Respiratory syncytial virus is a significant cause of morbidity and mortality in infancy, with most severe disease occurring before 6 months of age. Currently, prophylactic treatment with the humanized monoclonal antibody Synagis is the only licensed intervention for RSV and is used to prevent hospitalization caused by severe RSV disease. However, passive antibody treatment is expensive, only partially effective, and available only to those at highest risk. There is a great need for a preventive vaccine, or effective therapeutic treatment strategies. To be of most benefit, an RSV vaccine would need to be given early in life, and overcome many obstacles associated with the generation of effective immunity during infancy
[26]. Induction of effective immunity to RSV is challenging due to the failure of natural immunity to protect against reinfection. Vaccine safety is also a concern because of the history of vaccine-enhanced disease following natural infection after a formalin-inactivated vaccine given in the early 1960s
[27],
[28]. These challenges highlight the critical significance of understanding neonatal adaptive immune responses during both infection and vaccination.
Several studies have demonstrated the importance of the age of infection with regard to the immune response to RSV
[29],
[30],
[31],
[32],
[33],
[34],
[35],
[36]. Studies in neonatal mice have focused on the influence that neonatal infection has on the immune response to subsequent reinfection with RSV. It has been established that when neonatal BALB/c mice are infected prior to 7 days of age, they experience enhanced disease following reinfection as adults. This disease enhancement has been associated with increased airway hyperresponsiveness, increased airway inflammatory cell recruitment and immunopathology, mucus hyperproduction, eosinophil recruitment, and enhanced Th2 cytokine production
[30],
[31],
[32],
[33],
[34],
[35]. Additionally, infecting neonates with recombinant RSV expressing IFN-γ was found to abrogate disease enhancement, while RSV expressing IL-4 resulted in further enhancement of Th2 responses and eosinophilia
[37]. Importantly, in all studies, disease enhancement is not observed following reinfection of mice initially infected as adults. These studies in BALB/c mice provide an example of how early infection can modify and shape subsequent responses to reinfection or other airway insults. These studies also recapitulate some facets of human infection, where severe disease early in life has been linked to the development of childhood wheezing
[38] and vaccination during infancy caused enhanced disease following natural infection
[28].
As in humans, the CD8+ T cell response in RSV-infected mice is known to play a critical role in viral clearance. Using CB6F1 hybrid mice, the expression of both d- and b- MHC haplotypes creates a more complex phenotype and increases the number of T cell responses that can be measured. In BALB/c mice, the K
dM2
82-90 response is so dominant that other responses contribute very little to the outcome of infection. In CB6F1 mice, a reproducible epitope hierarchy is established following RSV infection. The K
dM2
82-90 response initially described in the BALB/c parent strain dominates, with an approximately 5-fold lower response to the D
bM
187-195 epitope initially described as dominant in the C57BL/6 parent strain
[22],
[39]. In striking contrast, mice infected as neonates were found to have codominant responses to K
dM2
82-90 and D
bM
187-195 throughout the course of primary infection, which were maintained in the memory phase. It is generally accepted that neonatal CD8+ T cell responses are lower than adult responses, and this has been described for the K
dM2
82-90 epitope following neonatal infection of BALB/c
[34]. While we also measure lower K
dM2
82-90 responses in CB6F1 neonates, the response to the D
bM
187-195 epitope is higher in infected neonates than adults. This observation demonstrates that the ability of neonates to generate CD8+ T cell responses is epitope-dependent and in some cases, may be superior to adult T cell responses. We found that the epitope hierarchy makes a radical shift when mice are infected between 3 and 13 days of age, with the emergence of K
dM2
82-90 dominance starting after infection at day of life 9. The dominance pattern skews dramatically for mice infected between days 9 and 13 and is associated with a lowering of the response to the D
bM
187-195 epitope and a significant increase in the response to K
dM2
82-90. It is likely that dampening of the D
bM
187-195 response following emergence of the dominant K
dM2
82-90 response reflects immunodomination by this epitope, which we have described in detail in adult CB6F1mice
[40]. The relatively low K
dM2
82-90 response generated in younger neonates may not reach a magnitude or functional activity sufficient for immunodomination of D
bM
187-195.
Functionally, neonatal CD8+ T cells are adept at producing effector cytokines following stimulation with saturating concentrations of cognate peptide. They were as proficient, if not more, in the production of IFN-γ and TNF-α as compared to CD8+ T cell responses generated in the adult. This suggestion of “adult-like” function may be deceptive, however, as peptide titrations showed clearly lower functional avidities for CD8+ T cell responses generated in the neonate, which may play a role in their responsiveness in vivo. This difference was particularly apparent in the spleen, where approximately one log more peptide was required to reach a half maximal response in neonatal CD8+ T cells. In both adults and neonates, DbM187-195-specific cells were found to have higher functional avidities than KdM282-90-specific cells, a property that appears to be independent of epitope hierarchy.
Factors known to influence CD8+ T cell epitope dominance fall into three main categories. The first is antigen processing and presentation and includes factors involved in peptide liberation, transport, and class I binding affinity. The second involves characteristics inherent to the CD8+ T cell response such as the T cell repertoire and precursor frequency, and the ability of cells to respond to stimulation by activation and proliferation. Finally, regulation of CD8+ T cell responses, either by other CD8+ T cells (immunodomination) or by regulatory T cells can play a role in the establishment of epitope hierarchy. Adoptive transfer experiments in which adult naïve CD8+ T cells were transferred into neonates gave us the ability to study the response of both neonatal and adult cells within the same infected host. The results of these experiments heavily suggested that intrinsic CD8+ T cell factors help dictate the dominance patterns we observed following RSV infection. We investigated several CD8+ T cell factors that may be involved, starting with characterization of the TCR Vβ repertoire in naïve and infected mice. Despite the dramatic difference in epitope response hierarchy, neonatal responses were surprisingly similar to responses seen in adults in many ways, particularly when responses were studied at the level of TCR Vβ protein expression. Further analysis by single-cell clonotyping was necessary to identify differences at the CDR3β amino acid level, and showed overall less diversity in the neonatal response, particularly for the DbM187-195 epitope. Despite some sequence and diversity differences, however, the general motifs within KdM282-90 and DbM187-195 CDR3βs were similar between adults and neonates. The impact that these relatively subtle repertoire differences between adults and neonates exert on epitope hierarchy is a subject of further investigation.
A lack of TdT activity in early life has been found to be responsible for shaping the murine neonatal repertoire
[41],
[42], and neonatal CD8+ T cell responses to infection can consist of shorter CDR3 sequences than those of adults
[43]. We hypothesized that TdT may play a role in epitope hierarchy differences between adults and neonates, and infected adult TdT
-/- CB6F1 mice to address this possibility. RSV-infected TdT
-/- animals had an overall lower CD8+ T cell response, but the relative dominance of the K
dM2
82-90-specific response was greater than in wild-type mice, indicating that TdT deficiency does not favor the D
bM
187-195 response or account for codominance in infected neonates. Additionally, the TCR Vβ repertoire within both the K
dM2
82-90 and the D
bM
187-195 response was similar between wild-type and TdT
-/- animals.
Precursor frequency is another CD8+ T cell factor that has been found to correlate with epitope hierarchy post-infection
[44],
[45],
[46]. Here, we describe the first reported enumeration of precursor frequencies in neonatal mice. Unlike in adults, lymph nodes cannot be acquired from naïve neonatal mice. The availability of only spleen tissue and the relative lymphopenia of neonates necessitated pooling of at least 8 neonates to work with sufficient cell numbers. Technical constraints in both adults and neonates imply that naïve precursor frequencies are an underestimate in each case, but relative comparisons between epitopes offers reproducible and meaningful results. We analyzed each cell population independently using the same tetramer conjugated to two different fluorochromes simultaneously. Consistent and expected results were seen for each set with regard to the negative controls, and the ratio of K
dM2
82-90/D
bM
187-195 cells seen in immune mice. While neonates had a more D
bM
187-195-skewed population of precursors than adults, precursor frequency did not predict the final epitope hierarchy post-infection. This interpretation was consistent with data generated with either in-house or commercial tetramers. Adult CB6F1 have as many, if not more D
bM
187-195-specific precursors, yet generate a severely K
dM2
82-90-skewed response. Similarly, the presence of more precursors specific for D
bM
187-195 than for K
dM2
82-90 in the neonate does not lead to dominance of the D
bM
187-195 response. La Gruta
et al., have reported that precursor frequency is unrelated to the immunodominance hierarchy observed in adult mice following infection with influenza A virus, and suggest that subdominance is a consequence of inefficient cell recruitment and clonal expansion
[47]. It is likely that immunodominance in the RSV model is influenced by a combination of precursor frequencies and differing abilities of naïve CD8+ T cells to be recruited and proliferate. Figure2A clearly illustrates a large net proliferative advantage for K
dM2
82-90-specific cells over D
bM
187-195-specific cells between days 5 and 7 post-infection in adult mice. The basis for this difference in net frequency of tetramer-positive adult T cells in the lung is currently being explored along with other factors including antigen processing and presentation, CD8+ T cell regulation, and the influence of MHC I-peptide epitope structure and TCR affinity on the functional T cell hierarchy.
In summary, we have described differences in epitope dominance between adult and neonatal CD8+ T cell responses, with associated differences in TCR diversity, functional avidity, and precursor frequency. We show that there are intrinsic properties of adult T cells that result in distinct functional responses in an epitope-dependent manner. The factors that account for the dramatic shift in T cell function between days 9 and 10 of life are the subject of ongoing investigation. This phenomenon is unlikely to be RSV-specific, and we believe that epitope dominance disparities due to age are likely to exist in other mouse models and in humans. A better understanding of the differences between how adult and neonatal responses are generated is of critical importance. The well-known plasticity of the neonatal response can be powerfully manipulated, but immune response patterns in neonates cannot necessarily be predicted by responses in adults. Therefore care must be taken to ensure that optimal effectiveness and safety of vaccine-induced immunity is achieved in neonates.