The ability of herpesviruses to persist and induce durable immune responses in their infected hosts makes them an attractive viral vector for delivery of an AIDS vaccine. We have previously reported on the efficacy of recombinant replication-deficient and replication-competent herpes simplex virus (HSV) vaccine vectors expressing SIV Env and Nef to protect rhesus macaques against a mucosal challenge with pathogenic SIV239 (
Murphy et al., 2000). Using a new generation of HSV-SIV recombinants based on the replication-deficient HSV vector, HSV-1
d106 (
Samaniego, Neiderhiser, and DeLuca, 1998), we now demonstrate considerable increase in vaccine immunogenicity as compared to the previous HSV vaccine vectors (
Murphy et al., 2000).
The previous HSV recombinants induced weak humoral and cellular immune responses against SIV. Binding antibodies were not readily detected by ELISA-based assays and neutralizing activity against lab-adapted SIV251 was not detected (
Murphy et al., 2000). Using the traditional CTL assay, weak CTL activity was detected at a single time-point in only two of seven immunized monkeys (
Murphy et al., 2000). In contrast, the HSV-1
d106 recombinants used in the current study induced readily detectable anti-SIV antibodies, and a robust cellular immune response in all six vaccinated monkeys. A single inoculation of HSV-1
d106 SIV recombinants expressing Gag, Env, and a Rev-Tat-Nef fusion protein was sufficient to induce anti-SIV T cell responses that were detectable ex vivo by IFNγ ELISPOT assay and by tetramer staining. Vaccination with recombinant HSV-SIV in the absence of DNA priming gave rise to peak anti-SIV T cell responses to the vaccine immunogens ranging between 528 and 818 SFC/10
6 PBMC, with more than half of this response being directed towards the Gag and Env proteins. These levels are higher or comparable in magnitude to those induced by several other recombinant viral vector SIV vaccines in rhesus macaques including attenuated poxviruses, vaccinia virus, vesicular stomatitis virus, semliki forest virus, and adeno-associated virus, given alone or in combination with DNA priming or as heterologous virus boost regimens (
Dale et al., 2004;
Doria-Rose et al., 2003;
Johnson et al., 2005;
Koopman et al., 2004;
Pal et al., 2002;
Ramsburg et al., 2004;
Santra et al., 2002). The magnitude of SIV-specific cellular immune responses in the DNA primed macaques was even higher and in the range of other highly immunogenic DNA prime / viral vector boost SIV vaccination regimens in rhesus macaques consisting of Modified Vaccinia Ankara (MVA) or replication-deficient Adenovirus Ad5 (
Amara et al., 2001;
Casimiro et al., 2003;
Horton et al., 2002;
Shiver et al., 2002), as well as with heterologous prime-boost immunization regimen using MVA and replication-defective Adenovirus vectors (
Casimiro et al., 2004), and replication-competent Adenovirus based SIV vaccines (
Patterson et al., 2003). Both CD4+ and CD8+ T lymphocyte responses to SIV were elicited in the vaccinated macaques. Furthermore, up to 50% of the vaccine-induced tetramer-positive CD8+ T lymphocytes in peripheral blood expressed the gut-homing molecule, α4β7, suggesting that systemic administration of recombinant HSV may be able to elicit mucosal immunity. These data are consistent with the finding of a recombinant NYVAC-SIV vaccine being able to induce anti-SIV CD8+ T cells in the rectal and vaginal mucosa even when administered via the intramuscular route (
Stevceva et al., 2002). Since mucosal priming can further accentuate mucosal immunity (
Bertley et al., 2004;
Egan et al., 2004;
Evans et al., 2003), the ability to deliver recombinant HSV vectors via mucosal routes may be an added advantage of this vaccine approach. In all, our finding of robust vaccine-induced cellular immune responses, combined with the potential of HSV vectors to elicit durable immune responses and induce mucosal immunity makes recombinant HSV-based AIDS vaccine worthy of further study.
Relative to the magnitude of SIV-specific cellular immune responses, anti-SIV antibody responses elicited by recombinant HSV were modest. Binding anti-SIV antibodies were elicited in all vaccinated macaques and neutralizing antibodies to the neutralization-sensitive lab-adapted strain of SIVmac251 were detected at several time-points prior to challenge in five of the six vaccinated macaques. A similar range of neutralizing antibody titers to HxB2, a lab isolate of HIV-1, were recently reported in rhesus macaques immunized with DNA and recombinant Adenovirus Ad5 vectors encoding HIV Env proteins (
Mascola et al., 2005). The neutralizing antibody titers against lab-adapted SIVmac251 generated in the immunized macaques in our study are 100 to 1000-fold lower than following wild-type SIV infection and at least 10-fold lower than that induced by live attenuated SIV 3 vaccination (
Wyand et al., 1999). The low levels of antibody responses are perhaps not surprising. In SIV vaccination approaches used thus far in rhesus macaques, high titer neutralizing antibodies during the vaccination phase have generally only been seen with regimens that incorporate a booster inoculation of envelope protein (
Patterson et al., 2004;
Peng et al., 2005;
Zhao et al., 2003), or AT2-inactivated SIV particles (
Willey et al., 2003), and even in these instances neutralizing antibodies to primary SIV isolates are not detected.
It is of interest that the enhanced immunogenicity of the current HSV-1
d106 SIV recombinants as compared to the earlier generation of HSV vectors (
Murphy et al., 2000) did not translate to better protection against SIV239 challenge. In the previous study, two of seven vaccinated macaques were solidly protected while one macaque had reduced viral load (
Murphy et al., 2000). In this study, three of six vaccinated macaques had reduced viral loads. However both studies differ in important aspects, particularly with regards to the route of SIV239 challenge (intrarectal versus intravenous), and the timing between immunization and challenge (22 weeks versus six weeks after the last vaccination), making direct comparison between the two studies difficult. A discrepancy between vaccine immunogenicity and protective efficacy was apparent on analysis of the six vaccinated macaques in this study. Thus, the magnitude of vaccine-induced SIV-specific cellular immunity to immunodominant antigens (Gag and Env), as measured by the frequency of IFNγ-secreting or tetramer-positive CD8+ T lymphocytes in peripheral blood, did not correlate with post challenge viral load. On the contrary, Mm 205-87, the rhesus macaque with the highest responses during the vaccine phase showed no evidence of viral control post challenge. Interestingly, immune parameters that significantly correlated with lower viral loads post challenge included the presence of Rev-specific T cell responses on the day of challenge, the rapidity of emergence of the anamnestic Tat-specific T cell response post challenge, and the magnitude of neutralizing antibody activity prior to challenge. These findings suggest that a successful AIDS vaccine may need to prime for T cell responses to accessory HIV proteins in addition to inducing neutralizing antibodies.
The vaccinated monkey that died 3 weeks after SIV challenge, likely a rapid progressor, had a unilateral lesion in the left occipital lobe. The microscopic findings were characterized by a necrotizing and suppurative vasculitis with secondary necrosis of the white matter. In addition, rare glial nodules were present in the cerebral white matter and brainstem but were unrelated to the occipital lobe lesion. Glial nodules are nonspecific lesions that usually result from viral infection (
An et al., 2002;
Prineas, MacDonald, and Franklin, 2002); in this case the nodules were negative by IHC for viruses, including SIV, and of unknown significance. Differential diagnoses for the occipital lobe lesion included a septic lesion of hematogenous origin (
Kennedy, 2004;
Moore, 2000), HSV encephalitis (
Kennedy, 2004;
Kennedy, 2005), and acute hemorrhagic leukoencephalitis (AHL). An extensive histopathologic workup failed to identify an infectious etiology, including HSV, as the cause of the vasculitis. Encephalitis related to reversion of the replication-deficient HSV vaccine to replication-competent HSV was considered unlikely for several reasons. In vivo replication of HSV-1
d106 vectors could hypothetically occur in two scenarios; one, in the presence of host cellular proteins able to compensate for the deleted immediate early HSV genes; and two, by recombination with herpes B virus naturally infecting rhesus macaques. Rhesus macaques in this study were seronegative for herpes B. Although a seronegative status for herpes B does not preclude herpes B infection in macaques (
Ward and Hilliard, 1994), the absence of herpes virions by electron microscopy makes the diagnosis of HSV encephalitis highly unlikely. In the absence of an infectious etiology, the morphologic changes of perivascular hemorrhages, perivascular myelinolysis and neutrophilic infiltration in the white matter are consistent with a diagnosis of AHL as the cause of the encephalitis (
An et al., 2002;
Bennetto and Scolding, 2004;
Hart and Earle, 1975;
Prineas, MacDonald, and Franklin, 2002). AHL is a rare, fulminant, and often fatal disorder of unknown etiology that is thought to be immune-mediated or a sequela of the acute perivascular inflammation (
Bennetto and Scolding, 2004;
Hart and Earle, 1975;
Prineas, MacDonald, and Franklin, 2002). A febrile or nonspecific respiratory infection often precedes onset of both AHL and postinfectious encephalitis with a temporal relationship of 1 to 4 weeks between the precipitating cause and onset of neurologic disease. While there was a temporal relationship (3 weeks) between experimental SIV infection and death, it cannot be ascertained that SIV was the precipitating cause. Finally, the morphology of the lesion and the long interval (8 weeks) between the last vaccination and death argues against a diagnosis of postvaccinal encephalomyelitis.
In this study, historical controls were used for assessment of vaccine efficacy. Although not ideal, the use of historical controls allowed us to include a large number of animals that would not otherwise have been possible with concurrent controls. The historical controls consisted of 31 SIV naïve rhesus macaques that had been infected with the same challenge stock of SIV239 that was used for infecting the vaccinated macaques in the present study. Peak height and set-point viral loads with this SIV239 are reasonably consistent from animal-to-animal and study-to-study (
Johnson et al., 2003). Furthermore, we were able to compare the vaccinated and control groups as a whole as well as stratified based on their Mamu-A*01 status. A significant vaccine effect on viral load persisted even when only the Mamu-A*01-positive macaques were examined. Although these results are encouraging, the small number of vaccinated macaques in the current study precludes definitive conclusion of vaccine efficacy independent of other attenuating MHC Class I alleles such as Mamu-B*17 and Mamu-A*1303 (
Muhl et al., 2002;
O'Connor et al., 2003). Furthermore, relative efficacy of the two vaccine approaches cannot be assessed with the small number of vaccinated monkeys in this study.
It is somewhat disappointing that stronger levels of protection were not observed in these experiments, particularly given the breadth and nature of the immune responses that were generated by the vaccines. The disappointing levels of protection occurred despite attempts to use unrealistic vaccine/challenge conditions that favor the possibility of protection. The challenge virus, SIV239, is not only a homogeneous clone, it is exactly matched in sequence to the sequences present in the vaccine. Furthermore, challenge occurred six weeks after the fourth vaccine administration. The challenge virus, like primary isolates of HIV-1, principally uses CCR5 as its second receptor, is difficult to neutralize, and induces a chronic, progressive disease course following long-term persistent infection. It could be argued that IV inoculation of 10 monkey infectious doses may be uncharacteristically higher than the 1–2 infectious doses that typify natural infection. However, in the absence of sterilizing immunity, it is still disappointing that the cellular responses could not do a more effective job in controlling the sequence-matched challenge virus. It seems likely that a vaccine will need to be able to provide much better levels of protection against homologous SIV239 challenge to have any hope of working in human field trials. Among factors that could improve protective efficacy are efficient induction of mucosal immunity, induction of long-lived memory T cells with good proliferative capacity, i.e., central memory T cells (
Vaccari et al., 2005;
Wherry et al., 2003), and induction of higher levels of potently-neutralizing antibodies. In DNA/viral vector vaccine approaches, priming with viral vector via the mucosal route followed by systemic administration of DNA can induce excellent mucosal and systemic T cell and humoral immune responses (
Eo et al., 2001). Whether priming with recombinant HSV via the mucosal route will similarly improve induction of mucosal immunity and improve protective efficacy against the AIDS virus remains to be determined.