The elevations were more modest (<1.5× upper normal EGFR inhibitor values here vs. 2- to 3-fold previously), not associated with symptoms, and not notably dose-related. We speculate that some bacteria may translocate the intestinal wall and be transported systemically, but at too low a level to generate strong systemic immune responses or be detected in blood cultures. No subject receiving BMB54 had abnormal transaminases, suggesting that as demonstrated in vitro (6), this organism may have decreased tropism for hepatic cells in humans. Other published murine studies in which the BMB54 parent strain vs. WT organisms

were injected i.v. showed that transaminases peaked approximately one and four days after intravenous administration, respectively (6). In that study, the BMB54 mutant caused much lower peak transaminase values, likely because of the lack of replication within the liver. After intravenous administration of a prfA-defective L. monocytogenes vaccine strain to humans, 1.5- to 3.5-fold elevations in both GGT and transaminases were reported eight days after administration, but these tests were apparently not performed during days 1 through 7 after i.v. administration (10). No clinical data suggest these transaminase elevations are harbingers of prolonged or serious hepatic dysfunction.

One murine cancer immunotherapy study using an inlB-positive L. monocytogenes Venetoclax solubility dmso strain exploited this hepatotropism. Hepatic metastases were more efficiently eliminated and survival was prolonged when attenuated L. monocytogenes were used as adjuvant/adjunctive therapy for an irradiated tumor cell vaccine expressing granulocyte-macrophage colony-stimulating factor (36), though that study did not include a comparator strain lacking inlB with decreased

liver tropism. We undertook this study to evaluate the physiological effect of two L. monocytogenes organisms as vectors for delivery of viral antigens. Oral delivery was hoped to stimulate or at least “prime” the mucosal immune system, as many viruses enter through mucosal sites. Bulk IFN-γ ELISpot studies performed on freshly isolated PBMC were chosen as a simple, for reproducible measure of systemic cellular immunity increasingly used in studies of viral vaccines. Our earlier human study was limited by a lack of immunological reagents, especially peptide reagents for ELISpots. Here we were able to test synthesized overlapping peptide pools for both listeriolysin and the foreign antigen. A recent study of PBMC derived from approximately 80 healthy human donors showed that bulk IFN-γ ELISpot responses to this same listeriolysin peptide pool also correlated in magnitude and incidence with IL-2 ELISpot responses to the pool (35), so this is likely a reasonable measure of cellular immunogenicity.