3限制性表位特异性的IFN-y、TNF和IL-2。重要的是,当作为预防性疫苗时用结核菌攻击之后,复合期多表位肽的免疫降低了肺部结核杆菌的数量。考虑到可用于免疫识别的潜在Mtb抗原的广谱性,我们的模型数据证明了复合期多表位肽疫苗预防结核病的潜力。     

结核分枝杆菌蛋白亚单位疫苗与疫苗诱导的T细胞免疫记忆研究进展

牛分枝杆菌减毒活疫苗--卡介苗(bacillus Calmette-Guérin,BCG)对预防严重的儿童结核病有效,但其免疫保护效率随儿童年龄增长而降低。BCG不能提供终身免疫保护可能与其诱导的记忆性T细胞主要是寿命较短的效应记忆性T细胞有关。新型结核分枝杆菌蛋白亚单位疫苗将有效的抗原有机组合起来,在适宜的疫苗佐剂辅助下诱导Th1型免疫应答。动物实验表明,增加抗原谱可有效提高亚单位疫苗的保护效率。更重要的是,亚单位疫苗在体内持续时间较短,可诱导寿命较长的中央记忆性T细胞,提供比BCG更持久的免疫保护力。记忆性T细胞的分化受抗原特性与剂量、细胞因子、转录因子及雷帕霉素等的调控。对亚单位疫苗及其诱导的免疫记忆进行研究将对新型结核分枝杆菌疫苗的设计与评价产生积极影响。     

新型结核杆菌抗原的免疫原性和保护效力

<正>鉴于结核病仍然是全球人类发病和死亡的主要原因,故迫切需求一种新的疫苗。结核亚单位疫苗已经显示出在人类能诱导强有力的免疫应答,并在HIV地方流行区可作为一种BCG的替代疫苗加以使用。在这项研究中,作者研究了16种不同的新的结核分枝杆菌抗原的保护效力,作者采用肺部结核病小鼠模型进行此项研究。这些抗原被用来作为亚单位疫苗而与双十八烷基溴化铵(DDA)-D(+)同海藻糖6.6 dibenenate(TDB)(DDA/TDB)佐剂配制     

肺外结核病微生物学诊断方法的研究和应用进展

肺外结核病指由结核分枝杆菌（Mycobacterium tuberculosis, MTB）感染所引起的发生在肺部以外器官和部位的结核病。近年来肺外结核的发病率逐渐升高,未能得到早期有效治疗的肺外结核病患者可能并发畸形、截瘫甚至死亡等严重后果。微生物学检测方法对从病原学角度诊断肺外结核病至关重要。基于此,总结了近年来肺外结核病细菌学检查方法、结核分枝杆菌的抗原检测与分子生物学检测等微生物学诊断方法的概况及应用进展,并对这些检测方法的优缺点及适用范围进行了分析、比较,以期为今后肺外结核病病原学诊断的研究提供相关信息。     

Improving vaccines against tuberculosis

Tuberculosis remains a major cause of mortality and physical and economic deprivation worldwide. There have been significant recent advances in our understanding of the Mycobacterium tuberculosis genome, mycobacterial genetics and the host determinants of protective immunity. Nevertheless, the challenge is to harness this information to develop a more effective vaccine than BCG, the attenuated strain of Mycobacterium bovis derived by Calmette and Guérin nearly 90 years ago. Some of the limitations of BCG include the waning of the protective immunity with time, reduced effectiveness against pulmonary tuberculosis compared to disseminated disease, and the problems of a live vaccine in immuno-compromised subjects. Two broad approaches to vaccine development are being pursued. New live vaccines include either attenuated strains of Mycobacterium tuberculosis produced by random mutagenesis or targeted deletion of putative virulence factors, or by genetic manipulation of BCG to express new antigens or cytokines. The second approach utilizes non-viable subunit vaccines to deliver immunodominant mycobacterial antigens. Both protein and DNA vaccines induce partial protection against experimental tuberculosis infection in mice, however, their efficacy has generally been equivalent to or less than that of BCG. The comparative effects of cytokine adjuvants and vaccines targeting antigen presenting cells on enhancing protection will be discussed. Coimmunization with plasmid interleukin-12 and a DNA vaccine expressing Antigen 85B, a major secreted protein, was as protective as BCG. The combination of priming with DNA-85B and boosting with BCG was superior to BCG alone. Therefore it is possible to achieve a greater level of protection against tuberculosis than with BCG, and this highlights the potential for new tuberculosis vaccines in humans.     

Intracellular bacteria as targets and carriers for vaccination

In this review we discuss intracellular bacteria as targets and carriers for vaccines. For clarity and ease of comprehension, we focus on three microbes, Mycobacterium tuberculosis, Listeria monocytogenes and Salmonella, with an emphasis on tuberculosis, one of the leading causes of death from infectious disease. Novel vaccination strategies against these pathogens are currently being considered. One approach favors the use of live attenuated vaccines and vaccine carrier strains thereof, either for heterologous antigen presentation or DNA vaccine delivery. This strategy includes both the improvement of attenuated vaccine strains as well as the 'de novo' generation of attenuated variants of virulent pathogens. An alternative strategy relies on the application of subunit immunizations, either as nucleic acid vaccines or protein antigens of the pathogen. Finally, we present a short summary of the vaccination strategies against tuberculosis.     

Genes for the protein antigens of the tuberculosis and leprosy bacilli

The lambda gt 11 expression vector permitted us to survey protein antigens of Mycobacterium leprae and Mycobacterium tuberculosis expressed in Escherichia coli. Using monoclonal antibodies, recombinant clones were detected producing three major antigens of M. tuberculosis and five major protein antigens of M. leprae. These recombinant antigens produced in E. coli should prove useful for diagnosis, epidemiology and possibly the development of recombinant mycobacterial vaccines.     

全球结核病疫苗研究进展

本文旨在对全球结核病疫苗研究进展进行系统综述,描述国际上目前进入临床试验不同阶段的新型疫苗,包括重组卡介苗、亚单位疫苗、治疗性疫苗等,分析我国结核病疫苗研究现状,介绍国际研究发展趋势,如人类疫苗计划、全细胞疫苗、多阶段疫苗等,并对存在的问题和挑战进行讨论,展望未来发展趋势。     

Nonspecificity of the Anda A60-tb ELISA test for serodiagnosis of mycobacterial disease.

The conventional methods for the laboratory diagnosis of tuberculosis and other mycobacterial diseases are time consuming and beyond the scope of most of the small and medium-sized hospital facilities. Therefore, there has been considerable interest in the development of a serological method for the detection of antibodies against mycobacteria. We recently evaluated a commercially available ELISA test (Anda Biologicals, Strasbourg, France) that measures antibody levels to A60 antigen, a membrane glycoprotein that is found in most mycobacteria. Of the 123 patients with positive pulmonary cultures for Mycobacterium tuberculosis, 82% had detectable antibodies against the kit antigen. Of the 68 patients with extrapulmonary tuberculosis, 59% yielded positive results. Specimens from 2 of the 12 patients that grew Mycobacterium avium-intracellulare complex, and one each with Mycobacterium fortuitum and Mycobacterium chelonei, were considered significant on the basis of medical history and repeated isolation of the bacterium from clinical specimens, and these patients yielded positive serology. Of the healthy, normal PPD positive and PPD negative controls, 24% gave false positive results.     

Characterization of serologic and cell-mediated reactivity of a 38-kDa antigen isolated from Mycobacterium tuberculosis

An antigen of Mycobacterium tuberculosis with an m.w. of 38,000 has been isolated by affinity chromatography using a monoclonal antibody. This antibody bound only to an antigen found in M. tuberculosis and Mycobacterium bovis BCG. The specificity of the antigen was tested in a vertical study by immunodetection on western blots reacted with hyperimmune sera against M. tuberculosis, M. bovis, and 10 other Mycobacterium species. The antigen was detected only by antisera to M. tuberculosis and M. bovis. Specificity in cell-mediated immunity was tested by skin tests in guinea pigs sensitized with M. tuberculosis, Mycobacterium intracellulare, and Mycobacterium kansasii and by lymphocyte proliferation tests. The 38-kDa antigen induced positive skin test reactions regardless of the Mycobacterium species used to sensitize the animal. The ability of the 38-kDa antigen to sensitize for cell-mediated immunity was tested by injecting mice with the 38-kDa antigen and challenging their lymphocytes in vitro with various mycobacterial antigens. Lymphocyte proliferation was observed in the presence of 38-kDa antigen, M. tuberculosis sonicate antigen, and tuberculin purified protein derivative and to M. kansasii and M. intracellulare. The 38-kDa antigen may contain a specific epitope detected by serology, but also contains epitopes that are cross-reactive for cellular immunity.     

In vitro and in vivo identification of a novel cytotoxic T lymphocyte epitope from Rv3425 of Mycobacterium tuberculosis

The identification of novel cytotoxic T lymphocyte (CTL) epitopes is important to analysis of the involvement of CD8(+) T cells in Mycobacterium tuberculosis infection as well as to the development of peptide vaccines. In this study, a novel CTL epitope from region of difference 11 encoded antigen Rv3425 was identified. Epitopes were predicted by the reversal immunology approach. Rv3425-p118 (LIASNVAGV) was identified as having relatively strong binding affinity and stability towards the HLA-A*0201 molecule. Peripheral blood mononuclear cells pulsed by this peptide were able to release interferon-γ in healthy donors (HLA-A*02(+) purified protein derivative(+)). In cytotoxicity assays in vitro and in vivo, Rv3425-p118 induced CTLs to specifically lyse the target cells. Therefore, this epitope could provide a subunit component for designing vaccines against Mycobacterium tuberculosis.     

对研发新型结核病疫苗的分析和展望

结核病是公共卫生当前面临的重要问题。由于BCG预防效果不佳,研究和开发新型结核病疫苗显得必须且急迫。新型结核病疫苗的研究开发路径和观念也经历了变迁,当前主流的研发路径有重组BCG或重组结核菌、重组痘病毒或重组腺病毒载体疫苗、蛋白质亚单位或重组融合蛋白质亚单位疫苗三类,它们在疫苗效力前景,抗原选型、配方、剂型,免疫应答,疫苗生产,疫苗质量控制,临床前研究动物试验,临床试验和使用,对结核病公共卫生政策的影响等方面各有优劣。新型结核病疫苗的成功研发,还需要病原学、发病机制、免疫学和疫苗研发科学的进一步努力。     

Genomics and gene engineering: rationale to the development of new means of tuberculosis control

The review contains information on modern approaches to the development of antituberculosis vaccines and remedies. Data on the comparative effectiveness of different subunit and DNA vaccines against tuberculosis are presented. The use of comparative and structural genomics for the search and characterization of new Mycobacterium tuberculosis genes, whose products may prove to be important antigens for the development of vaccines or target proteins for remedies against tuberculosis, is considered.