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3 Carbohydrate-Based Antiviral Vaccines
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TM
4
Bacterial Glycolipid Lipid Asand Their Potential asAdjuvants
Atsushi Shimoyama and Koichi Fukase

560-0043, Japan
4.1 Introduction
Bacterial components have long been known to regulate the immune system[1]. Tumor shrinkage due to bacterial infections has occasionally been reported for the past hundreds of years[2]. In 1893, Corey etal. first attempted to use immunother­apy for cancer with Streptococcus pyogenes and Serratia marcescens. The immu­nostimulatory effects of killed Salmonella typhimurium and Mycobacterium tuberculosis were confirmed in 1916 and 1924, respectively. These immunostimula­tory effects, now widely known as the innate immune system, are triggered by rec­ognizing molecular pattern characteristics of pathogens and microbes by various innate immune receptors in multicellular organisms. Because innate immune stim­ulants also activate acquired immune responses such as antigen–antibody interac­tions and cell-to-cell immunity, several studies have been conducted to develop innate immune stimulants as adjuvants [3], which are vaccine ingredients that enhance antibody production.
Lipopolysaccharide (LPS), a major glycoconjugate in the outer membrane of Gram-negative bacteria, is a well-known innate immune stimulator [4]. Lipid A, which is linked to the terminal of the polysaccharide part via the peculiar acidic sugar Kdo (2-keto-3-deoxy--mannooctanoic acid), is the active principal of LPS, and the chemical structure of an authorized Escherichia coli lipid A (1) is described in Figure4.1. The recognition of LPS/lipid A by Toll-like receptor (TLR) 4/myeloid dif­ferentiation protein (MD)2 receptor induces various immune responses, including cytokine production, nitric oxide production, reactive oxygen species production, leukocyte migration, and lymphocyte activation, which trigger the host defense sys­tem against bacteria. LPS and lipid A are also extremely strong inflammatory agents and are known as endotoxins, which are the major contributors to sepsis and trigger serious systemic diseases that cause multiple organ failure, hypotension, and septic shock [4a]. Canonical E. coli LPS is highly toxic; therefore, its application as an
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Carbohydrate-Based Therapeutics, First Edition. Edited by Roberto Adamo and Luigi Lay. © 2024 WILEY-VCH GmbH. Published 2024 by WILEY-VCH GmbH.
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Polysaccharide
Figure4.1 E. coli LPS and Kdo-lipid A.
adjuvant requires modification to attenuate any inflammatory effects and eliminate significant toxicity. Monophosphoryl lipid A (MPL) derivative, 3D-MPL (2) (Figure4.2), has already been developed by GlaxoSmithKline (GSK) and approved as an adjuvant component[5]. Here, we introduce the structure–activity relationship of lipid A and the strategy for regulating the immune functions of lipid A for the devel­opment of lipid A as an adjuvant.
Figure4.2 Chemical structure of 3D-MPL and lipid IVa.
4.2 Bacterial Glycolipid Lipid A: an Innate Immune Stimulant
4.2 Bacterial Glycolipid Lipid A: an Innate Immune Stimulant
In 1892, Pfeiffer (a disciple of the bacteriologist Koch) revealed that Vibrio cholerae produces two different toxic components: one is a heat-labile exotoxin and the other is a heat-stable endotoxin [6]. In 1945, Westphal (later the first director of the Max Planck Institute of Immunobiology and Epigenetics) reported that the active ingredi­ent of endotoxin is LPS, the outer membrane component of Gram-negative bacte­ria [6]. In 1957, the LPS terminus-acylated disaccharide, glycolipid lipid A, was reported as the active core of LPS[6]. Shiba and Kusumoto began collaborating with a German research group and submitted the correct structure of E. coli lipid A (1) (Figure4.1), and in 1985, they succeeded in the first total synthesis of E. coli lipid A (1), confirming that lipid A is the active core of endotoxin[7]. Simultaneously, Qureshi and Takayama identified the lipid A structure [8]. Shiba and Kusumoto also achieved lipid IVa (3) synthesis (Figure4.2), a precursor of E. coli lipid A[1], and found that lipid IVa (3) has an immunostimulatory effect in mice but an antag­onistic effect in humans[9]. The presence of an antagonist suggested the presence of receptors, which led to LPS receptor exploratory studies. In 1996, a breakthrough was achieved by Hoffmann, who revealed that the Toll gene, which regulates dors­oventral axis formation in Drosophila, is essential to the defense mechanism against the fungus, leading to the discovery of various innate immune recep­tors[10]. In 1997, TLRs were found to be human homologs of the Drosophila Toll protein[11], and Beutler identified TLR4 as an LPS receptor in 1998[12]. To date, 10 types of TLRs (TLR1–10) in humans and 12 types (TLR1–9, TLR11–13) in mice have been identified.
TLRs are membrane glycoproteins containing a leucine-rich repeat motif in the ecto­domain and a cytoplasmic signaling domain homologous to the interleukin 1 receptor (IL-1R), called the Toll/IL-1R (TIR) domain. TLR4 signaling is mediated via various adaptor molecules (MyD88, TRIF, TIRAP, and TRAM), including the TIR domain (Figure4.3) [15]. MyD88-mediated signaling activates NF-κB, a transcription factor involved in inflammation, and induces the production of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α and IL-6. These inflammatory cytokines are pro­duced as a protective response against infection. However, TRIF-mediated signaling leads to the activation of interferon (IFN) regulator 3 (IRF3) and induces the produc­tion of the antiviral cytokine type I IFN. Canonical E. coli LPS strongly activates both signals simultaneously (Figure 4.3), resulting in a massive inflammatory response leading to lethal toxicity. Therefore, lipid A attenuation and TLR4-signaling pathway regulation are essential for the development of lipid A-based adjuvants.
To achieve lipid A attenuation and TLR4-signaling regulation, it is essential to elucidate the molecular basis of lipid A recognition by TLR4. Miyake found that MD2, an accessory protein to TLR4, is essential for TLR4 signaling[16]. We synthe­sized a radiolabeled E. coli lipid A analog 4 (Figure4.4), which Miyake used to elu­cidate the interaction between the TLR4/MD-2 complex and lipid A (Figure4.4)[17]. Miyake also clarified that the species specificity of TLR4/MD-2 is due to differences in lipid A recognition by MD-2 [18]. Furthermore, X-ray crystallography revealed
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Lee and coworkers [14]
Satow and coworkers [13]
Figure4.3 Innate immune system activation via TLR4/MD2.
the binding modes of TLR4/MD-2 to agonists and antagonists. The crystal structure of the complex of human MD-2 with lipid IVa (3) was revealed by Ohto and Satow[13], and the crystal structure of mouse TLR4/MD-2 complex with Eritoran (5) (Figure 4.5), a TLR4 antagonist developed by Eisai, was demonstrated by Lee[14]. In 2009, X-ray crystallography of the human TLR4/MD-2 complex with E. coli LPS was performed by Lee[19]. The results indicate that five of the six acyl chains of E. coli lipid A (1) are housed within the hydrophobic pocket of MD-2, while the remaining acyl chain interacts with the hydrophobic surface of the adja­cent TLR4. These interactions trigger the dimerization of the TLR4/MD-2 complex to activate the immune response. For lipid IVa (3), an antagonist, the lipid A moiety binds to MD-2in the form in which lipid A is rotated by 180° compared to the ago­nistic E. coli lipid A (1), and all acyl chains are placed within the MD-2 pocket, thus not causing TLR4/MD-2 dimerization. Ohto revealed the crystal structure of mouse TLR4/MD-2 with lipid IVa (3); incidentally, lipid IVa (3) acts as an antagonist in humans but as an agonist in mice[20]. In mice, three of the four acyl chains of lipid IVa (3) are housed within the MD-2 pocket, and the remaining one interacts with the hydrophobic surface of the adjacent TLR4, resulting in TLR4/MD-2 dimeriza­tion. These studies revealed that differences in the binding mode of lipid A to MD-2 significantly affect TLR4-mediated immune regulation.
Miyake and coworkers [17, 18]
Lee and coworkers [14, 19]
Lien and coworkers [21]
Figure4.4 Molecular mechanism of TLR4/MD2 dimerization.
Ohto et al. [13]
Ohto et al. [20]
Fukase et al. [22]