Mechanism of Ad5 Vaccine Immunity and Toxicity: Fiber Shaft Targeting of Dendritic Cells

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Abstract
Recombinant adenoviral (rAd) vectors elicit potent cellular and humoral immune responses and show promise as vaccines for HIV-1, Ebola virus, tuberculosis, malaria, and other infections. These vectors are now widely used and have been generally well tolerated in vaccine and gene therapy clinical trials, with many thousands of people exposed. At the same time, dose-limiting adverse responses have been observed, including transient low-grade fevers and a prior human gene therapy fatality, after systemic high-dose recombinant adenovirus serotype 5 (rAd5) vector administration in a human gene therapy trial. The mechanism responsible for these effects is poorly understood. Here, we define the mechanism by which Ad5 targets immune cells that stimulate adaptive immunity. rAd5 tropism for dendritic cells (DCs) was independent of the coxsackievirus and adenovirus receptor (CAR), its primary receptor or the secondary integrin RGD receptor, and was mediated instead by a heparin-sensitive receptor recognized by a distinct segment of the Ad5 fiber, the shaft. rAd vectors with CAR and RGD mutations did not infect a variety of epithelial and fibroblast cell types but retained their ability to transfect several DC types and stimulated adaptive immune responses in mice. Notably, the pyrogenic response to the administration of rAd5 also localized to the shaft region, suggesting that this interaction elicits both protective immunity and vector-induced fevers. The ability of replication-defective rAd5 viruses to elicit potent immune responses is mediated by a heparin-sensitive receptor that interacts with the Ad5 fiber shaft. Mutant CAR and RGD rAd vectors target several DC and mononuclear subsets and induce both adaptive immunity and toxicity. Understanding of these interactions facilitates the development of vectors that target DCs through alternative receptors that can improve safety while retaining the immunogenicity of rAd vaccines. Recombinant adenovirus (rAd) vectors are remarkable for their ability to stimulate potent immune responses and to mediate highly efficient gene transfer. These vectors have been used extensively in human studies with generally acceptable tolerability. As with many bioactive compounds, adenoviruses can also cause potentially serious side effects, as observed in a human gene therapy trial several years ago that led to a fatality. The first manifestation of this toxicity is fever, but the relation of this side effect to the ability of the vector to stimulate immunity was unknown. We show that targeting of rAd vectors induces vaccine responses and toxicity through a previously unrecognized mechanism related to its attachment and entry into cells. We find that both adaptive immunity and fever are mediated by targeting of the rAd vector to dendritic cells and some monocytes, independent of the coxsackievirus and adenovirus receptor and RGD binding domains, mediated instead by the fiber shaft. This finding suggests that a distinct receptor present on dendritic and mononuclear cells mediates both effects. The immunogenicity of rAd vectors is dependent on targeting of virus through a specific fiber region and mediates rAd toxicity, which has implications for vaccine and gene therapy vector design that may help to improve rAd safety and efficacy.