Oligonucleotide Adjuvants for T Helper 1 (Th1)–specific Vaccination

T helper cell 1 (Th1)-dependent delayed hypersensitivity reactions are an important part of host defenses against intracellular infections. Yet, more than two centuries after Jenner's successful inoculation against smallpox, we still do not know exactly how to produce safe vaccines that stimulate Th1 immunity. Specialized bone marrow–derived an-tigen-presenting cells normally are required to initiate all T cell–dependent immune responses (1). However, in order for Th responses to shift to a Th1 phenotype, interleukin (IL)-12 needs to be present at the time of antigen recognition (2). IL-12 drives natural killer (NK) and Th1 cells to generate interferon (IFN)-␥ , that subsequently impels mac-rophages to initiate delayed hypersensitivity reactions. IFN-␥ also inhibits the synthesis of IL-4 and IL-5 by Th2 cells (3). In the absence of IL-12 induced IFN-␥ production, Th2 responses usually dominate. But how do particular infectious agents induce IL-12 re-lease? Accumulating evidence indicates that immunostimu-latory CpG sequences (ISS) in the DNA of bacteria may be one of the major IL-12–inducing factors (4). Complete Freund's adjuvant, composed of killed mycobacteria dispersed in mineral oil, is an established inducer of Th1-dependent delayed hypersensitivity reactions. More than 10 years ago, Tokunaga and coworkers discovered that DNA purified from mycobacteria fostered the release of IFN-␥ by mouse NK cells (5). Fractionation of the DNA led to the isolation of several different short palindromic sequences , most of them centered around a CpG dinucleotide core, that had direct NK stimulatory activity (6). Subsequent studies showed that synthetic phosphodiester or phosphothioate oligodeoxynucleotides, which reproduced the immunostimulatory DNA sequences from mycobacte-ria, could activate NK cells and induce B lymphocyte proliferation in vitro (6–9). Methylation of cytosine residues in the bacterial DNA or in the corresponding oligodeoxynu-cleotides destroyed their immunostimulatory activities (7). During early investigations of DNA vaccination, we observed that nonspecific bacterial DNA enhanced immune responses to a coinjected antigen expression vector (10). Naked DNA immunization stimulated a selective Th1 immune response that persisted upon secondary challenge with protein antigen (11). In some instances, the Th1 skewing effects of gene vaccines could be manipulated by changing the number of immunostimulatory sequences in the plasmid DNA backbone (12). Simple coinjection of bacterial DNA or immunostimulatory oligodeoxynucle-otides with a DNA vaccine or with representative protein antigens also promoted antigen-specific Th1 responses (13, 14), even in mice with preexistent Th2 immunity. Incubation of purified human macrophages with bacterial DNA, or with immunostimulatory CpG oligodeoxynucleotides, stimulated the production of IL-12, …