A groundbreaking study from the La Jolla Institute for Immunology (LJI) reveals that children with multiple dengue virus infections develop robust dengue-fighting T cells, offering critical insights into immunity against this widespread and possibly deadly virus. Published in JCI Insights, the research highlights the importance of T cells in combating dengue, which infects up to 400 million people annually. With few effective vaccines and no approved therapies for the four serotypes of dengue,this discovery suggests a pathway toward developing more effective preventative measures. The study’s findings are particularly timely as dengue-carrying mosquitoes expand their territory, including into Southern California, where locally acquired cases have been reported.

The research indicates that T cells are a key component of dengue virus immunity. The study found that most children who had experienced two or more dengue infections exhibited very minor symptoms, or even no symptoms at all, when they were afterward infected with the virus.

Dengue virus poses a notable global health threat,infecting up to 400 million people each year. Compounding the problem, there are currently few effective vaccines and no approved therapies available to combat any of the four serotypes of the virus. This new research offers a beacon of hope, suggesting a pathway toward developing more effective preventative measures.

Researchers hope their findings will pave the way for the growth of a dengue virus vaccine that can elicit a similarly strong T cell response, thereby providing robust and lasting immunity.

This research is notably timely, as dengue-carrying mosquitos are expanding their territory into new regions, including Southern California. In 2023, California health officials reported the state’s first-ever case of locally acquired dengue virus. As then,Los Angeles County has reported 12 additional cases of locally acquired dengue virus,and San Diego County has confirmed two locally acquired cases.

“Dengue virus is expanding into areas where the majority of people have never seen the virus,” says Daniela Weiskopf, Ph.D., study leader and LJI Assistant Professor, who is also a member of LJI’s Center for Vaccine Innovation.“That will change the game.”

Unlocking the Role of T Cells in Dengue Immunity

The central question driving Weiskopf and her colleagues’ research was to understand the precise role that T cells play in determining the severity of dengue virus infection. Were these immune cells helping or hindering young patients in their fight against the virus?

The immune system must maintain a delicate balance when combating viral infections. A weak T cell response can leave the body vulnerable and unable to effectively fight off the infection. Conversely, an overly aggressive T cell response can trigger harmful inflammation and potentially lead to fatal complications.

To investigate this complex interplay, the researchers conducted a detailed study of 71 children in Managua, Nicaragua, a region where dengue virus is endemic. Since 2004,study co-author Eva Harris,Ph.D., Director of the Center for Global Public Health at UC Berkeley, has collaborated with Nicaraguan scientists to study dengue infections within this patient group.

These children, ranging in age from 2 to 17, participated in regular blood draws to test for the presence of antibodies against dengue virus. By detecting an increase in these antibodies compared to the previous year, the researchers could determine whether a child had experienced a past dengue virus infection. Crucially, the blood tests also allowed researchers to identify inapparent cases of dengue infection, where a child had been exposed to the virus but exhibited no clinical symptoms.

The researchers’ analysis revealed a clear trend: the number of dengue-fighting T cells in these children increased with each subsequent infection. Moreover, these T cells appeared to be playing a protective role in the pediatric patients.

The data showed that children with a history of two or more dengue infections were substantially less likely to exhibit clinical symptoms if they contracted the virus again. In contrast,children who had only been infected once were more likely to experience clinical symptoms of the disease during a later infection.

We saw a significant T cell response in children who had been infected more than once before.

Daniela Weiskopf, Ph.D., study leader and LJI Assistant Professor

Implications for future Vaccine Development

This new study may shed light on why a recent dengue virus vaccine, known as Dengvaxia, demonstrated safety and efficacy in only a specific subset of patients at risk for dengue infection. The vaccine received FDA approval only for children aged 9 to 16 who resided in dengue-endemic areas,under the assumption that they had already experienced a dengue infection by that age. subsequent licensure in other countries required an antigen test to confirm prior exposure.

The vaccine proved ineffective in individuals who had not previously been exposed to dengue virus. A key question arises: Could it be that their T cells were not adequately primed to respond effectively?

As the new study suggests, multiple dengue virus exposures might potentially be necessary to achieve robust immunity. Weiskopf emphasizes that scientists will continue to investigate how to effectively harness the power of T cells to combat dengue virus.

“There’s a lot more work to be done,” says Weiskopf.

The study, titled “Frequency of Dengue Virus-Specific T Cells is related to Infection Outcome in Endemic Settings,” also included contributions from Rosa Isela Gálvez, Amparo Martínez-Pérez, E. Alexandar Escarrega, Tulika Singh, José Víctor Zambrana, and Ángel Balmaseda.