The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB
| dc.contributor.advisor | Shey, Muki | |
| dc.contributor.advisor | Meintjes , Graeme | |
| dc.contributor.author | Balfour, Avuyonke | |
| dc.date.accessioned | 2026-06-25T09:33:32Z | |
| dc.date.available | 2026-06-25T09:33:32Z | |
| dc.date.issued | 2026 | |
| dc.date.updated | 2026-06-25T09:32:12Z | |
| dc.description.abstract | A small proportion of individuals with sustained tuberculosis (TB) exposure remain persistently uninfected, classified as resisters. Understanding the immune mechanisms underlying this natural resistance is critical for developing TB vaccines and therapeutics. This study characterized the epidemiological, immunological, and transcriptional profiles of resisters among healthcare workers in Cape Town, South Africa. We conducted a cross-sectional study which screened 780 HIV-uninfected healthcare workers from TB facilities in Cape Town, South Africa, who had worked for a minimum of five years in those settings. Participants were classified as resisters, latent TB infection (LTBI), or discordant based on QuantiFERON TB Gold Plus (QFT) and tuberculin skin test results. Resisters were defined as individuals with both a negative QFT (IFN-γ < 0.35 IU/mL) and a negative TST (induration < 10 mm), LTBI participants had a positive QFT (IFN-γ ≥ 0.35 IU/mL) and a positive TST (induration ≥ 10 mm), participants in the Discordant group had a positive QFT (≥ 1 IU/mL) and negative TST (induration = 0 mm). Individuals with a previous TB episode were also included. Blood was collected, and plasma and peripheral blood mononuclear cells (PBMCs) were isolated for downstream analyses. Epidemiologically, resisters and LTBI participants were largely similar, although healthcare workers with 10 to 15 years of TB exposure had lower odds of being resisters, likely reflecting cumulative infection risk. Immunologically, resisters exhibited a distinct T cell profile: MAIT cell frequencies were comparable between groups, but resisters showed higher baseline activation (HLA-DR+, CD27+) yet significantly reduced mycobacteria-specific functional responses (lower frequencies of IFN-γ+ and granzyme B+ cells) and lower proportions of effector memory MAIT cells. Plasma analyses revealed elevated baseline immune mediators in resisters (IFN-α, IL-15, IL-23), while LTBI participants demonstrated stronger T cell responses to M.tb-specific antigens (ESAT-6/CFP-10). Notably, resisters demonstrated greater cytokine secretion following whole mycobacterial stimulation compared to LTBI. Gene expression patterns were largely similar between groups, although resisters showed trends toward upregulated T cell activation genes and downregulated cytotoxic genes following M.tb stimulation. This comprehensive study demonstrates that natural resistance to M.tb is characterized by distinct immune activation patterns rather than altered immune cell frequencies. The contrasting profile of heightened baseline activation coupled with reduced mycobacteria-specific memory responses suggests resisters may clear M.tb through enhanced innate immune readiness before establishing classical adaptive immunity. These findings advance our understanding of protective immunity against M.tb and may inform vaccine strategies targeting early innate activation rather than memory T cell responses alone. | |
| dc.identifier.apacitation | Balfour, A. (2026). <i>The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/43382 | en_ZA |
| dc.identifier.chicagocitation | Balfour, Avuyonke. <i>"The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2026. http://hdl.handle.net/11427/43382 | en_ZA |
| dc.identifier.citation | Balfour, A. 2026. The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB. . University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/43382 | en_ZA |
| dc.identifier.ris | TY - Thesis / Dissertation AU - Balfour, Avuyonke AB - A small proportion of individuals with sustained tuberculosis (TB) exposure remain persistently uninfected, classified as resisters. Understanding the immune mechanisms underlying this natural resistance is critical for developing TB vaccines and therapeutics. This study characterized the epidemiological, immunological, and transcriptional profiles of resisters among healthcare workers in Cape Town, South Africa. We conducted a cross-sectional study which screened 780 HIV-uninfected healthcare workers from TB facilities in Cape Town, South Africa, who had worked for a minimum of five years in those settings. Participants were classified as resisters, latent TB infection (LTBI), or discordant based on QuantiFERON TB Gold Plus (QFT) and tuberculin skin test results. Resisters were defined as individuals with both a negative QFT (IFN-γ < 0.35 IU/mL) and a negative TST (induration < 10 mm), LTBI participants had a positive QFT (IFN-γ ≥ 0.35 IU/mL) and a positive TST (induration ≥ 10 mm), participants in the Discordant group had a positive QFT (≥ 1 IU/mL) and negative TST (induration = 0 mm). Individuals with a previous TB episode were also included. Blood was collected, and plasma and peripheral blood mononuclear cells (PBMCs) were isolated for downstream analyses. Epidemiologically, resisters and LTBI participants were largely similar, although healthcare workers with 10 to 15 years of TB exposure had lower odds of being resisters, likely reflecting cumulative infection risk. Immunologically, resisters exhibited a distinct T cell profile: MAIT cell frequencies were comparable between groups, but resisters showed higher baseline activation (HLA-DR+, CD27+) yet significantly reduced mycobacteria-specific functional responses (lower frequencies of IFN-γ+ and granzyme B+ cells) and lower proportions of effector memory MAIT cells. Plasma analyses revealed elevated baseline immune mediators in resisters (IFN-α, IL-15, IL-23), while LTBI participants demonstrated stronger T cell responses to M.tb-specific antigens (ESAT-6/CFP-10). Notably, resisters demonstrated greater cytokine secretion following whole mycobacterial stimulation compared to LTBI. Gene expression patterns were largely similar between groups, although resisters showed trends toward upregulated T cell activation genes and downregulated cytotoxic genes following M.tb stimulation. This comprehensive study demonstrates that natural resistance to M.tb is characterized by distinct immune activation patterns rather than altered immune cell frequencies. The contrasting profile of heightened baseline activation coupled with reduced mycobacteria-specific memory responses suggests resisters may clear M.tb through enhanced innate immune readiness before establishing classical adaptive immunity. These findings advance our understanding of protective immunity against M.tb and may inform vaccine strategies targeting early innate activation rather than memory T cell responses alone. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - tuberculosis KW - immune mechanisms LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB TI - The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB UR - http://hdl.handle.net/11427/43382 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/43382 | |
| dc.identifier.vancouvercitation | Balfour A. The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB. []. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43382 | en_ZA |
| dc.language.iso | en | |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Medicine | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.publisher.institution | University of Cape Town | |
| dc.subject | tuberculosis | |
| dc.subject | immune mechanisms | |
| dc.title | The role of mucosal-associated invariant T (MAIT) cells in long-term resistance to Mycobacterium tuberculosis (M.tb) infection in healthcare workers with sustained occupational exposure to TB | |
| dc.type | Thesis / Dissertation | |
| dc.type.qualificationlevel | Doctoral | |
| dc.type.qualificationlevel | PhD |