All Covid-19 vaccines given are by injection, but the antibodies in the body could not last long. Several works of literature show that the antibodies cannot protect against SARS-CoV-2 infection post six months of vaccination [9], meaning that it is necessary to vaccinate periodically. Thus, we developed a vaccine possible to be administered via oral or nasal route, which is less invasive. The results of our study showed that L. lactis carrying the HCR plasmid after overexpression using nisin 40 ug/ml increased the production of IgG and IgA in the serum of experimental animals. This L. Lactis vaccine is food grade and safer because it uses a lactose selection system and does not use antibiotics. L. lactis has been widely tested as a therapeutic career [10, 11], including in vaccine delivery systems [7, 12].
This microbe-based vaccine is highly suitable when administered via the intranasal and oral routes, which is in line with the results of this study. Vaccines utilizing the mucosal route can activate various immune system pathways, including the mucosal immune system, through the production of sIgA, serum IgG antibodies, and the cellular immune system. s-IgA is an antibody circulating on the surface of the mucosal layer and plays a role in preventing the attachment and invasion of pathogens and neutralizes enterotoxins. Serum IgG contributes to capturing invasive pathogens that enter through the mucosa or circulate systemically. Meanwhile, the response of the cellular immune system is involved against intracellular pathogens [13].
Nasal administration in this study showed better results than oral because nasal administration can increase the immune system respond better due to the enzymes’ elimination mechanism in the digestive tract. It is in line with a previous study conducted by Blanchett et al., that showed an increased immune response of B cells and T cells in mice vaccinated with food-grade L. lactis expressing Ag85b protein [14].
Vaccination via the intranasal route will stimulate a different immune response than vaccination by the oral route, as Takaki et al. (2018) explained comprehensively. In vaccination via the intranasal route, there is an increasing mucosal immune response through the production of secretory-IgA (s-IgA) in addition to a systemic immune response. S-IgA will provide extra protection before the virus penetrates the epithelial membrane of respiratory mucosal cells [15]. Furthermore, s-IgA can also provide cross-reactivity protection against other heterologous viruses [15]. This makes vaccination against SARS-CoV-2 via the intranasal route more advantageous because it could provide better protection against various SARS-CoV-2 variants.
Further, in the respiratory tract of experimental animals, there is nasal-associated lymphoid tissue (NALT), which is similar to Waldeyer's ring and the adenoid, tubal, palatine, and lingual tonsils in humans. NALT has a different formation mechanism than the other mucosal immunity because NALT is formed after birth through an interaction mechanism with indigenous bacteria in the nasal cavity. The NALT system consists of several components of immune cells, including T cells, B cells, dendritic cells (DCs), macrophages, and microfold cells. NALT is also the first immune tissue exposed to inhalant antigens and pathogens, where pathogens trapped by DC will be carried by microfold cells to NALT. Pathogens exposed by DCs activate T cells and induce the formation of cytokines suitable for IgA production at the inductive site of mucosal immunity. Then, there will be IgA switching and B cell maturation. Activated T cells and IgA-producing B cells will be stored in the effector area, so these two types of immune cells can immediately provide protection when pathogen invasion occurs in the nasal area [16].
Measurement of serum IgA also showed similar results, and there was a higher increase in serum IgA levels when administered via the nasal route than the oral route. Other studies have also shown that administration of L. lactis via the mucosal route could increase serum IgA levels in experimental animals [17, 18].
Through oral route administration, L. lactis will be captured after entering the digestive system. The immune system will recognize the carrier bacteria on the surface of the gastrointestinal tract, especially by Microfold cells (M cells) and dendritic cells. In the intestinal tract, dendritic cells have a special morphology, which has transepithelial dendrite that can penetrate the intestinal lumen [13]. Antigen will be carried across the intestinal epithelial barrier and delivered to the APC. Further, the activated APC will induce CD4+ T cells in germinal centers located in Peyer's Patches and mesenteric lymph nodes. CD4+ T cells will activate B cells, resulting in isotype switching that produces B cells [19].
The resulting B cells can be either antibody secreting plasma B cells (ASC) or memory B cells. Upon repeated exposure, memory B cells will immediately differentiate into plasma B cells that can secrete antibodies, either in the form of s-IgA on the mucosal surface or IgG on the systemic side. s-IgA on the mucosal surface contributes to recognizing and neutralizing antigens entering through the oral route. Meanwhile, plasma cells in the spleen or in the circulation play a role in producing IgG, which neutralizes pathogens entering the circulatory system [13].
One of the weaknesses in this study is the presence of IgG/IgA levels that appear in the control, indicating that the possible nCov antibody that we use cannot specifically detect IgG, particularly against SARS-CoV-2. Although, in general, the results of this study showed an acceptable rationale because the IgG levels in control and treatment were different, plasma B cells that produced antibodies would accumulate on the effector site close to the inductive site. Therefore, it is vital to administer vaccination by the route closest to where the pathogen will invade. Since SARS-CoV-2 invades through the respiratory route, vaccination via the intranasal route would be very beneficial.