High-dimensional assessment of B-cell responses to quadrivalent meningococcal conjugate and plain polysaccharide vaccine
- Daniel O’Connor†1, 2Email author,
- Elizabeth A. Clutterbuck†1, 2,
- Amber J. Thompson1, 2,
- Matthew D. Snape1, 2,
- Maheshi N. Ramasamy1, 2,
- Dominic F. Kelly1, 2 and
- Andrew J. Pollard1, 2
© The Author(s). 2017
Received: 19 August 2016
Accepted: 5 January 2017
Published: 30 January 2017
Neisseria meningitidis is a globally important cause of meningitis and septicaemia. Twelve capsular groups of meningococci are known, and quadrivalent vaccines against four of these (A, C, W and Y) are available as plain-polysaccharide and protein-polysaccharide conjugate vaccines. Here we apply contemporary methods to describe B-cell responses to meningococcal polysaccharide and conjugate vaccines.
Twenty adults were randomly assigned to receive either a meningococcal plain-polysaccharide or conjugate vaccine; one month later all received the conjugate vaccine. Blood samples were taken pre-vaccination and 7, 21 and 28 days after vaccination; B-cell responses were assessed by ELISpot, serum bactericidal assay, flow cytometry and gene expression microarray.
Seven days after an initial dose of either vaccine, a gene expression signature characteristic of plasmablasts was detectable. The frequency of newly generated plasma cells (CXCR3+HLA-DR+) and the expression of transcripts derived from IGKC and IGHG2 correlated with immunogenicity. Notably, using an independent dataset, the expression of glucosamine (N-acetyl)-6-sulfatase was found to reproducibly correlate with the magnitude of immune response. Transcriptomic and flow cytometric data revealed depletion of switched memory B cells following plain-polysaccharide vaccine.
These data describe distinct gene signatures associated with the production of high-avidity antibody and a plain-polysaccharide-specific signature, possibly linked to polysaccharide-induced hyporesponsiveness.
Polysaccharide-encapsulated organisms are the leading causes of bacterial meningitis and pneumonia in children. Neisseria meningitidis is estimated to cause 500,000 serious illnesses worldwide each year . Clinical outcomes of invasive infection vary by setting and strain, but even in resource rich countries they are poor, with permanent neurological sequelae common and up to 10% of those affected dying . While susceptibility to invasive meningococcal disease is not completely understood, an inverse relationship is seen with the prevalence of complement-dependent serum bactericidal assay (SBA) titres , and the levels of bactericidal antibody correlate with post-immunisation population protection .
Meningococci comprise 12 capsular groups, six of which, A, B, C, W, X and Y, are responsible for the vast majority of meningococcal disease . Immunisation with meningococcal capsular polysaccharides (with the exception of capsular group B polysaccharide) induces capsular group-specific SBA activity . However, meningococcal polysaccharide vaccines provide only short-term protection in adults, have limited immunogenicity in early childhood and have been associated with hyporesponsiveness following subsequent doses [6, 7]. These shortcomings have been attributed to the T cell-independent nature of responses to polysaccharides that do not drive the formation of immunological memory. Chemical conjugation of the polysaccharide to a protein carrier directs T-dependent responses . Quadrivalent meningococcal vaccines (MenACWY) are licensed in two forms: plain polysaccharide or polysaccharide conjugated to a carrier protein (CRM197 non-toxic mutant of diphtheria toxin or tetanus toxoid). While both of these vaccines are immunogenic in adults, the B-cell responses to these vaccines have not been described in detail. In particular, the mechanisms underlying hyporesponsiveness (inferior responses to subsequent doses), which is evident after plain-polysaccharide but not protein-conjugated vaccines, have yet to be elucidated .
We have previously shown pneumococcal polysaccharide and conjugate vaccines produce distinct B-cell responses in adults, with the former depleting memory and B1b-cell subsets . Here, we apply contemporary systems biology tools (gene expression, multi-parameter flow cytometry and cellular and serological assays) to describe B-cell responses to the quadrivalent plain-polysaccharide vaccine (MenACWY-PS) and quadrivalent conjugate vaccine (MenACWY-CRM).
Study participants and vaccines
Healthy adult volunteers (30–70 years of age) were randomly assigned into four groups to be immunised with intramuscular MenACWY-CRM (group 1; n = 5), intramuscular MenACWY-PS (group 2; n = 5), subcutaneous MenACWY-PS (group 3; n = 5), or one-fifth dose intramuscular MenACWY-PS (group 4; n = 5). Allocation to groups was performed on a 1:1:1:1 basis, generated by computer randomisation with block size of 4 and concealed in sequentially labelled opaque envelopes. This study was open labelled with randomisation occurring at the point that the opaque envelope corresponding to the designated study number was opened (just prior to first vaccination). MenACWY-CRM (Menveo®; Novartis Vaccines, Bellario-Rosia, Italy) consisted of N. meningitidis capsular groups A, C, W and Y oligosaccharides (10, 5, 5 and 5 μg, respectively) individually conjugated to CRM197 carrier protein. MenACWY-PS (ACWYVax®; GlaxoSmithKline, Rixensart, Belgium) consisted of N. meningitidis capsular groups A, C, W and Y capsular polysaccharides (50 μg each serogroup).
All participants then received intramuscular MenACWY-CRM vaccine 28 days after the initial meningococcal vaccine. Blood samples were taken at study days 0 (prior to the first vaccine), 7, 28 (prior to the second vaccine), 35 and 56. One participant withdrew from the study. The study was open labelled, with both clinical staff members and participants aware of the vaccine received; however, laboratory staff members were blinded to the group allocations. An Oxfordshire research ethics committee approved this study (NRES Committee South Central Oxford C 12/SC/0275).
Total RNA was extracted from 2.5 ml peripheral blood collected into a PAXgene™ RNA stabilisation tube, using the Blood RNA Kit (PreAnalytiX, Switzerland). These RNAs were then globin depleted using GLOBINclear™ (Thermo Fisher scientific, Massachusetts). RNA samples were randomly allocated to an Illumina® Human HT12v4.0 Expression BeadChip microarray. RNA was converted into biotin-labelled cRNA and hybridised to a BeadChip microarray. Hybridised microarrays were scanned using an Illumina® iScan scanner by the Wellcome Trust Centre for Human Genetics core facility (Oxford, UK). Sample transcript profile raw data were extracted from Illumina® GenomeStudio version 1.9.0. Negative background intensities for each array were subtracted from their respective transcript intensities prior to normalisation. Transcript intensities were normalised using robust spline normalisation . Microarray data were filtered to return transcripts that were significantly different from their local background (detection p value of less than 0.05) in at least 60% of all the samples assessed. Variance-based statistical methods (sample transcript intensity distribution boxplots, principal component analysis and hierarchical clustering) were used to quality control microarray and check for sample outliers.
A linear model was fitted with normalised expression of each transcript as the response variable and each paired sample and vaccination status as predictors. The empirical Bayes method was then used to generate moderated t-statistics, moderated F-statistics and log-odds of differential expression using the eBayes function in the Limma R package .
Gene set and blood transcriptional module analysis
Gene-set enrichment analysis (GSEA) was undertaken on the entire list of filtered transcripts, ranked by their t-statistic from Limma, using the GseaPreranked tool in the Java-based desktop application of GSEA v2.0.14 . Analysis was completed using the 1910 gene sets in the ‘c7:Immunological signature’ database identified from microarray experiments of gene expression in immunological studies (http://www.broadinstitute.org/gsea/msigdb/index.jsp). Blood transcriptional module analysis was undertaken using the tmod R package on genes ranked by t-statistic; statistical testing for module expression was evaluated using the tmodCERNOtest function, which is a nonparametric test working on gene ranks . Module activity scores were determined by taking the mean of the absolute log2 fold changes in gene expression.
Gene Expression Omnibus validation cohort
We utilised a publicly available dataset, acquired from the genomics data repository Gene Expression Omnibus (GEO; http://www.ncbi.nlm.nih.gov/geo/), as a validation cohort. This dataset comprised adults vaccinated with either MenACWY-PS (n = 13) or MenACWY-CRM (n = 17), as described by Li et al. . Series and platform data were downloaded from GEO using the GEOquery R package . These data were robust multi-array average (RMA) normalised and analysed as previously detailed.
Isolation of peripheral blood mononuclear cells and purification of CD19+ B cells
Peripheral blood mononuclear cells (PBMCs) were isolated from 35 ml heparinised whole blood using lymphoprep density centrifugation. Purified CD19+ B cells where then obtained by anti-CD19-magnetic bead separation (Miltenyi Biotech, UK) as per the manufacturer’s instructions using AutoMACs® (Miltenyi Biotech, UK).
Antibodies for flow cytometric characterisation of B cells and plasma cells
Antibodies for flow cytometric characterisation of B cells and plasma cells were CD19-FITC (clone HIB19, ebioscience, UK), CD5-FITC (clone L17F12, ebioscience, UK), CD38-PE (clone HB7, ebioscience, UK), CD43-PE (clone 84-3C1, ebioscience, UK), HLA-DR-PerCPCy5.5 (clone L243, Biolegend, Cambridge Bioscience, UK), IgM-PerCPCy5.5 (clone MHM-88, Biolegend, Cambridge Bioscience, UK), CD27-PECy7 (clone 0323, ebioscience, UK), CD3-V500 (clone UCHT1, BD Biosciences, UK), CD14-V500 (clone M5E2, BD Biosciences, UK), CD16-V500 (clone 3G8, BD Biosciences, UK), CXCR3-APC (clone G02SH7, Biolegend, Cambridge Bioscience, UK), IgD-APC (clone IgD26, Miltenyi Biotech, UK) and CD20-APCH7 (clone L27, BD Biosciences, UK). Propidium iodide (PI; ebioscience, UK) was used as viability stain.
Flow cytometric characterisation of B cells and plasma cells
Purified, CD19+ B cells, re-suspended in phosphate-buffered saline (PBS)-EDTA + 0.5% bovine serum albumin (BSA), were added at 2 × 105 cells per well of a V-bottom, 96-well culture plate in a 50-μl volume. The B cells were then labelled with a combination of the above antibodies to give: (1) plasma cells, which were viable (PI−) CD3−CD14−CD16− CD19+CD20lo/-CD38hiCD27hi with subsets based on expression of CXCR3 and HLA-DR; (2) memory B cells, which were viable (PI−) CD3−CD14−CD16− CD19+CD20+CD43− CD5−CD27+ with subsets based on IgM and IgD expression (IgM+ only, IgM+IgD+, IgD+ only and switched IgM−IgD−).
The antibodies were incubated on ice in the dark for 30 minutes and then washed twice in 200 μl of PBS-EDTA + 0.5% BSA, at 250 × g for 10 minutes. The B cells were then fixed for 10 minutes with BD Cell Fix® (BD Biosciences UK) at room temperature in the dark and then washed once as above and resuspended in 200 μl PBS-EDTA-0.5% BSA. The cells were transferred to microtubes in a total volume of 350 μl PBS-EDTA-0.5% BSA and stored at 4 °C overnight. The cells were analysed on a Beckman-Coulter Cyan Flow Cytometer with 9-colour parameters. The data were acquired using SummitTM software and analysed using Flow Jo® version 10.0.6 software (Tree Star, USA).
Serum bactericidal assay
Human complement serum bactericidal assays (SBAs) for detection of meningococcal serogroups A and C were performed at Vaccine Evaluation Unit, Public Health England, Manchester. Serum samples collected at days 0, 28 and 56 were assessed for human SBA activity against serogroup A (F8238) and serogroup C (C11). In brief, twofold dilutions of heat-inactivated sera were incubated with suspensions of the aforementioned N. meningitidis strains and freshly thawed exogenous human complement. SBA titres were expressed as the reciprocal end point serum dilutions yielding ≥50% killing of bacterial colonies after 60 minutes of incubation compared with growth at time 0. The lower limit of quantification for the SBA assays was 4; samples without detectable SBA activity were assigned an arbitrary value of 2.
B-cell enzyme-linked immunospot assay
PVDF 96 well plates (Millipore) were coated with 100 μl of either 5 μg/ml (capsular group A and C) of purified meningococcal polysaccharide (National Institute for Biological Standards and Control (NIBSC) 98/722 and 07/318) conjugated to 5 μg/ml methylated human albumin (NIBSC), 10 μg/mL diphtheria toxoid (Statens Serum Institut 2675) or phosphate-buffered saline (background control). Prior to cells being seeded onto the plates, all wells were blocked with complete medium.
Memory B cells were assessed using cultured ELISpot performed on blood samples collected at days 0, 28 and 56. PBMCs were suspended in R10 at a concentration of 2 × 106 cells/ml. These cells were cultured with an additional 100 μl of RPMI with 10% newborn bovine serum (NBBS), Staphylococcus aureus Cowan strain (SAC) at 1:2500 dilution of the Pansorbin cell suspension (Calbiochem-Novabiochem), 166 ng/ml pokeweed mitogen (Sigma-Aldrich) and 3.4 μg/ml CpG oligonucleotide (InvivoGEN). The cells were incubated for 6 days at 37 °C in 5% carbon dioxide and 95% humidity, after which time they were washed and processed as described by Lazarus et al. .
Quantitative real-time PCR
Total RNA, extracted from PAXgene™ tubes, was reverse transcribed to cDNA using SuperScript III Reverse Transcriptase (Thermo Fisher scientific, Massachusetts). A primer sequence specific to the spliced XBP1 isoform was obtained from the literature, sense 5′-GGTCTGCTGAGTCCGCAGCAGG-3′ and anti-sense 5′-GGGCTTGGTATATATGTGG-3′ . The last two nucleotides of the spliced isoform sense primer were modified to 5′-GGTCTGCTGAGTCCGCAGCACT-3′ to create a primer complementary to the unspliced XBP1 isoform; specificities of these primers were demonstrated by comparison of the amplicons run on an agarose (1%) gel (Additional file 1: Figure S12). GAPDH mRNA expression was used as an internal control, sense 5′- GAAGGTGAAGGTCGGAGTC-3′ and anti-sense 5′-GAAGATGGTGATGGGATTTC-3′. The real-time PCR (RT-PCR) used the Platinum® SYBR® Green SuperMix-UDG detection system (with ROX) on a StepOnePlus™ instrument (Thermo Fisher scientific, Massachusetts). The RT-PCR settings were 95 °C for 5 minutes, followed by 40 cycles of 95 °C for 30 s, 50 °C for 30 s, 72 °C for 30 s. Samples were assayed in triplicate and the median ΔCt (cycle threshold compared with the internal control GAPDH) used in subsequent analyses.
Overview of study time points, interventions and analyses
Study day 0
Study day 7
Study day 21
Study day 28
Study day 35
Study day 49
Study day 56
Group 1 (n = 5)
Group 2 (n = 5)
Group 3 (n = 5)
Group 4 (n = 5)
MenACWY-PS (1/5 i/m)
SBA (MenA and MenC)
B mem ELISpots (MenA, MenC, DT)
The rise in bactericidal antibody following an initial dose of either plain polysaccharide or conjugate MenACWY vaccine is similar and is not boosted by a subsequent dose of conjugate vaccine
We evaluated B-cell responses in 20 healthy adults vaccinated with either MenACWY-CRM (group 1, intramuscular, n = 5) or MenACWY-PS (group 2, intramuscular, n = 5; group 3, subcutaneous, n = 5; group 4, one-fifth dose intramuscular, n = 5), followed by an additional dose of MenACWY-CRM 28 days later. We measured anti-meningococcal capsular group A (MenA) and C (MenC) specific SBA titers, ex vivo and cultured antibody-secreting cell (ASC) frequencies using enzyme-linked immunospot (ELISpot), following each vaccination.
Expansion of recently generated plasma cells can be detected 7 days after a first dose of MenACWY vaccine but does not distinguish polysaccharide and conjugate vaccines
A plasma cell gene signature is evident in whole blood 7 days after the initial dose of MenACWY vaccine with similarities and differences between plain polysaccharide and conjugate vaccines
In addition to single-transcript-level analysis, gene set analysis can be evaluated, which increases statistical power by incorporating data from other relevant biological experiments. GSEA (http://www.broadinstitute.org/gsea/) was undertaken on the entire list of transcripts using the 1910 gene sets in the ‘c7: Immunological signature’ collection. Of note, 7 days post-MenACWY (combined group analysis), GSEA demonstrated the up-regulation of gene sets induced 7 days after trivalent inactivated influenza and yellow fever vaccines (Additional file 4: Table S3). Furthermore, GSEA at this time point also indicated the upregulation of gene sets associated with plasma cells (Additional file 4: Table S3). Analysis of blood transcriptional modules also showed enrichment of B-cell, plasmablast and immunoglobulin modules 7 days after vaccination (Additional file 1: Figure S3).
Next, we explored the difference in the mRNA transcripts induced by the two vaccines by comparing the fold-change in transcript expression 7 days (over baseline) following MenACWY-CRM (group 1) to that induced by MenACWY-PS (groups 2, 3 and 4); these vaccines differentially regulated a single transcript, PRKAG2, an adenosine monophosphate-activated protein kinase (Additional file 5: Table S4). GSEA revealed a number of immunological gene sets that were differentially regulated by these vaccines; in particular, a number of T cell-associated gene sets were comparatively upregulated in the MenACWY-CRM vaccinees (Additional file 6: Table S5).
There is a correlation between transcriptomic and phenotypic plasma cell responses and vaccine immunogenicity for capsular group C meningococcal responses
Correlations between frequency of total and plasma cell subsets and day 28 MenA and MenC-specific serum bactericidal assay titres
Plasma cell subset
MenA SBA correlation (r)
MenA SBA correlation (p value)
MenC SBA correlation (r)
MenC SBA correlation (p value)
Total plasma cells
HLADR + CXCR3+
HLADR + CXCR3-
To identify a parsimonious set of transcripts with fold changes that had a linear relationship with subsequent immunological phenotypes (Table 1), without imposing a threshold for differential expression, a regression shrinkage method (LASSO) was used [18, 19]. The fold change in a single transcript, GNS, at day 7 was significantly associated with MenC SBA 28 days after MenACWY when corrected for multiple testing (Additional file 7: Table S6). Moreover, the genes selected using the LASSO method were enriched for genes in pathways such as ‘cytokine signalling’ and ‘immune system’ (Additional file 8: Table S7). No gene fold changes were significantly associated with day 28 MenA-specific SBA titres when corrected for multiple testing.
Disparate gene expression profiles observed 7 days after the second dose compared with those seen after the initial dose of MenACWY
A plot of mRNA transcript fold changes and accompanying p values 7 days after the second dose of quadrivalent meningococcal vaccine is shown in Fig. 3b. Seven days following the second vaccination (MenACWY-CRM), 448 transcripts were differentially expressed; this represents a notable enrichment of differentially expressed transcript (DETs) compared with 7 days following the initial dose of vaccine (Additional file 1: Figure S3a; Additional file 9: Table S8). Moreover, a number of these DETs were immune-related, including TGFBR2, which has an important role in immune regulation, binding TGF-β, subsequently triggering a signalling cascade that suppresses T- and B-cell proliferation and effector function [20, 21, 22]. Contemporaneously, NFKB2, a central activator of genes involved in inflammation and immune function, was upregulated . B cell-specific transcripts such as FCRLA and BANK1 were downregulated; conversely, FOXP1, a transcription factor essential for B-cell development and germinal centre regulation, was upregulated, as was SIVA1, which binds to the tail of CD27 (present on a subset of T and B cells), inducing apoptosis .
Next, we assessed transcriptional responses following the second dose of vaccine in those who previously received MenACWY-CRM compared with those who received a prior dose of MenACWY-PS, finding 32 transcripts that were differentially regulated between these groups (group 1 versus groups 2, 3 and 4; Additional file 11: Table S10). Moreover, GSEA of these data showed the enrichment of a number of gene sets; of particular interest, the downregulation of the ‘switched memory B cells compared with IgM memory B cells’ gene set was found to be driven by those who previously received a dose of MenACWY-PS (Additional file 12: Table S11). When the data were subsetted by initial vaccine the ‘switched memory B cells compared with IgM memory B cells’ gene set was exclusively downregulated in the MenACWY-PS cohort, with a greater enrichment score than for the combined analysis (data not shown).
The correlation between the transcriptomic profile induced at 7 days and vaccine immunogenicity is reproduced in an independent dataset
XBP1 upregulated 7 days after either plain polysaccharide or conjugate MenACWY vaccine
Interestingly in the Li et al. dataset, 440 transcripts were differentially regulated 7 days after MenACWY-CRM compared with MenACWY-PS; amongst the most differentially expressed transcripts were genes involved in responses to unfolded protein pathway, including XBP1 (Additional file 13: Table S12). Moreover, GSEA showed significant enrichment of gene sets associated with ‘unfolded protein response’ and ‘activation of chaperone genes by XBP1s’ 7 days after MenACWY-CRM compared with the equivalent time point following MenACWY-PS (Additional file 14: Table S13). Conversely, the microarray data in our study did not show differences in expression of XBP1 between MenACWY-CRM and MenACWY-PS vaccinees; however, scrutiny of the XBP1 probe sequences on this microarray platform implied that these would not be able to distinguish between the unspliced (XBP1u) and spliced (XBP1s) isoforms of this gene, the former being constitutively expressed and the latter being the potent transcription factor implicated in plasma cell differentiation . To address this query, we conducted quantitative PCR using primers specific for the spliced and unspliced isoforms of XBP1, finding upregulation of XBP1s but not XBP1u 7 days after an initial dose of either MenACWY-CRM or MenACWY-PS vaccine (Additional file 1: Figure S11). However, we did not demonstrate a statistically significant difference in the induction of XBP1s between those who received the conjugated or plain polysaccharide vaccine (p = 0.22).
In this report we describe novel and reproducible transcriptional correlates of vaccine immunogenicity. Seven days after a dose of MenACWY vaccine, plasma cell responses, measured both phenotypically and at the transcriptomic level, correlated with subsequent MenC-specific antibody titres. Notably, 7 days after an additional dose of MenACWY vaccine, given one month later, highly disparate responses were observed compared with the initial dose. Intriguingly, considerable differences in transcriptional responses after the second dose of vaccine were seen in those who received a prior dose of MenACWY-PS compared with those who previously received a MenACWY-CRM vaccine, with downregulation of a ‘switched memory B cell’ gene set exclusively observed in those who previously received the plain polysaccharide vaccine.
The transcriptomic profile 7 days after the initial dose of MenACWY vaccine was characterised by differential expression of transcripts annotated as antibody segments; fold-changes in IGKC and IGHG2 genes correlated with MenC-specific SBA titres and memory B cell ELISpots 28 days post-vaccination. IGHG2 encodes the constant region of the heavy chain of IgG2, which is the predominant IgG subclass directed to polysaccharide antigens (including those in protein-conjugated meningococcal vaccines) in older children and adults [26, 27, 28]. It is possible to infer from the correlation between the expression of IGHG2 and MenC-SBA titres that this gene is a marker of a population of MenC-specific plasma cells, secreting high avidity complement-fixing IgG2. While IgG2 is not as efficient at fixing complement as IgG1, it can activate the classic pathway at high epitope density and when antibody is at equivalence or in excess . We were also able to describe statistically significant relationships between the activity of B-cell, plasmablast and immunoglobulin gene modules assessed 7 days after vaccination and later measures of vaccine immunogenicity (28 days post-vaccination); this is consistent with previous reports that have correlated these modules with responses to other vaccinations such as pneumococcal polysaccharide vaccine and trivalent-inactivated influenza vaccine [14, 30]. Further description of the B-cell receptor transcript repertoire in this study is described elsewhere .
While we observed a correlation between day 7 MenC-specific ex vivo ASC frequencies and day 28 MenC-specific SBA titres, we did not see a statistically significant correlation between MenA-specific ex vivo ASC frequencies and MenA-specific SBA titres. A possible explanation for this disparity could be lack of statistical power, given the modest number of participants assessed; alternatively, it may be due to intrinsic differences between the ex vivo ELISpot, which measures total MenA-specific ASCs, and the MenA-specific SBA, which measures a subset of antibodies with functional activity (bactericidal).
To further investigate predictors of vaccine immunogenicity, we identified a minimal set of transcripts that independently predicted post-vaccination SBA titres using a shrinkage variable selection algorithm (LASSO); the resultant gene set was enriched for transcripts involved in pathways such as ‘cytokine signalling’ and the ‘immune system’. A statistically significant association was seen between the fold rise in GNS at day 7 and day 28 MenC-specific SBA titres. Additionally, a correlation between day 7 GNS expression and day 30 MenC IgG concentrations was also observed in the Li et al. cohort. Glucosamine (N-acetyl)-6-sulfatase (GNS) is a lysosomal enzyme found in all cells and has been shown to be perturbed following yellow fever and live-attenuated influenza vaccine [32, 33]. Deficiencies in GNS result in the lysosomal storage disorder mucopolysaccharidosis type IIID (MPS IIID), a condition predominantly characterised by severe neurological manifestations; however, this condition is also associated with recurrent ear and upper respiratory infections . These data show a relationship between expression of GNS and antibody responses against polysaccharide-encapsulated bacteria and, together with the observations in MPS IIID, indicate a potential role for this gene in controlling infection caused by encapsulated bacteria .
Analysis of day 7 data following the second dose of vaccine appeared highly disparate from those observed after the initial dose, with a notable enrichment of DETs. B cell-specific transcripts, such as FCRLA and BANK1, were downregulated at this time point; conversely, FOXP1, which has been shown to repress plasma cell differentiation, was upregulated . Pro-apoptotic SIVA1 was also upregulated, which binds to the cytoplasmic tail of CD27, expressed by a subpopulation of T and B cells, including plasma cells . At this time point we also observed the downregulation of TGFBR2, which is essential for the normal maintenance of conventional B cells . Concurrently, NFKB2 (subunit of NF-kB), which is induced downstream of several pathways, including signalling via the B-cell receptor (BCR), was upregulated . While NF-kB is often regarded as a prototypical pro-inflammatory factor, it also has an important role in limiting inflammatory responses, for example by promoting activation-induced cell death of T and B cells . It is possible to postulate these data may partly reflect immunoregulatory processes induced by repeated exposure to recently encountered (or persistent) antigens.
GSEA of gene profiles 7 days after the second dose of vaccine indicated the downregulation of the ‘switched memory B cells compared with IgM memory B cells’ gene set; however, this observation was exclusively driven by individuals who previously received the plain polysaccharide vaccine. Flow cytometric analysis implied that this observation was due to a decrease in switched memory B cells rather than an increase in IgM memory B cells. While previous data have shown the depletion of antigen-specific switched memory B cells following polysaccharide vaccines, remarkably, we witnessed a reduction in the total frequency of these cells [6, 38]. Murine studies have shown polysaccharide vaccines deplete antigen-specific memory B cells by inducing apoptosis, which has been proposed as the mechanism underlying hyporesponsiveness following these vaccines . However, factors involved in isotype switching, such as TACI and BAFFR, have been shown to be downregulated by B cells following administration of capsular group C meningococcal polysaccharide vaccine, resulting in less BAFF- and APRIL-induced IgG secretion . The aforementioned study proposed this as an additional mechanism, independent of B-cell receptor specificity, by which polysaccharide vaccines induce suppression of B-cell responses . Importantly, the downregulation of the ‘switched memory B cells compared with IgM memory B cells’ gene set was solely observed in individuals who previously received MenACWY-PS, which is consistent with the notion that hyporesponsiveness is not a feature of conjugate vaccines . Nevertheless, these data imply that an additional dose of MenACWY-CRM one month after MenACWY-PS does not mitigate the depletion of switched memory B cells, and therefore theoretically hyporesponsiveness.
As the number of participants involved in this study was modest, some of the deductions made from this work merit further confirmatory investigation. To strengthen some of our conclusions we reproduced some of our finding in a publicly available dataset. Interestingly, in contrast to the Li et al. study, we did not observe differences in the expression of XBP1 between MenACWY-CRM and MenACWY-PS vaccinees; rather, we found the functional transcript (XBP1s) to be upregulated 7 days after an initial dose of either vaccine. XBP-1 is a transcription factor that is a key regulator of major histocompatibility complex class II expression on B cells and is critical to the function of highly secretory cells such as plasma cells [25, 41]. XBP1 is critical for normal plasma cell secretory function, which would logically explain its upregulation coinciding with the peak plasma cell frequency in peripheral blood following vaccination [25, 42]. Interestingly, XBP1 did not appear to be upregulated 7 days after plain polysaccharide vaccine in the Li et al. dataset, which corresponded with modest plasma cell responses to this vaccine. A possible explanation for the disparities between our XBP1 findings and those described by Li et al. may be differing polysaccharide-specific plasma cell kinetics due to dissimilarities in the pre-existing immune status of the study participants. The appearance of plasma cells in peripheral blood has been shown to differ between primary and secondary immune responses, peaking at 10 and 7 days, respectively . While Li et al. observed that the vast majority of plasma cells induced by the protein-conjugate meningococcal vaccine were carrier protein-specific and that the plain polysaccharide vaccine induced few plasma cells 7 days post-vaccination, our data indicated comparable plasma cell responses between these vaccines . It may be the case that historical differences in meningococcal nasopharyngeal carriage incidence between these populations underlie these observations. Importantly, carriage varies by country; for example, the epidemic of MenC disease observed in the UK in the late 1990s was not seen in the US . Furthermore, the UK participants were older (30–70 years of age, median 55 years, interquartile range 44–59 years) than the US participants (18–45 years of age), and therefore have an increased risk of having previously carried as a function of time . In addition, these disparities may reflect intrinsic differences between the vaccines administered in these studies (here, Menveo® (Novartis Vaccines) and/or ACWYVax® (GlaxoSmithKline); Li et al., Menomune® (Sanofi Pasteur) or Menactra® (Sanofi Pasteur)).
In this study we observed similar MenA- and MenC-specific SBA titres following a single dose of both MenACWY-PS and MenACWY-CRM, which is consistent with previous immunogenicity data in adults [46, 47]. No further rise in SBA titres was seen following the additional dose of vaccine; this is not surprising as polysaccharide vaccines do not induce immunology memory, and a minimal interval of ~4 months is required for effective booster responses . Interestingly, we demonstrated inferior MenC-specific ex vivo ASC frequencies following the second dose of vaccine in those who previously received the plain polysaccharide vaccine, compared with those who received the protein-conjugated vaccine; these data are consistent with polysaccharide vaccine-induced hyporesponsiveness. While this was not seen with regards to MenA-specific ex vivo ASCs, this may reflect lack of power to demonstrate statistical significance.
We describe distinct gene signatures that appear to be associated with the production of high-avidity antibody and control of B-cell responses after repeated doses of meningococcal vaccines. We demonstrate the downregulation of a gene set associated with switched memory B cells that was unique to those who received an initial dose of plain polysaccharide vaccine, which may represent an early molecular signal of hyporesponsiveness induced by this vaccine.
Bovine serum albumin
Cluster of differentiation
Differentially expressed transcript
Geometric mean titre
Gene-set enrichment analysis
Group A meningococcus
Group A,C,W,Y meningococci
Group C meningococcus
- MPS IIID:
Mucopolysaccharidosis type IIID
National Institute for Biological Standards and Control
Peripheral blood mononuclear cell
Serum bactericidal assay
The authors thank the volunteers who participated in this study and are grateful for the clinical and administrative assistance of Dr Alistair McGregor, Kathryn Howarth and Simon Kerridge.
The NIHR Oxford Biomedical Research Centre supported this study. AJP is a Jenner Investigator and James Martin Senior Fellow. DO’C was supported by a European Union’s FP7 award during the production of this manuscript (EC-GA no. 279185). EAC, DFK and MSD receive salary support from the NIHR Oxford Biomedical Research Centre.
Availability of data and materials
The gene expression datasets generated and/or analysed during the current study are available in the Gene Expression Omnibus (GSE92884; https://www.ncbi.nlm.nih.gov/geo/).
MNR, EAC, MDS, DFK and AJP were responsible for designing the clinical trial. EAC and AJT performed the laboratory experiments detailed in this study. DC and EAC analysed the data presented in this article. All authors were involved in interpreting and drafting this manuscript and read and approved the final manuscript.
DFK and MDS have received financial assistance from vaccine manufacturers to attend conferences. None of the other authors declare competing interests.
Consent for publication
Ethics approval and consent to participate
An Oxfordshire Research Ethics Committee (South Central Oxford C, NRES reference number 12/SC/0275) approved this study. Informed consent was obtained from participants before enrolment, in accordance with the Declaration of Helsinki.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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