Coccidioidomycosis: host response and vaccine development

Cox, Rebecca A.; Magee, D. Mitchell

doi:10.1128/cmr.17.4.804-839.2004

Cited by 205Fungal Infections and StudiesAntifungal resistance and susceptibilityImmune responses and vaccinations

Coccidioidomycosis: host response and vaccine development

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Cox, Rebecca A., Magee, D. Mitchell·2004·Clinical Microbiology Reviews

DOI 10.1128/cmr.17.4.804-839.2004PMC PMC523560

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Abstract

SUMMARY: Coccidioidomycosis is caused by the dimorphic fungi in the genus Coccidioides. These fungi live as mycelia in the soil of desert areas of the American Southwest, and when the infectious spores, the arthroconidia, are inhaled, they convert into the parasitic spherule/endospore phase. Most infections are mild, but these organisms are frank pathogens and can cause severe lethal disease in fully immunocompetent individuals. While there is increased risk of disseminated disease in certain racial groups and immunocompromised persons, the fact that there are hosts who contain the initial infection and exhibit long-term immunity to reinfection supports the hypothesis that a vaccine against these pathogens is feasible. Multiple studies have shown that protective immunity against primary disease is associated with T-helper 1 (Th-1)-associated immune responses. The single best vaccine in animal models, formalin-killed spherules (FKS), was tested in a human trial but was not found to be significantly protective. This result has prompted studies to better define immunodominant Coccidioides antigen with the thought that a subunit vaccine would be protective. These efforts have defined multiple candidates, but the single best individual immunogen is the protein termed antigen 2/proline-rich antigen (Ag2/PRA). Studies in multiple laboratories have shown that Ag2/PRA as both protein and genetic vaccines provides significant protection against mice challenged systemically with Coccidioides. Unfortunately, compared to the FKS vaccine, it is significantly less protective as measured by both assays of reduction in fungal CFU and assays of survival. The capacity of Ag2/PRA to induce only partial protection was emphasized when animals were challenged intranasally. Thus, there is a need to define new candidates to create a multivalent vaccine to increase the effectiveness of Ag2/PRA. Efforts of genomic screening using expression library immunization or bioinformatic approaches to identify new candidates have revealed at least two new protective proteins, expression library immunization antigen 1 (ELI-Ag1) and a β-1,3-glucanosyltransferase (GEL-1). In addition, previously discovered antigens such as Coccidioides-specific antigen (CSA) should be evaluated in assays of protection. While studies have yet to be completed with combinations of the current candidates, the hypothesis is that with increased numbers of candidates in a multivalent vaccine, there will be increased protection. As the genome sequences of the two Coccidioides strains which are under way are completed and annotated, the effort to find new candidates can increase to provide a complete genomic scan for immunodominant proteins. Thus, much progress has been made in the discovery of subunit vaccine candidates against Coccidioides and there are several candidates showing modest levels of protection, but for complete protection against pulmonary challenge we need to continue the search for additional candidates.

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HLA class II antigens HLA-A9 and HLA-B9 and ABO blood type B have been associated with more severe coccidioidomycosis infection, although it is unclear if the association is causal or due to an increased proportion of these phenotypes in Filipino and black or African American individuals.
“Human leukocyte antigens (HLA) class II antigens (HLA-A9 and HLA-B9 antigens) and ABO blood type B have been associated with more severe coccidioidomycosis infection, although it is unclear if there is a causal association or if this association is merely due to an increased proportion of these phenotypes in Filipino and black or African American individuals [44,45].”
From Race and ethnicity: Risk factors for fungal infections? (2023) · cites this paper as [44]

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RNA Sequencing-Based Genome Reannotation of the DermatophyteArthroderma benhamiaeand Characterization of Its Secretome and Whole Gene Expression Profile during Infection
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Early Treatment With Fluconazole May Abrogate the Development of IgG Antibodies in Coccidioidomycosis
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Authors: Cox, R. A., & Magee, D. M.
Affiliations: The University of Texas at San Antonio Health Science Center (US)
Venue: Clinical Microbiology Reviews
Publisher: American Society for Microbiology
Published: 2004-10
Volume: 17
Issue: 4
Pages: 804-839
ISSN: 0893-8512 (ISSN-L)
1098-6618
DOI: 10.1128/cmr.17.4.804-839.2004
PMC: PMC523560
OpenAlex: W2153910927
Cited by: 205
References: 319
Citations by year: 2026: 2 · 2025: 6 · 2024: 4 · 2023: 15 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 6 · 2018: 7 · 2017: 8 · 2016: 11 · 2015: 8 · 2014: 12 · 2013: 4 · 2012: 13
FWCI: 1.79
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: journals.asm.org/non-commercial-tdm-license (tdm)
Locations: Clinical Microbiology Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
Keywords: coccidioidomycosis, Coccidioides, Th1 response, immunodominant antigens, multivalent vaccine, host immune response
MeSH terms: Animals, Antibodies, Fungal, Antigens, Fungal, Coccidioides, Coccidioidomycosis, Fungal Vaccines, Humans

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Coccidioidomycosis: host response and vaccine development

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