Brucellosis is one of the most common worldwide bacterial zoonotic diseases during which osteoarticular complications may arise in up to 80% of human cases (
12,
13). The study of
Brucella-induced osteoarthritis has been challenging due to the lack of a suitable laboratory animal model as well as the impracticality of using natural hosts. Although few mouse models (IFN-γ
−/−, CXCR2
−/−, and IL-1R
−/−) have been used to understand the mechanism of osteoarticular brucellosis, they required either a virulent biosafety level 3 (BSL3)
Brucella strain to induce detectable bone damage or injection directly into the joints (
17,
19,
20). The development and characterization of an NSG immunocompromised mouse bearing a mutated interleukin-2 receptor gamma chain (
IL2rγnull) have facilitated its use as a humanized mouse model to study human hemopoietic stem cell engraftment and infectious diseases caused by Epstein-Barr virus, dengue virus,
Salmonella enterica serovar Typhi, and
Plasmodium falciparum (
22,
31–36). In the present study, we sought to investigate the potential of using an NSG mouse model as a means to study the side effects (if any) associated with vaccination and its use to study osteoarticular brucellosis. The currently available
B. abortus S19 vaccine, which is essential for the control of bovine brucellosis, is a live attenuated vaccine that is not suitable for use in humans (
37) due to its known side effects. Very recently, Xie et al. in their meta-analysis have clearly shown various adverse effects associated with the existing licensed
Brucella vaccines, including
Brucella abortus S19,
Brucella melitensis Rev1, and
Brucella abortus RB51. Some of these adverse effects associated with
Brucella abortus S19 vaccination include arthropathy, arthralgia, and myalgia (
38). As a control, we utilized
B. abortus S19 vaccine to compare with our vaccine candidate,
B. abortus S19
ΔvjbR. The present study demonstrated that within 13 weeks of
B. abortus S19 vaccine strain inoculation, NSG immunocompromised mice had to be euthanized due to overwhelming infection. Mice developed gross and histopathological changes and osteoarticular lesions resembling chronic human brucellosis, making this model suitable to study not only vaccine safety but also osteoarticular brucellosis. NSG mice inoculated with
B. abortus S19 displayed signs of illness, a low survival rate, splenomegaly, and high bacterial loads in the spleen, liver, and lung. It is well known that
Brucella has a tropism to reticuloendothelial tissues such as spleen and liver (
39). The high bacterial colonization was associated with marked histiocytic and neutrophilic inflammation, which is typically observed in patients with brucellosis (
40–45). In contrast, NSG mice inoculated with the vaccine candidate
B. abortus S19
ΔvjbR exhibited milder clinical and pathological changes associated with
Brucella infection, indicating that the
B. abortus S19
ΔvjbR vaccine seems to be a safer choice. These results support our previous findings that demonstrated the safety of
ΔvjbR mutants in wild-type and IRF-1
−/− mice (
24,
25,
27). The previous study showed that NSG mice are not capable of inducing an inflammatory immune reaction against infectious agents (
46). Interestingly, in spite of having decreased immunity, NSG mice were capable of mounting inflammation against
Brucella infection in this study. This may be attributed to the presence of neutrophils, monocytes, macrophages, and dendritic cells in NSG mice (
21). Taken together, these observations suggest that the NSG mouse model might be a more sensitive predictor of vaccine safety for brucellosis, especially in immunodeficient individuals. The most frequent clinical sign associated with brucellosis in humans is undulant fever and weight loss (
3,
5). Fever or hyperthermia is a physiological response to an inflammatory process and infection that aims to enhance host survival (
47). In this study, NSG mice inoculated with
B. abortus S19 showed a decrease in body temperature or hypothermia, which is considered a sign of septicemia and poor health (
48–50). In mice, interestingly, the vaccine strain
B. abortus S19
ΔvjbR did not induce hypothermia in NSG mice, a result that is similar to what we have previously reported (
27). While normal weight gain is considered a sign of the healthy animal, weight loss is considered a sign of disease (
3,
51). In this study, weight loss was recorded in the
B. abortus S19-infected NSG mice in a dose-dependent manner; however, this was not the case in NSG mice infected with the
B. abortus S19
ΔvjbR vaccine candidate. This corroborates the observation that the
B. abortus S19
ΔvjbR vaccine seems to be safer than the
B. abortus S19 vaccine.
Once the clinical signs of brucellosis were characterized, we focused our attention to the bone lesions as well as immunolocalization of bacterial antigen in the affected areas (
52). Although a recent report demonstrated that NSG mice have a mild reduction in trabecular bone mass, they do not display any apparent abnormalities in bone development or bone homeostasis (
53). Grossly and histologically, we found that the bones in NSG mice are normal despite their immune status. In the present study, NSG mice infected with
B. abortus S19 developed severe diskospondylitis, which is a common finding in chronically infected
Brucella patients (
52). Importantly, when animals were inoculated with the vaccine candidate
B. abortus S19
ΔvjbR, no arthritic lesions were observed. Importantly,
Brucella antigen distribution as demonstrated by immunohistochemistry, immunofluorescence, and FISH techniques revealed a direct relationship between bacterial virulence and pathological changes in the affected tissues. This suggests that the severity of bone damage is dependent not only on the inflammatory cell response but also the concentration of
Brucella antigen. Indeed,
B. abortus S19-infected NSG mice showed a dose-dependent increase in antigen accumulations and damage in the tail.
Brucella as an intracellular pathogen resides inside phagocytic and nonphagocytic cells (
54). Confocal microscopy revealed that although
B. abortus S19 was located both extracellularly and intracellularly, large numbers of bacteria were observed inside mature osteoclasts at different cellular depths. Osteoclasts are multinucleated bone-resorbing cells that differentiate from monocyte/macrophage lineage under the effect of two osteoclastogenic cytokines that are required for their survival and differentiation: receptor activator of nuclear factor κB (NF-κB) ligand (RANKL) and macrophage colony-stimulating factor (MCSF) (
55–58). Osteoclasts degrade bone matrix through secretion of several osteolytic enzymes and acids that solubilize bone components (
59,
60), and previous studies have reported that activated osteoclasts play a pivotal role in bone destruction, such as an inflammatory bone loss and rheumatoid arthritis (
61). In light of the significant bone destruction observed in NSG mice, it is possible that
Brucella may use these cells as a replicative niche to spread or sustain the infection. Therefore, future studies are required to investigate whether mature osteoclasts are involved in
Brucella infection and therefore the progression of
Brucella-induced bone destruction.
Collectively, our results revealed that NSG mice can be used as a more sensitive tool to study potential side effects associated with vaccination of live attenuated vaccine candidates. Interestingly, we observed that it could be used not only to study a potential side effect of vaccination including osteoarticular disease but also, most importantly, as a tool to understand the host-antigen interaction that can cause bone damage. While mice inoculated with B. abortus S19 developed symptoms of brucellosis, S19ΔvjbR-inoculated mice did not show significant clinical changes, supporting the safety of the S19ΔvjbR vaccine candidate.