Abstract

Clinical and experimental evidence suggests that the tuberculosis vaccine BCG offers protection against unrelated pathogens including the malaria parasite. Cerebral malaria (CM) is the most severe complication associated with Plasmodium falciparum infection in humans and is responsible for most of the fatalities attributed to malaria. We investigated whether BCG protected C57BL/6 mice from P. berghei ANKA (PbA)-induced experimental CM (ECM). The majority of PbA-infected mice that were immunized with BCG showed prolonged survival without developing clinical symptoms of ECM. However, this protective effect waned over time and was associated with the recovery of viable BCG from liver and spleen. Intriguingly, BCG-mediated protection from ECM was not associated with a reduction in parasite burden, indicating that BCG immunization did not improve anti-parasite effector mechanisms. Instead, we found a significant reduction in pro-inflammatory mediators and CD8+ T cells in brains of BCG-vaccinated mice. Together these data suggest that brain recruitment of immune cells involved in the pathogenesis of ECM decreased after BCG vaccination. Understanding the mechanisms underlying the protective effects of BCG on PbA-induced ECM can provide a rationale for developing effective adjunctive therapies to reduce the risk of death and brain damage in CM.

Highlights

  • Mycobacterium (M.) bovis bacillus Calmette–Guérin (BCG) is a live attenuated strain of M. bovis and the only licensed vaccine against tuberculosis (TB)

  • It has been suggested that the non-specific protective effects of BCG are due to trained immunity, which increases the responsiveness of innate immune cells to other pathogens and is mediated by epigenetic changes [18,19,20,21,22]

  • Cerebral malaria (CM) is the most severe complication associated with Plasmodium falciparum infection in humans and is responsible for most of the fatalities attributed to malaria [24]

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Summary

Introduction

Mycobacterium (M.) bovis bacillus Calmette–Guérin (BCG) is a live attenuated strain of M. bovis and the only licensed vaccine against tuberculosis (TB). It is one of the most widely used of all current vaccines, reaching >80% of neonates and infants in countries where it is part of the national childhood immunization program [1]. There is evidence that BCG may protect immunized infants from pathogens other than M. tuberculosis, called heterologous or non-specific protection [3,4,5,6,7,8]. The study demonstrates that BCG vaccination alters the clinical and immunological response to malaria, and emphasizes to further explore its potential in strategies for clinical malaria vaccine development

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