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Mucosal Immunisation (Lung and Middle Ear) Allan W Cripps AO Mucosal Immunology Research Group menzies.griffith.edu.au Small Intestinal Lumen The lungs as part of the CMIS Antigen T Cells migrate via the afferent lymph B Mesenteric Lymph Nodes Peyer’sPatch Thoracic Duct Efferent lymphatics Mucosal Tissues Blood circulation Middle Salivary Lacrimal Mammary ear glands glands glands Oral cavity Eye Milk URT Lungs GI T UGT Small Intestinal Lumen The lungs as part of the CMIS Antigen T Cells migrate via the afferent lymph B Mesenteric Lymph Nodes Peyer’sPatch Thoracic Duct Efferent lymphatics Mucosal Tissues Blood circulation Middle Salivary Lacrimal Mammary ear glands glands glands Oral cavity Eye Milk URT Lungs GI T UGT Experimental Background In an animal model of acute NTHi and Pa infection in the lungs we have demonstrated: Mucosal immunisation results in enhanced clearance of bacteria Mucosal immunisation modifies the inflammatory response observed as a result of infection Primary interest in application to COPD and cystic fibrosis exacerbations and middle ear infections Clearance of an acute NTHi infection from the lung # p<0.05 TNFα response in BAL during acute NTHi infection PMN and macrophage response in BAL during acute NTHi infection Oral Immunisation against NTHi exacerbations in patients with COPD Multi-centre Australian trial Clancy 2013 •HI-H005 – RCT in 320 patients with COPD (FEV1 < 60%) •Oral immunisation with HI-164OV followed for 9 months over winter + spring •Post-hoc analysis in those aged <64yrs (n=35) or placebo (n=56) Time to first moderate-severe exacerbation HI-164OV Significantly reduced moderate-severe exacerbations (54%), corticosteroid use (63%) hospitalisations (57%), hospitals days (59%), Antibiotic courses (29%) and SGRQ scores Conclusions • Mucosal immunisation modulates inflammatory processes in the lung (and middle ear). • Mucosal immunisation strategies are available against acute (and chronic) NTHi infections of the lung and middle ear. Clearance of acute Pa infection from the lung Immune Mechanisms in the Lung Upper and lower respiratory epithelium Ciliated Mucocillary clearance: ~1010 particles per day Alveolar Macrophages Poor APC but excellent “cleaners” without initiating inflammation Neutrophils Excellent “cleaners” but cause significant collateral damage Dendritic Cells Predominant APC in the lung Lymphatic tissue Immune induction sites (BALT, NALT) Part of common mucosal immune network Antigen specific responses (T cells, B cells, secretory IgA, IgG)