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a Mayo Vaccine Research Group
b Program in Translational Immunovirology and Biodefense
Departments of c Pediatric and Adolescent Medicine
d Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| ABSTRACT |
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METHODS. To identify genetic factors that might contribute to variations in mumps vaccine–induced immune responses, we performed HLA genotyping in a group of 346 healthy schoolchildren (12–18 years of age) who previously received 2 doses of live mumps vaccine. Single-nucleotide polymorphisms (minor allele frequency of >5%) in cytokine and cytokine receptor genes were genotyped for a subset of 118 children.
RESULTS. Median values for mumps-specific antibody titers and lymphoproliferative stimulation indices were 729 IU/mL and 4.8, respectively. Girls demonstrated significantly higher mumps antibody titers than boys, indicating gender-linked genetic differences in humoral immune response. Significant associations were found between the HLA-DQB1*0303 alleles and lower mumps-specific antibody titers. An interesting finding was the association of several HLA class II alleles with mumps-specific lymphoproliferation. Alleles of the DRB1 (*0101, *0301, *0801, *1001, *1201, and *1302), DQA1 (*0101, *0105, *0401, and *0501), and DQB1 (*0201, *0402, and *0501) loci were associated with significant variations in lymphoproliferative immune responses to mumps vaccine. Additional associations were observed with single-nucleotide polymorphisms in the interleukin-10RA, interleukin-12RB1, and interleukin-12RB2 cytokine receptor genes. Minor alleles for 4 single-nucleotide polymorphisms within interleukin-10RA and interleukin-12RB genes were associated with variations in humoral and cellular immune responses to mumps vaccination.
CONCLUSIONS. These data suggest the important role of HLA and immunoregulatory cytokine receptor gene polymorphisms in explaining variations in mumps vaccine–induced immune responses.
Key Words: mumps mumps vaccine immunity cellular antibodies viral lymphocyte proliferation genes HLA complex single-nucleotide polymorphisms
Abbreviations: MMR—measles-mumps-rubella IL—interleukin IgG—immunoglobulin G EIA—enzyme immunoassay SI—stimulation index PCR—polymerase chain reaction SNP—single-nucleotide polymorphism IFN-
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interferon IQR—interquartile range STAT—signal transducer and activator of transcription
Despite the availability of an effective vaccine, outbreaks of mumps continue to occur throughout the world. Although primarily an acute, self-limited, nonsuppurative parotitis, mumps can lead to a variety of relatively frequent and potentially serious complications. In 2006, the United States experienced its largest outbreak of mumps since 1988, with nearly 3000 cases reported in at least 11 states.1,2 In the US outbreak, 63% of patients had received 1, 2, or more doses of measles-mumps-rubella (MMR) vaccine.1 The underlying reason for this epidemic is unknown. The United Kingdom also experienced a recent mumps epidemic that peaked during 2005 with
56000 cases and a high attack rate among young adults,3 although the epidemiology behind the US (highly vaccinated population) and British (decline in vaccine use) mumps epidemics is different.4 The majority of mumps epidemics affect the unvaccinated5,6; however, mumps epidemics have also occurred in highly vaccinated populations.7,8 It is not known exactly why mumps outbreaks are occurring, especially in highly vaccinated populations; therefore, understanding the genetic factors that might influence immunity to mumps vaccination could provide additional insight into mumps vaccine nonresponse.
In this regard, the HLA genes encode proteins expressed on antigen-presenting cells and are the mechanism by which processed antigenic peptides are presented to T cells and, hence, in part determine the ability of the person to respond immunologically to endogenous and exogenous mumps antigens.9,10 Binding of antigenic peptides occurs within the HLA peptide binding groove, and the repertoire of naturally processed peptides depends on HLA allele–specific polymorphisms.11 As intercellular protein messengers, cytokines also play an important role in the regulation of both humoral and cellular immunity.12,13 Cytokines act on their target cells by binding specific membrane receptors (ie, cytokine receptors). On the basis of their 3-dimensional structure and activities, the receptors and their corresponding cytokines have been divided into several families.14,15 In recent years, the cytokine receptors have received special attention because of their characteristics and the important role of cytokine and cytokine receptor gene polymorphisms in inflammatory and infectious diseases.16,17 Because of the importance of cytokines in shaping immune responses, polymorphisms in cytokines or their receptors that alter cytokine levels or cytokine activity could significantly influence the immune response to mumps virus. For example, by integrating interleukin (IL)-15 cytokine into the vaccinia virus strains, new smallpox vaccine candidates with greater immunogenicity, efficacy, and safety were developed.18
Few data are available regarding the influence of such immune response gene polymorphisms on mumps vaccine immune responses.19,20 Understanding genetic mechanisms for variation among individuals with regard to mumps antibody and lymphoproliferative responses may allow for better understanding of mumps immunity. We hypothesize that HLA and cytokine gene polymorphisms significantly influence the immune response to mumps viral vaccine. We sought to determine whether associations exist between individual HLA, cytokine, and cytokine receptor genes and mumps-specific humoral (immunoglobulin G [IgG] antibody titer) and cellular (lymphocyte proliferation) immune responses in patients after 2 doses of mumps-containing vaccine. We now report the first data regarding associations between HLA and cytokine receptor gene polymorphisms and immune responses after 2 doses of mumps vaccine.
| METHODS |
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Mumps-specific humoral immunity was determined by measuring mumps-specific IgG titers using a whole-virus enzyme immunoassay (EIA; anti-parotitis virus/IgG EIA; Dade Behring, Marburg, Germany; sensitivity: 95.4%; specificity: 93.7%) for all patients as described previously.19,22 The limit of detection of the test was <230 of mumps IgG antibody titer. The cellular immune status to mumps vaccine was assessed by using an in vitro [3H]thymidine incorporation assay as previously described.20 Results were expressed as antigen-specific stimulation indices (SIs), defined as the ratio of the median counts per minute of mumps vaccine–stimulated wells to the median counts per minute of unstimulated wells. An SI of
3 was considered to be a marker of a positive lymphoproliferative response, consistent with standard practice.23
DNA Extraction and HLA Genotyping
Details of HLA typing have been published elsewhere.19,20 High molecular weight genomic DNA was extracted from blood samples by using the Puregene extraction kit (Gentra Systems Inc, Minneapolis, MN) and used for polymerase chain reaction (PCR)-based high-resolution HLA genotyping, including PCR with sequence-specific primers (Invitrogen, Brown Deer, WI). All class I and class II 4-digit molecular typing was performed with negative controls, and every 50th PCR was repeated for quality control.
Genotyping of Cytokine and Cytokine Receptor Gene Polymorphisms
Single-nucleotide polymorphisms (SNPs; minor allele frequency > 5%) in cytokine (IL-2, IL-4, IL-10, IL-12A, IL-12B, and
interferon [IFN-
]) and cytokine receptor (IL-2RA, IL-2RB, IL-4RA, IL-10RA, IL-10RB, IL-12RB1, IL-12RB2, and IFN-
R) genes were genotyped on a subset of 118 patients selected from a previous study. Criteria for selection of patients for additional study were based on extreme (high or low) values of measles antibody and cellular immune response in an attempt to maximize the probability of finding an association, if 1 existed, by studying individuals at the 2 ends of the immunity spectrum. As described previously, we used multiplex PCR and SNP analyses by means of the GenomeLab SNPstream platform (Beckman Coulter Inc, Fullerton, CA).24 Genotyping for IL-10.G microsatellite and IFN-
CA repeats polymorphisms were analyzed using an Applied Biosystems (Foster City, CA) 3100 DNA sequencer. A total of 58 SNPs that met Hardy-Weinberg equilibrium assumptions were examined.
Statistical Analysis
Data were summarized by using frequencies and percentages for categorical variables and medians and interquartile ranges (IQRs) for continuous variables. Plots of immune response by assay date identified an upward trend of cellular proliferation values over time. We fit polynomial linear regression models to evaluate this association and used the resulting models to recalibrate measures of cellular immune response. No recalibration was necessary for humoral immune response. Associations of immune response with demographic and clinical variables were assessed using analysis of variance methods. Because of data skewness, all P values were calculated on the basis of log-transformed values. Descriptive associations between immune response and HLA loci were obtained on an allelic level. Each person contributed 2 observations to these summaries, 1 for each allele. Alleles were grouped for each locus by subtype and summarized using medians and IQRs. After these descriptive evaluations, associations were more formally examined using linear regression analyses. In contrast to the descriptive comparisons, each patient contributed 1 observation to these analyses on the basis of an observed genotype. Regression variables were created for each allele and coded as 0, 1, or 2 according to the number of copies of the allele that a patient carried. Rare alleles, defined as those with fewer than 5 occurrences overall, were pooled into a category labeled "other." Original response values were again replaced with corresponding logarithmic values. Global differences in immune response among all alleles within a given locus were evaluated by simultaneously including all but 1 of the allele variables in a linear regression model. After these global tests, we examined individual allele effects. These series of tests were performed in the spirit of Fisher's protected least significant difference test; associations of individual alleles were not considered statistically significant when the overarching global gene test was nonsignificant.25 Each allele variable was included in a separate linear regression analysis, effectively comparing immune response for the allele of interest against all other alleles combined. All analyses described were performed after adjustment for the following set of potential confounding variables: age, race, gender, age at first MMR, and age at second MMR. Cytokine and cytokine receptor SNPs from a subset of 118 patients were examined on a genotypic level, using 3 categories to describe each SNP: homozygous major allele, heterozygous, and homozygous minor allele. Associations with immune response were performed using analysis of covariance, accounting for the measles antibody and cellular immune response variables that were used to select the patients. Because of data skewness, all P values were calculated by using log-transformed values. All statistical tests were 2-sided, and all analyses were conducted by using the SAS system (SAS Institute, Inc, Cary, NC).
| RESULTS |
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.05) and mumps-specific IgG antibody titers (Table 4). The presence of minor allele T for intronic SNP rs2201584 (P = .05) within the IL-12RB2 gene was associated with an allele dose-related decrease in mumps antibody titers. In contrast, the minor allele for intronic SNP rs372889 (P = .03) within the IL-12RB1 gene was associated with an allele dose-related increase in mumps-specific antibody titers. A genotype variant for another intronic SNP (rs1870063; P = .01) in the IL-12RB1 gene also demonstrated significant associations with variations in mumps antibody titers; however, no allele dose-related response was observed in our study cohort.
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| DISCUSSION |
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Our multivariate linear regression analyses demonstrated an association of class II DQB1*0303 with humoral immune response to mumps vaccination, as reflected by the lower antibody titers in DQB1*0303-positive individuals. In addition, we observed suggestive associations with the expression of class I B*1302, B*3701, and B*3801 alleles and higher mumps vaccine cellular immune responses. An interesting finding was the association of several class II HLA alleles with mumps-specific lymphoproliferative responses. Class II DRB1*0301, DRB1*0801, DRB1*1201, DRB1*1302, DQA1*0401, DQA1*0501, DQB1*0201, and DQB1*0402 alleles were significantly associated with lower mumps-specific lymphoproliferation, whereas DRB1*0101, DRB1*0701, DRB1*1001, DQA1*0101, DQA1*0105, and DQB1*0501 alleles were associated with higher mumps vaccine lymphoproliferative responses. These data might suggest that cellular immune responses to mumps vaccine could be restricted or at least influenced by class II DR and DQ molecules, although additional studies are required to prove this. Our experiment-wise type I error rate was controlled by focusing only on global tests of significance. Even so, we are cognizant of multiple testing issues; therefore, attempts to replicate these data in future studies should be conducted. Together, these findings are consistent with the important role that HLA molecules play in the process of immune recognition and activation.32 The associations between HLA and mumps vaccine–induced immune responses do not fully explain the genetic influence on mumps immunity, so we performed gene polymorphism association study testing 58 SNPs.
There is considerable cross-regulation of humoral and cellular immune responses by cytokines and their receptors and polymorphisms that influence cytokine and cytokine receptor levels, which can have an impact on these responses. In this study, associations between mumps antibody titers and lymphoproliferation and SNPs in the cytokine and corresponding receptor genes were determined in a selected group of 118 study patients. These patients were originally selected on the basis of measles antibody and cellular immune response variables.24 This issue can potentially affect our study results, because it is not known whether patients mumps-specific immune responses systematically differ from their measles immune responses. We accounted for the sampling design in the analysis phase by including the measles antibody and cellular response variables as covariates in resulting regression models; however, it is possible that some level of residual confounding may remain. Significant associations were observed for 4 SNPs in the IL-10RA, IL-12RB1, and IL-12RB2 cytokine receptor genes, implicating a role for IL-10R and IL-12R in immune responses to mumps vaccine. We recognize that associations with some rare SNPs may have been missed as a result of our modest sample size. Furthermore, the possibility of associations by chance also cannot be dismissed because of the number of statistical tests. Hence, the cytokine receptor gene effects reported here should be confirmed in other populations. This information may provide additional understanding of the functional HLA and cytokine receptor gene polymorphisms in vaccine-induced immunity and could point to novel mechanisms and targeted therapeutics.
Prospective effects of cytokine genes encoding IL-10 and IL-12 merit particular attention, because the use of recombinant cytokines (and cytokine receptors) as vaccine adjuvants may offer a mechanism whereby the magnitude and phenotype of the immune response to vaccination can be altered. Both IL-10 and IL-12 are key immunoregulatory cytokines. Signal transducers and activators of transcription 3 (STATs) and small amounts of STAT1 transcription factors are activated during IL-10 signaling.15 It has been reported that mumps virus V protein prevents responses to IL-6 and viral cytoplasmic tyrosine kinase signals and can induce apoptosis in STAT3-dependent multiple myeloma cells.33 Blocking the receptor for IL-10 improves antimycobacterial chemotherapy and response to a mycobacterial subunit vaccination.34 In addition, IL-10 inhibits Th1 cytokine production and expression of CD80 and CD86 molecules by antigen-presenting cells.35 The heterodimeric proinflammatory cytokine IL-12 represents a functional bridge between innate resistance and antigen-specific adaptive immune response.36 The important role of IL-12 and the IL-12R β 2 subunit in the generation of pathogenic autoreactive Th1 cells has been reported.37 Regulation of the IL-12 receptor β 2 chain has also been suggested as a molecular switch in determining T-cell phenotype.36
Polymorphisms in both coding and noncoding regions of cytokine genes can affect multiple aspects of cytokine biology, such as transcriptional activity, protein production, receptor binding, direct interactions with viral proteins, and functional activity.16,38,39 Cytokine receptor polymorphisms can similarly affect cytokine function.16,40,41 Polymorphisms that affect functional activity are known for all of the cytokines and their respective receptors. For instance, SNPs at the IL-12B promoter (heterozygous L/S genotype) are associated with nonresponsiveness to hepatitis B virus vaccine in North American adolescents.42 Similarly, it was shown that cytokine polymorphisms play a role in susceptibility to ultraviolet B–induced modulation of immune responses after hepatitis B virus vaccination, and exposure to ultraviolet B significantly suppressed antibody responses to hepatitis B vaccine in individuals with the minor variant for the IL-1β (+3953) polymorphism.43 Associations between disease severity and cytokine gene polymorphisms have been found for many other viral pathogens, including respiratory syncytial virus, hepatitis C virus, human immunodeficiency virus, human T-cell leukemia virus type 1, and parvovirus B19.44–48 Our data suggest that certain SNPs in IL-10RA and IL-12RB genes are associated with variations in immune responses to mumps vaccination. Understanding the genetic factors that might influence lower immunity to mumps vaccination by modulating the cytokine microenvironment of the host may provide additional insight into mumps vaccine–induced immune responses and possible vaccine/therapeutic approaches.
We also found that median titers of mumps-specific antibodies were significantly higher in girls than in boys (P = .003) after 2 doses of mumps vaccine. Similar gender differences in the humoral (antibody) response to live measles and rubella vaccine in young adults were previously described.49,50 In some observational studies, girls have had higher rates of mumps despite similar rates of vaccination5,51; however, not all outbreaks demonstrate this association.52 Gender differences may represent social or behavioral differences in disease exposure or gender-linked genetic differences in immune response.49
| CONCLUSIONS |
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| ACKNOWLEDGMENTS |
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We thank the parents and children who participated in this study, and the nurses, fellows, and technicians from the Mayo Vaccine Research Group and Mayo Advanced Genomic Technology Center. We thank Cheri A. Hart for editorial assistance in preparing this manuscript.
| FOOTNOTES |
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Address correspondence to Gregory A. Poland, MD, Mayo Clinic College of Medicine, 611 C Guggenheim Building, 200 First St SW, Rochester, MN 55905. E-mail: poland.gregory{at}mayo.edu
This work was presented in part at the 44th annual meeting of the Infectious Disease Society of America; October 12–15, 2006; Toronto, Ontario, Canada [abstract 602].
Financial Disclosure: Dr Poland is the chair of a data monitoring and safety board for nonmumps vaccine clinical trials funded by Merck, and Drs Poland and Jacobson have performed non-mumps clinical trials funded by Merck. The other authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject Mumps outbreaks throughout the world reveal the continued susceptibility to mumps virus in highly vaccinated populations. Immune responses to mumps-containing vaccine may vary from person to person. Limited information exists regarding the genetic basis for variation in mumps vaccine–induced immune responses.
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| What This Study Adds This study examined how genetic polymorphisms lead to individual and population variations in immune responses to mumps viral vaccine. Both HLA and cytokine receptor gene polymorphisms play an important role in variations in mumps-induced humoral and cellular immune responses after mumps immunization.
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