Dengue virus infection reprograms baseline innate immune gene expression.

Background: All three dengue vaccines that have completed phase 3 clinical trials have shown greater efficacy in dengue-seropositive compared to dengue-seronegative individuals. This includes the live-attenuated tetravalent dengue vaccine TAK-003, where immunogenicity in baseline seronegative individuals remains lower after two doses, despite seroconversion after the first dose, compared to baseline seropositive individuals after one dose.

Methods: A whole-genome microarray was used to analyze the host response to TAK-003. Bulk whole-blood RNA sequencing was used to confirm pre-vaccination baseline gene expression differences between seronegative and seropositive individuals.

Findings: We found that the host response to TAK-003 in baseline seropositive individuals was driven, at least in part, by reprogrammed innate immune response from prior dengue virus (DENV) infection. Indeed, three independent cohorts of volunteers showed differential immune gene expression between dengue-seropositive compared to dengue-seronegative individuals at baseline. Gene modules related to the cell cycle were positively enriched, while innate immune gene modules were negatively enriched, in dengue-seropositive compared to dengue-seronegative subjects in all 3 cohorts. Remarkably, while a single DENV infection reprogrammed the gene expression of innate immune markers, including those implicated in dengue pathogenesis and disease severity, vaccination did not show evidence of similar innate immune reprogramming.

Conclusions: Our findings suggest a lasting effect of DENV infection on the innate immune system that potentially impacts vaccination outcome and secondary dengue pathogenesis.

Funding: The DEN-210 clinical trial and gene expression analyses were funded by Takeda Vaccines. The cohort studies in Singapore were funded by the National Medical Research Council.