Exploration of Orally Disintegrating Tablet for Sublingual Vaccination against Mucosal Bacterial Infection

Oral mucosal bacterial infections impose a substantial global disease burden, yet current clinical management typically reduces microbial load only transiently and rarely establishes durable protection at the oral surface. Analysis of 200 patients with periodontitis revealed that elevated levels of pathogen-specific salivary secretory Immunoglobulin A (sIgA) were strongly associated with reduced bacterial burden and improved clinical periodontal outcomes, identifying sIgA as a key determinant of effective oral protection. Guided by this observation, we developed a sublingual, orally disintegrating tablet vaccine (Capot) that incorporates bacterial extracellular vesicles providing a comprehensive repertoire of native antigens and multiple pathogen-associated molecular patterns, encapsulated within a calcium phosphate nanoshell to enable safe transmucosal delivery to submandibular lymph nodes. The rapidly disintegrating tablet format minimizes inadvertent swallowing and enhances local mucosal bioavailability. In mice and non-human primates, Capot induced robust and long-lasting salivary sIgA responses without overt oral mucosal or gastrointestinal inflammation and conferred strong protection against primary, recurrent, and antibiotic-resistant periodontitis. Together, these findings establish sublingual tablet vaccination as a practical strategy for selectively engaging oral mucosal immunity and preventing chronic bacterial diseases at oral mucosal surfaces.