The type 6 secretion system (T6SS) is sometimes described as a molecular “harpoon” that is most often used by bacteria to deliver harmful effectors to other prokaryotes or eukaryotic cells [
115,
116]. Less commonly, they can also play a role in scavenging nutrients and metal ions [
115,
116,
117]. The T6SS consists primarily of the harpoon-like structure, a sheath surrounding it, and a membrane-spanning complex and base plate. The shaft of the harpoon consists of polymerized Hcp (TssD) proteins that end in a tip made of VgrG (TssI) and PAAR. Cargo molecules can bind to the shaft or tip for delivery into the recipient cell, though Hcp, VgrG, and PAAR can have effector functions as well [
118,
119,
120]. The sheath consists of polymerized TssB and TssC, the length of which is controlled by TssA at the base. This sheath contracts to thrust the harpoon into an adjacent cell via a contact-dependent manner (virulence) or into the extracellular milieu in a contact-independent manner (nutrient acquisition). Both the sheath and shaft reside primarily in the cytoplasm until the shaft is fired across the cell envelope. Finally, the membrane-spanning complex and base plate consist of TssE-G and TssJ-M, providing a channel for the harpoon-like structure to pass the bacterial envelope. Only TssJ is found in the outer membrane, and it appears to be located exclusively within the lipid bilayer and periplasm [
115,
116]. In summary, none of the components of contact dependent T6SSs are predicted to be exposed to the extracellular space before or after secretion, indicating that they are likely serving as T cell antigens and not antibody targets when used in vaccination.
The
B. pseudomallei genome harbors six T6SS loci (T6SS-1-6). There are two distinct numberings of these systems used in the literature which can be a source of confusion. In this review, we have opted to use the nomenclature introduced by Schell et al [
121]. The T6SS-2 was characterized as a contact-independent system involved in Zn
2+ and Mn
2+ acquisition to combat oxidative stress [
117]. The T6SS-4 was recently implicated as being involved in biofilm formation, flagella biosynthesis, and intracellular survival in A549 cells, though the exact mechanistic role of the T6SS-4 in these wide-ranging functions has yet to be elucidated [
122]. The T6SS-6 is highly conserved across
B. pseudomallei and all Bcc species, leading Spiewak et al. to conclude that it is the prototypical T6SS of
Burkholderia [
123]. It is currently held that this system is used to impede the growth of other Gram-negative bacteria [
123]. Very little is known about the T6SS-3 and -5; however, they along with the T6SS-2, -4, and -6 do not appear to play any significant role in virulence in mammalian models of infection [
123,
124,
125]. For the sake of developing a cross-protective vaccine, it is worth noting that
B. mallei has lost the entire T6SS-5 locus as well as seven T6SS-6 genes, likely rendering the T6SS-6 non-functional [
121]. Additionally, only the T6SS-6 is broadly conserved across Bcc species and is thus the only T6SS that could theoretically be targeted for
B. pseudomallei-to-Bcc cross-protection (
Table 2) [
123].
The T6SS-1 is the most well-studied T6SS in
B. pseudomallei and
B. mallei on account of its clearly defined role in virulence [
124,
125]. It was first identified in a screen for
B. pseudomallei proteins that are upregulated during macrophage invasion and intracellular survival [
126]. Around the same time, studies in
B. mallei indicated that overexpression of the VirAG virulence-associated transcriptional regulatory system resulted in upregulation of the T6SS-1 [
121]. In the absence of this system,
B. mallei and
B. pseudomallei’s ability to replicate in macrophages and induce the formation of multinucleated giant cells (MNGCs), a characteristic disease manifestation, is decreased [
125,
127]. To date, no cargo molecules have been identified for the T6SS-1. Instead, our current understanding of the T6SS-1’s mechanism of action indicates that the tip protein VgrG [
118,
119], and potentially PAAR as well [
120], are directly responsible for inducing host cell membrane fusion with neighboring cells, leading to the formation of MNGCs.
5.1. T6SS Shaft Proteins
Multiple studies have demonstrated that Hcp1 is highly immunogenic, reacting particularly strongly to human melioidosis sera [
125,
129] and glanders sera from mice, horses, and one human [
121,
130]. PBMCs from melioidosis seropositive donors also respond to stimulation with Hcp1, correlating with patient survival [
131]. By comparison, Hcp2 (BPSS0518), Hcp3 (BPSS2098), Hcp4 (BPSS0171), Hcp5 (BPSS0099), and Hcp6 (BPSL3105) are minimally reactive to human melioidosis serum [
125], suggesting they may not be similarly immunogenic during an infection. Burtnick et al. screened these Hcp proteins as potential melioidosis vaccine antigens [
125]. Female BALB/c mice were intraperitoneally immunized with one of each of the Hcp proteins formulated in SAS. The animals were subsequently challenged i.p. with ~50,000 CFU of
B. pseudomallei strain K96243, ~50 times the median lethal dose. In this first trial, Hcp2 exhibited the greatest protective efficacy with 5 of 6 mice surviving to day 42 post-challenge. Hcp1, 3, 4, and 6 all had 2 or 3 animals survive to day 42, while Hcp5 did not confer any protection. However, in a subsequent replicate of this study using only Hcp1, 2, 3, and 6, Hcp6 conferred the highest level of protection with 4 of 12 animals surviving to day 42. In the Hcp1, 2, and 3 groups, only 2, 1, and 3 animals survived, respectively, which was approximately the same degree of protection as afforded by the adjuvant alone group in which 2 animals survived. This study appears to be the only published use of Hcp2 through Hcp6 in vaccination. Given that Hcp6 provided the highest level of protection in the follow-up experiment, even if only marginally, it may be worth revisiting as a potentially cross-protective antigen to Bcc species due to its extremely high degree of sequence conservation between
B. pseudomallei and Bcc species (
Table 2) [
123].
Likely due to the T6SS-1’s clear role in virulence and Hcp1’s potent immunogenicity during natural infection, only Hcp1 has been explored further as a subunit vaccine antigen, despite the somewhat lackluster protection afforded by the protein in the initial screen [
125]. In another study, Whitlock et al. tested whether
B. mallei-derived Hcp1 was protective against a respiratory glanders challenge [
70]. When female BALB/c mice were immunized i.n. with the antigen paired with CpG ODN 2395 and immune-stimulating complex AbISCO 100, mice were 80% protected from a 2x LD
50 challenge of
B. mallei strain ATCC 23344, in-line with the other antigens tested in this study (LolC, BimA, BopA) [
70]. In this study, Hcp1 conferred markedly higher protection than reported in the Hcp screen [
125], though it is unclear if this is due to the different pathogen, immunization/challenge routes, adjuvant systems, or challenge doses.
In recent years, Hcp1 has become a particularly popular component of glycoconjugate vaccines, either directly conjugated to
B. thailandensis-derived LPS [
56,
57,
58,
59] or admixed with CPS that has been conjugated to a non-
Burkholderia carrier protein [
128,
132]. Gregory et al. were the first to chemically link LPS to Hcp1, which was in turn linked to a gold nanoparticle vector. When this gold nanoparticle construct was administered in an intranasal immunization/challenge model in mice, it was noted that it elicited markedly higher LPS-specific IgG titers than when FliC or a tetanus toxoid carrier were used as carrier proteins [
56]. When mice were subsequently challenged with a low dose of 1.9-2.6x LD
50 B. mallei strain China7, 89% of the Hcp1-LPS-vaccinated animals survived, which was superior to but not significantly different from animals receiving the tetanus toxoid- or FliC-containing constructs [
56]. In a subsequent experiment using a higher dose of 7x LD
50 of the same challenge strain, the animals given the Hcp1-LPS formulation were 22% protected, largely in-line with the other two groups [
56]. In both studies, the three groups receiving protein linked LPS exhibited significantly higher protection and lower spleen colonization than the negative control animals. However, the lack of any significant difference in protection between the Hcp1-LPS vaccinated group and those receiving the FliC or tetanus toxoid carriers may indicate that Hcp1-specific immune responses played little to no direct role in the observed protection, which was instead likely mediated primarily by LPS-specific immunity. Regardless, this study at least confirmed that Hcp1 could elicit robust T cell responses, as indirectly indicated by higher LPS-specific IgG titers.
Our group later used the same gold nanoparticle platform to test a wider array of
B. mallei-derived carrier proteins for their ability to protect against melioidosis and glanders challenges when conjugated to LPS [
57,
58,
59]. In all three of these studies, we did not observe any significant improvement in LPS-specific antibody titers afforded by the inclusion of Hcp1, at least compared to the other carrier proteins that were screened [
57,
58,
59]. On the contrary, it was observed that the Hcp1-containing glycoconjugate elicited the lowest LPS-specific titers in one such study [
59]. When a variety of these different constructs were tested for their ability to protect against a respiratory glanders challenge, the Hcp1 glycoconjugate elicited 89% protection, which was more-or-less in line with all the other carrier protein formulations that were assessed [
58]. The lack of differences in protection against glanders afforded by the different carrier proteins may again suggest that protection is primarily being mediated by LPS-specific antibodies rather than carrier protein-specific responses. One of the primary arguments for including a strong T cell antigen such as Hcp1 in a
B. mallei or
B. pseudomallei vaccine formulation is that it may provide superior sterilizing immunity by providing additional protection from the intracellular phase of infection. However, in the glanders studies significant differences were not observed in spleen and lung colonization in surviving animals between the different carrier protein groups, and sterilizing immunity was not achieved [
58]. When these constructs were used to immunize against a heterologous melioidosis challenge, the Hcp1-containing glycoconjugates failed to elicit any detectable protection [
57,
59].
Burtnick et al. paired
B. pseudomallei-derived Hcp1 with a CPS glycoconjugate consisting of CPS chemically linked to the potent T cell antigen CRM197, a non-toxic mutant of diptheria toxin [
128]. The authors demonstrated via IFN-γ ELISpot that PBMCs from mice immunized with Hcp1 or Hcp1 paired with CPS-CRM197 were strongly reactive to stimulation with the protein, further supporting Hcp1’s T cell antigenic properties [
128]. When the authors assessed Hcp1’s protective efficacy in vaccination, they found that the combination of Hcp1 and CPS-CRM197 conferred 100% protection against an intranasal challenge of 10x LD
50 B. pseudomallei strain K96243 compared to 67% in the CPS-CRM197 group, 30% in the Hcp1 group, and 0% in the adjuvant group [
128]. This study thus provides some of the strongest support for the inclusion of Hcp1 in a subunit vaccine, demonstrating its protective efficacy with and without the B cell antigen CPS. Most surviving animals in both the combination and CPS-CRM197 groups had sterilizing immunity in the lungs, livers, and spleens, which may indicate that CPS-specific responses were primarily responsible [
128]. Based on these results, Biryukov et al., recently performed a similar immunization study using CPS-CRM197+Hcp1 with or without AhpC, another robust T cell antigen discussed later [
132]. Somewhat counterintuitively, the inclusion of AhpC lowered the degree of protection to an aerosol challenge from 80% to 50%, though both groups performed far better than the adjuvant alone group at 0% survival. Furthermore, bacterial loads in the spleens and lungs of these animals were significantly reduced 3 days post-challenge compared to controls [
132]. When splenocytes from these two immunization groups were recalled with either AhpC or Hcp1, it was determined that AhpC was the more potent T cell antigen, as PBMCs recalled with AhpC elicited 1-2 orders of magnitude higher levels of various Th1- and Th2-associated cytokines compared to stimulation with Hcp1 [
132]. Finally, these authors also noted that the Hcp1+CPS-CRM197 formulation conferred protection to
B. pseudomallei strain MSHR5855 and a heterologous challenge with
B. mallei strain FMH, though it is unclear to what extent Hcp1 was responsible for this strain and species cross-protection given the lack of Hcp1 and CPS-CRM197 alone controls [
132].
Another novel approach to Hcp1 vaccination was recently conducted by Zhu et al., who were able to produce
Staphylococcus aureus-derived membrane vesicles loaded with Hcp1 [
133]. This was achieved by fusing the
hcp1 sequence to the
S. aureus pyruvate dehydrogenase E1 component subunit beta (
pdhB), a protein known to be efficiently loaded into membrane vesicles. BALB/c mice were immunized with recombinant Hcp1 or the Hcp1-loaded vesicles, either alone or adjuvanted with Freund’s adjuvant. Animals were simultaneously immunized subcutaneously, intramuscularly, and intraperitoneally. Only the animals receiving the adjuvanted vesicles elicited significant Hcp1-specific antibody titers, though this did not translate to any significant difference in protective efficacy between the adjuvanted (70% survival) and unadjuvanted (60%) groups receiving the vesicles after a challenge with 5x LD
50 of
B. pseudomallei strain BPC006. Given that Hcp1 is predicted to mediate protection primarily through T cell responses, it may have been more relevant to perform ELISpots or similar assays using Hcp1-recalled splenocytes from the immunized animals. By comparison, the recombinant Hcp1 conferred no protection, though this can likely be attributed at least in part to the lack of adjuvant in this group. Finally, five days post-challenge, the adjuvanted and unadjuvanted groups receiving the vesicles had no colonization of the lungs, liver, or spleens [
133].
Overall, there appears to be just as much evidence in support of including Hcp1 in a vaccine to
B. mallei or
B. pseudomallei as there is weighing against it. As previously stated, the wide range of efficacies reported for this protein could be due to a variety of reasons such as the route of immunization/infection, the adjuvant used, inclusion of other antigens, etc. That said, there is another potential drawback to using Hcp proteins as antigens that may provide additional context for why Hcp1-mediated protection appears so variable. Specifically, it has been demonstrated previously that the Hcp protein of the sci-1 T6SS in enteroaggegative
E. coli is capable of spontaneously associating into hexameric rings even in the absence of other T6SS components [
134]. Furthermore, these hexamers were capable of self-assembling into a shaft-like structure in an unregulated manner such that they could arrange in head-to-head, tail-to-tail, or head-to-tail orientations [
134]. This finding has significant implications for using the protein as a subunit vaccine antigen, assuming Hcp1 is similarly capable of this spontaneous assembly. Even if Hcp1 is only being used as a soluble, unmodified antigen, the degree of spontaneous polymerization could result in significant batch-to-batch variability, and in turn, could significantly impact the pharmacokinetics and pharmacodynamics of the protein. For example, larger particulates are much more readily detected by innate immune cells than non-aggregated antigen due to size-dependent differences in immune recognition [
135,
136,
137]. Furthermore, large particulates have a decreased ability to passively diffuse to secondary lymphoid tissues [
135]. In the case of nanoparticle-vectored vaccines such as the gold nanoparticle platform, conjugation efficiency may be directly affected by the degree of Hcp1 polymerization. While these observations are speculative at this point, exploration of this matter appears justified if Hcp1 is to ever make it to regulated pre-clinical or clinical studies, particularly if post-expression modifications are to be utilized.