Protective antibodies against enterotoxigenic Escherichia coli are generated from heat-labile toxoid vaccination and exhibit subject- and vaccine-specific diversity

Heat-labile toxin (LT) from enterotoxigenic Escherichia coli (ETEC) is an important pathogenic protein. Anti-LT antibodies (Abs) induced by vaccination can neutralize the toxin and potentially prevent diarrheal secretion from ~ 60% of ETEC strains expressing LT. However, only superficial investigation of the anti-toxin response is usually conducted in clinical trials. Here, we utilized human serum samples from two clinical trials performed to assess safety, immunogenicity and protection in a controlled human infection model with a LT + ST + CFA/I + H10407 ETEC strain. These Phase 1 and Phase 2b clinical trials explored a prototype ETEC adhesin (CfaE) and a chimeric adhesin-toxoid protein (dscCfaE-CTA2/LTB5) delivered intradermally or transcutaneously with a mutated form of LT (mLT) as an adjuvant. Serum samples were tested for antigen-specific IgG or IgA Abs by immunoblot, enzyme-linked immunosorbent assay (ELISA), or functional neutralizing Abs using LT holotoxin, LTA or LTB subunits. Abs to both LT subunits were present, but the response to each was altered by vaccine formulation, dose, and delivery routes as well as subject. The anti-LT IgG response correlated best to neutralizing antibodies and protection from H10407 controlled challenge when compared to other measures including serum IgA or anti-fimbriae (CfaE) Abs. In addition, our results helped to explain cohort attack rate differences in naïve unvaccinated participants and we found higher anti-LTA IgG post-challenge significantly related to ETEC severity score. Thus, strategies generating and measuring immunity to the complete AB₅ structure of LT and subunits are better determinant of assessing protective immunity against LT + or LT + ST + ETEC diarrheal secretion in humans.