Differential induction of mucosal and systemic antibody responses in women after nasal, rectal, or vaginal immunization: Influence of the menstrual cycle

A cholera vaccine containing killed vibrios and cholera toxin B subunit (CTB) was used to compare mucosal immunization routes for induction of systemic and mucosal Ab. Four groups of women were given three monthly immunizations by the rectal immunization (R_imm) route, nasal immunization (N_imm) route, or vaginal immunization route during either the follicular (V-FP_imm) or luteal (V-LP_imm) menstrual cycle phase. N_imm was performed with 10-fold less vaccine to determine if administration of less Ag by this route can, as in rodents, produce mucosal Ab responses comparable to those induced by higher dose R_imm or vaginal immunization. Concentrations of Ab induced in sera and secretions were measured by ELISA. None of these routes produced durable salivary Ab responses. N_imm induced greatest levels of CTB-specific IgG in sera. R_imm failed to generate CTB-specific IgA in genital tract secretions. N_imm, V-FP_imm, and V-LP_imm all produced cervical CTB-specific IgA responses comparable in magnitude and frequency. However, only V-FP_imm induced cervical IgA2-restricted Ab to the bacterial LPS vaccine component. V-FP_imm, but not V-LP_imm, also induced CTB-specific IgA in rectal secretions. N_imm was superior to V-FP_imm for producing rectal CTB-specific IgA, but the greatest amounts of CTB-specific IgA and LPS-specific IgA, IgG, and IgM Ab were found in rectal secretions of R_imm women. These data suggest that in women, N_imm alone could induce specific Ab in serum, the genital tract, and rectum. However, induction of genital tract and rectal Ab responses of the magnitude generated by local V-FP_imm or R_imm will likely require administration of comparably high nasal vaccine dosages.