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Chen J, Zhang T, Lu Y, Yang X, Ouyang Z. Emerging trends of research on mRNA vaccines: A co-citation analysis. Hum Vaccin Immunother 2022; 18:2110409. [PMID: 36018287 DOI: 10.1080/21645515.2022.2110409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This study was designed to evaluate the emerging trends of research on mRNA vaccines. Altogether 3056 research articles related to mRNA vaccines published since 2010 were retrieved from the Web of Science database, based on which a co-citation analysis was conducted using CiteSpace. A total of 12 clusters were derived, all of which were classified into three periods according to the content and publication time of articles: (1) The preliminary exploratory period before early 2010s, when the potential of mRNA to induce immune response was evaluated; (2) the growing up period from early 2010s to 2019, when the stability and immunogenicity of mRNA vaccines were improved and the clinical development of products were pushed forward; (3) the rapid maturity period after the outbreak of COVID-19, when two products for COVID-19 were authorized for the first time. The approval of COVID-19 vaccines is an encouraging start, while the enormous potential of mRNA vaccines remains to be explored. Future research on mRNA-based infectious disease vaccines will focus on further optimizing mRNA modification and delivery, solving problems of the approved vaccines in real world, investigating mRNA vaccines for other infectious indications, and developing self-amplifying or thermostable vaccines. Future research on mRNA-based therapeutic cancer vaccines will focus on screening proper neoantigens, enhancing the delivery of mRNA into antigen-presenting cells and overcoming suppressive tumor microenvironment.
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Affiliation(s)
- Juan Chen
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ting Zhang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan Lu
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyi Yang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhaolian Ouyang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Provine NM, Klenerman P. Adenovirus vector and mRNA vaccines: Mechanisms regulating their immunogenicity. Eur J Immunol 2022:10.1002/eji.202250022. [PMID: 36330560 PMCID: PMC9877955 DOI: 10.1002/eji.202250022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
Replication-incompetent adenovirus (Ad) vector and mRNA-lipid nanoparticle (LNP) constructs represent two modular vaccine platforms that have attracted substantial interest over the past two decades. Due to the COVID-19 pandemic and the rapid development of multiple successful vaccines based on these technologies, there is now clear real-world evidence of the utility and efficacy of these platforms. Considerable optimization and refinement efforts underpin the successful application of these technologies. Despite this, our understanding of the specific pathways and processes engaged by these vaccines to stimulate the immune response remains incomplete. This review will synthesize our current knowledge of the specific mechanisms by which CD8+ T cell and antibody responses are induced by each of these vaccine platforms, and how this can be impacted by specific vaccine construction techniques. Key gaps in our knowledge are also highlighted, which can hopefully focus future studies.
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Affiliation(s)
- Nicholas M. Provine
- Translational Gastroenterology UnitNuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Paul Klenerman
- Translational Gastroenterology UnitNuffield Department of MedicineUniversity of OxfordOxfordUK,Peter Medawar Building for Pathogen ResearchUniversity of OxfordOxfordUK
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Verbeke R, Hogan MJ, Loré K, Pardi N. Innate immune mechanisms of mRNA vaccines. Immunity 2022; 55:1993-2005. [PMID: 36351374 PMCID: PMC9641982 DOI: 10.1016/j.immuni.2022.10.014] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/08/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
The lipid nanoparticle (LNP)-encapsulated, nucleoside-modified mRNA platform has been used to generate safe and effective vaccines in record time against COVID-19. Here, we review the current understanding of the manner whereby mRNA vaccines induce innate immune activation and how this contributes to protective immunity. We discuss innate immune sensing of mRNA vaccines at the cellular and intracellular levels and consider the contribution of both the mRNA and the LNP components to their immunogenicity. A key message that is emerging from recent observations is that the LNP carrier acts as a powerful adjuvant for this novel vaccine platform. In this context, we highlight important gaps in understanding and discuss how new insight into the mechanisms underlying the effectiveness of mRNA-LNP vaccines may enable tailoring mRNA and carrier molecules to develop vaccines with greater effectiveness and milder adverse events in the future.
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Affiliation(s)
- Rein Verbeke
- Ghent Research Group on Nanomedicines, Faculty of Pharmacy, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Department of Biochemistry and Molecular Biology, University of British Columbia, BC V6T 1Z4, Vancouver, Canada.
| | - Michael J Hogan
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Karin Loré
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, 171 64 Solna, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Pardi
- Department of Microbiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
Messenger RNA (mRNA) is an emerging class of therapeutic agent for the prevention and treatment of a wide range of diseases. The recent success of the two highly efficacious mRNA vaccines produced by Moderna and Pfizer-BioNTech to protect against COVID-19 highlights the huge potential of mRNA technology for revolutionizing life science and medical research. Challenges related to mRNA stability and immunogenicity, as well as in vivo delivery and the ability to cross multiple biological barriers, have been largely addressed by recent progress in mRNA engineering and delivery. In this Review, we present the latest advances and innovations in the growing field of mRNA nanomedicine, in the context of ongoing clinical translation and future directions to improve clinical efficacy.
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Cacicedo ML, Weinl-Tenbruck C, Frank D, Limeres MJ, Wirsching S, Hilbert K, Pasha Famian MA, Horscroft N, Hennermann JB, Zepp F, Chevessier-Tünnesen F, Gehring S. Phenylalanine hydroxylase mRNA rescues the phenylketonuria phenotype in mice. Front Bioeng Biotechnol 2022; 10:993298. [PMID: 36277393 PMCID: PMC9585315 DOI: 10.3389/fbioe.2022.993298] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Phenylketonuria (PKU) is an inborn error of metabolism caused by a deficiency in functional phenylalanine hydroxylase (PAH), resulting in accumulation of phenylalanine (Phe) in patients’ blood and organs. Affected patients encounter severe developmental delay, neurological deficits, and behavioral abnormalities when not treated. Early diagnosis and treatment are extremely important; newborn screening programs have been implemented in most countries to ensure early identification of patients with PKU. Despite available treatment options, several challenges remain: life-long adherence to a strict diet, approval of some medications for adults only, and lack of response to these therapies in a subpopulation of patients. Therefore, there is an urgent need for treatment alternatives. An mRNA-based approach tested in PKU mice showed a fast reduction in the accumulation of Phe in serum, liver and brain, the most significant organ affected. Repeated injections of LNP-formulated mouse PAH mRNA rescued PKU mice from the disease phenotype for a prolonged period of time. An mRNA-based approach could improve the quality of life tremendously in PKU patients of all ages by replacing standard-of-care treatments.
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Affiliation(s)
- Maximiliano L. Cacicedo
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
- *Correspondence: Maximiliano L. Cacicedo,
| | | | - Daniel Frank
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Maria Jose Limeres
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Sebastian Wirsching
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Katja Hilbert
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | | | | | - Julia B. Hennermann
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Fred Zepp
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | | | - Stephan Gehring
- Children’s Hospital, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
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Lenart K, Hellgren F, Ols S, Yan X, Cagigi A, Cerveira RA, Winge I, Hanczak J, Mueller SO, Jasny E, Schwendt K, Rauch S, Petsch B, Loré K. A third dose of the unmodified COVID-19 mRNA vaccine CVnCoV enhances quality and quantity of immune responses. Mol Ther Methods Clin Dev 2022; 27:309-323. [PMID: 36217434 PMCID: PMC9535876 DOI: 10.1016/j.omtm.2022.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/04/2022] [Indexed: 10/24/2022]
Abstract
A third vaccine dose is often required to achieve potent, long-lasting immune responses. We investigated the impact of three 8 μg doses of CVnCoV, CureVac's SARS-CoV-2 vaccine candidate containing sequence-optimized unmodified mRNA encoding spike (S) glycoprotein, administered at 0, 4 and 28 weeks on immune responses in rhesus macaques. Following the third dose S-specific binding and neutralizing antibodies increased 50-fold compared with post-dose 2 levels, with increased responses also evident in the lower airways and against the SARS-CoV-2 B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma) and B.1.617.2 (Delta) variants. Enhanced binding affinity of serum antibodies after the third dose correlated with higher somatic hypermutation in S-specific B cells, corresponding with improved binding properties of monoclonal antibodies expressed from isolated B cells. Administration of low dose mRNA led to fewer cells expressing antigen in vivo at the injection site and in the draining lymph nodes compared with a tenfold higher dose, possibly reducing the engagement of precursor cells with the antigen and resulting in the suboptimal response observed following two-dose vaccination schedules in phase IIb/III clinical trials of CVnCoV. However, when immune memory is established, a third dose efficiently boosts the immunological responses as well as improves antibody affinity and breadth.
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Affiliation(s)
- Klara Lenart
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrika Hellgren
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Ols
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Xianglei Yan
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Cagigi
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rodrigo Arcoverde Cerveira
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Inga Winge
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jakub Hanczak
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | - Karin Loré
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden,Correspondence should be addressed to: Karin Loré, Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Visionsgatan 4, BioClinicum J7:30, Karolinska University Hospital, 171 64 Stockholm, Sweden. E-mail address:
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Du Y, Wang H, Yang Y, Zhang J, Huang Y, Fan S, Gu C, Shangguan L, Lin X. Extracellular Vesicle Mimetics: Preparation from Top-Down Approaches and Biological Functions. Adv Healthc Mater 2022; 11:e2200142. [PMID: 35899756 DOI: 10.1002/adhm.202200142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/15/2022] [Indexed: 01/27/2023]
Abstract
Extracellular vesicles (EVs) have attracted attention as delivery vehicles due to their structure, composition, and unique properties in regeneration and immunomodulation. However, difficulties during production and isolation processes of EVs limit their large-scale clinical applications. EV mimetics (EVMs), prepared via top-down strategies that improve the yield of nanoparticles while retaining biological properties similar to those of EVs have been used to address these limitations. Herein, the preparation of EVMs is reviewed and their characteristics in terms of structure, composition, targeting ability, cellular uptake mechanism, and immunogenicity, as well as their strengths, limitations, and future clinical application prospects as EV alternatives are summarized.
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Affiliation(s)
- Yuan Du
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Hongyi Wang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yang Yang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jianfeng Zhang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China
| | - Yue Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Hangzhou OrigO Biotechnology Co. Ltd., Hangzhou, 311200, China
| | - Chenhui Gu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,Hangzhou OrigO Biotechnology Co. Ltd., Hangzhou, 311200, China
| | - Liqing Shangguan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xianfeng Lin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, 310020, China.,Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,Hangzhou OrigO Biotechnology Co. Ltd., Hangzhou, 311200, China
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Li Z, Liu S, Li F, Li Y, Li Y, Peng P, Li S, He L, Liu T. Efficacy, immunogenicity and safety of COVID-19 vaccines in older adults: a systematic review and meta-analysis. Front Immunol 2022; 13:965971. [PMID: 36177017 PMCID: PMC9513208 DOI: 10.3389/fimmu.2022.965971] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundOlder adults are more susceptible to severe health outcomes for coronavirus disease 2019 (COVID-19). Universal vaccination has become a trend, but there are still doubts and research gaps regarding the COVID-19 vaccination in the elderly. This study aimed to investigate the efficacy, immunogenicity, and safety of COVID-19 vaccines in older people aged ≥ 55 years and their influencing factors.MethodsRandomized controlled trials from inception to April 9, 2022, were systematically searched in PubMed, EMBASE, the Cochrane Library, and Web of Science. We estimated summary relative risk (RR), rates, or standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects meta-analysis. This study was registered with PROSPERO (CRD42022314456).ResultsOf the 32 eligible studies, 9, 21, and 25 were analyzed for efficacy, immunogenicity, and safety, respectively. In older adults, vaccination was efficacious against COVID-19 (79.49%, 95% CI: 60.55−89.34), with excellent seroconversion rate (92.64%, 95% CI: 86.77−96.91) and geometric mean titer (GMT) (SMD 3.56, 95% CI: 2.80−4.31) of neutralizing antibodies, and provided a significant protection rate against severe disease (87.01%, 50.80−96.57). Subgroup and meta-regression analyses consistently found vaccine types and the number of doses to be primary influencing factors for efficacy and immunogenicity. Specifically, mRNA vaccines showed the best efficacy (90.72%, 95% CI: 86.82−93.46), consistent with its highest seroconversion rate (98.52%, 95% CI: 93.45−99.98) and GMT (SMD 6.20, 95% CI: 2.02−10.39). Compared to the control groups, vaccination significantly increased the incidence of total adverse events (AEs) (RR 1.59, 95% CI: 1.38−1.83), including most local and systemic AEs, such as pain, fever, chill, etc. For inactivated and DNA vaccines, the incidence of any AEs was similar between vaccination and control groups (p > 0.1), while mRNA vaccines had the highest risk of most AEs (RR range from 1.74 to 7.22).ConclusionCOVID-19 vaccines showed acceptable efficacy, immunogenicity and safety in older people, especially providing a high protection rate against severe disease. The mRNA vaccine was the most efficacious, but it is worth surveillance for some AEs it caused. Increased booster coverage in older adults is warranted, and additional studies are urgently required for longer follow-up periods and variant strains.
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Affiliation(s)
- Zejun Li
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shouhuan Liu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fengming Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yifeng Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Yilin Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Pu Peng
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sai Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Li He
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Tieqiao Liu, ; Li He,
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Tieqiao Liu, ; Li He,
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Ascaso-del-Rio A, García-Pérez J, Pérez-Olmeda M, Arana-Arri E, Vergara I, Pérez-Ingidua C, Bermejo M, Castillo de la Osa M, Imaz-Ayo N, Riaño Fernández I, Astasio González O, Díez-Fuertes F, Meijide S, Arrizabalaga J, Hernández Gutiérrez L, de la Torre-Tarazona HE, Mariano Lázaro A, Vargas-Castrillón E, Alcamí J, Portolés A. Immune response and reactogenicity after immunization with two-doses of an experimental COVID-19 vaccine (CVnCOV) followed by a third-fourth shot with a standard mRNA vaccine (BNT162b2): RescueVacs multicenter cohort study. EClinicalMedicine 2022; 51:101542. [PMID: 35795398 PMCID: PMC9249303 DOI: 10.1016/j.eclinm.2022.101542] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is no evidence to date on immunogenic response among individuals who participated in clinical trials of COVID-19 experimental vaccines redirected to standard national vaccination regimens. METHODS This multicentre, prospective controlled cohort study included subjects who received a COVID-19 experimental vaccine (CVnCoV)(test group, TG) - and unvaccinated subjects (control group, CG), selected among individuals to be vaccinated according to the Spanish vaccination program. All study subjects received BNT162b2 as a standard national vaccination schedule, except 8 (from CG) who received mRNA-1273 and were excluded from immunogenicity analyses. Anti-RBD antibodies level and neutralising titres (NT50) against G614, Beta, Mu, Delta and Omicron variants were analysed. Reactogenicity was also assessed. FINDINGS 130 participants (TG:92; CG:38) completed standard vaccination. In TG, median (IQR) of anti-RBD antibodies after first BNT162b2 dose were 10740·0 BAU/mL (4466·0-12500) compared to 29·8 BAU/mL (14·5-47·8) in CG (p <0·0001). Median NT50 (IQR) of G614 was 2674·0 (1865·0-3997·0) in TG and 63·0 (16·0-123·1) in CG (p <0·0001). After second BNT162b2 dose, anti-RBD levels increased to ≥12500 BAU/mL (11625·0-12500) in TG compared to 1859·0 BAU/mL (915·4-3820·0) in CG (p <0·0001). NT50 was 2626·5 (1756·0-5472·0) and 850·4 (525·1-1608·0), respectively (p <0·0001). Variant-specific (Beta, Mu, Omicron) response was also assessed. Most frequent adverse reactions were headache, myalgia, and local pain. No severe AEs were reported. INTERPRETATION Heterologous BNT162b2 as third and fourth doses in previously suboptimal immunized individuals elicit stronger immune response than that obtained with two doses of BNT162b2. This apparent benefit was also observed in variant-specific response. No safety concerns arose. FUNDING Partly funded by the Institute of Health Carlos-III and COVID-19 Fund, co-financed by the European Regional Development Fund (FEDER) "A way to make Europe".
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Affiliation(s)
- Ana Ascaso-del-Rio
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, C/ Prof Martín Lagos s/n, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del hospital Clínico San Carlos
| | - Javier García-Pérez
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III (ISCIII), Cra Pozuelo km2, Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mayte Pérez-Olmeda
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Serology Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Itziar Vergara
- Primary Care Research Group, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Carla Pérez-Ingidua
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, C/ Prof Martín Lagos s/n, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria del hospital Clínico San Carlos
| | - Mercedes Bermejo
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III (ISCIII), Cra Pozuelo km2, Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Castillo de la Osa
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Serology Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Natale Imaz-Ayo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ioana Riaño Fernández
- Donostia University Hospital, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Oliver Astasio González
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, C/ Prof Martín Lagos s/n, 28040 Madrid, Spain
| | - Francisco Díez-Fuertes
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III (ISCIII), Cra Pozuelo km2, Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Susana Meijide
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Julio Arrizabalaga
- Donostia University Hospital, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Lourdes Hernández Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Serology Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Humberto Erick de la Torre-Tarazona
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III (ISCIII), Cra Pozuelo km2, Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Emilio Vargas-Castrillón
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, C/ Prof Martín Lagos s/n, 28040 Madrid, Spain
- Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Instituto de Investigación Sanitaria del hospital Clínico San Carlos
| | - José Alcamí
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III (ISCIII), Cra Pozuelo km2, Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Corresponding authors.
| | - Antonio Portolés
- Clinical Pharmacology Department, Hospital Clínico San Carlos, IdISSC, C/ Prof Martín Lagos s/n, 28040 Madrid, Spain
- Pharmacology and Toxicology Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
- Instituto de Investigación Sanitaria del hospital Clínico San Carlos
- Corresponding authors.
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Toubasi AA, Al‐Sayegh TN, Obaid YY, Al‐Harasis SM, AlRyalat SAS. Efficacy and safety of COVID-19 vaccines: A network meta-analysis. J Evid Based Med 2022; 15:245-262. [PMID: 36000160 PMCID: PMC9538745 DOI: 10.1111/jebm.12492] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Several vaccines showed a good safety profile and significant efficacy against COVID-19. Moreover, in the absence of direct head to head comparison between COVID-19 vaccines, a network meta-analysis that indirectly compares between them is needed. METHODS Databases PubMed, CENTRAL, medRxiv, and clinicaltrials.gov were searched. Studies were included if they were placebo-controlled clinical trials and reported the safety profile and/or effectiveness of COVID-19 vaccines. The quality of the included studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials and the Revised Cochrane risk-of-bias tool for nonrandomized trials. RESULTS Forty-nine clinical trials that included 421,173 participants and assessed 28 vaccines were included in this network meta-analysis. The network meta-analysis showed that Pfizer is the most effective in preventing COVID-19 infection whereas the Sputnik Vaccine was the most effective in preventing severe COVID-19 infection. In terms of the local and systemic side, the Sinopharm and V-01 vaccines were the safest. CONCLUSION We found that almost all of the vaccines included in this study crossed the threshold of 50% efficacy. However, some of them did not reach the previously mentioned threshold against the B.1.351 variant while the remainder have not yet investigated vaccine efficacy against this variant. Since each vaccine has its own strong and weak points, we strongly advocate continued vaccination efforts in individualized manner that recommend the best vaccine for each group in the community which is abundantly required to save lives and to avert the emergence of future variants.
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Jenkin D, Ritchie AJ, Aboagye J, Fedosyuk S, Thorley L, Provstgaad-Morys S, Sanders H, Bellamy D, Makinson R, Xiang ZQ, Bolam E, Tarrant R, Ramos Lopez F, Platt A, Poulton I, Green C, Ertl HCJ, Ewer KJ, Douglas AD. Safety and immunogenicity of a simian-adenovirus-vectored rabies vaccine: an open-label, non-randomised, dose-escalation, first-in-human, single-centre, phase 1 clinical trial. THE LANCET. MICROBE 2022; 3:e663-e671. [PMID: 35907430 PMCID: PMC7614839 DOI: 10.1016/s2666-5247(22)00126-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rabies kills around 60 000 people each year. ChAdOx2 RabG, a simian adenovirus-vectored rabies vaccine candidate, might have potential to provide low-cost single-dose pre-exposure rabies prophylaxis. This first-in-human study aimed to evaluate its safety and immunogenicity in healthy adults. METHODS We did a single-centre phase 1 study of ChAdOx2 RabG, administered as a single intramuscular dose, with non-randomised open-label dose escalation at the Centre for Clinical Vaccinology and Tropical Medicine, Oxford, UK. Healthy adults were sequentially allocated to groups receiving low (5 × 109 viral particles), middle (2·5 × 1010 viral particles), and high doses (5 x 1010 viral particles) of ChAdOx2 RabG and were followed up to day 56 after vaccination. The primary objective was to assess safety. The secondary objective was to assess immunogenicity with the internationally standardised rabies virus neutralising antibody assay. In an optional follow-up phase 1 year after enrolment, we measured antibody maintenance then administered a licensed rabies vaccine (to simulate post-exposure prophylaxis) and measured recall responses. The trial is registered with ClinicalTrials.gov, NCT04162600, and is now closed to new participants. FINDINGS Between Jan 2 and Oct 28, 2020, 12 adults received low (n=3), middle (n=3), and high doses (n=6) of ChAdOx2 RabG. Participants reported predominantly mild-to-moderate reactogenicity. There were no serious adverse events. Virus neutralising antibody concentrations exceeded the recognised correlate of protection (0·5 IU/mL) in three middle-dose recipients and six high-dose recipients within 56 days of vaccination (median 18·0 IU/mL). The median peak virus neutralising antibody concentrations within 56 days were 0·7 IU/mL (range 0·0-54·0 IU/mL) for the low-dose group, 18·0 IU/mL (0·7-18·0 IU/mL) for the middle-dose group, and 18·0 IU/mL (6·0-486·0 IU/mL) for the high-dose group. Nine participants returned for the additional follow-up after 1 year. Of these nine participants, virus neutralising antibody titres of more than 0·5 IU/mL were maintained in six of seven who had received middle-dose or high-dose ChAdOx2 RabG. Within 7 days of administration of the first dose of a licensed rabies vaccine, nine participants had virus neutralising antibody titres of more than 0·5 IU/mL. INTERPRETATION In this study, ChAdOx2 RabG showed an acceptable safety and tolerability profile and encouraging immunogenicity, supporting further clinical evaluation. FUNDING UK Medical Research Council and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Daniel Jenkin
- Jenner Institute, University of Oxford, Oxford, UK; Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | | | | | | | - Luke Thorley
- Jenner Institute, University of Oxford, Oxford, UK
| | | | | | | | | | - Zhi Quan Xiang
- Wistar Institute of Anatomy & Biology, Philadelphia, PA, USA
| | - Emma Bolam
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | - Richard Tarrant
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | - Fernando Ramos Lopez
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Abigail Platt
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ian Poulton
- Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Catherine Green
- Clinical Biomanufacturing Facility, University of Oxford, Oxford, UK
| | | | - Katie J Ewer
- Jenner Institute, University of Oxford, Oxford, UK
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Khoshnood S, Ghanavati R, Shirani M, Ghahramanpour H, Sholeh M, Shariati A, Sadeghifard N, Heidary M. Viral vector and nucleic acid vaccines against COVID-19: A narrative review. Front Microbiol 2022; 13:984536. [PMID: 36118203 PMCID: PMC9470835 DOI: 10.3389/fmicb.2022.984536] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022] Open
Abstract
After about 2 years since the first detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Wuhan, China, in December 2019 that resulted in a worldwide pandemic, 6.2 million deaths have been recorded. As a result, there is an urgent need for the development of a safe and effective vaccine for coronavirus disease 2019 (COVID-19). Endeavors for the production of effective vaccines inexhaustibly are continuing. At present according to the World Health Organization (WHO) COVID-19 vaccine tracker and landscape, 153 vaccine candidates are developing in the clinical phase all over the world. Some new and exciting platforms are nucleic acid-based vaccines such as Pfizer Biontech and Moderna vaccines consisting of a messenger RNA (mRNA) encoding a viral spike protein in host cells. Another novel vaccine platform is viral vector vaccine candidates that could be replicating or nonreplicating. These types of vaccines that have a harmless viral vector like adenovirus contain a genome encoding the spike protein of SARS-CoV-2, which induces significant immune responses. This technology of vaccine manufacturing has previously been used in many human clinical trials conducted for adenoviral vector-based vaccines against different infectious agents, including Ebola virus, Zika virus, HIV, and malaria. In this paper, we have a review of nucleic acid-based vaccines that are passing their phase 3 and 4 clinical trials and discuss their efficiency and adverse effects.
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Affiliation(s)
- Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Student Research Committee, Ilam University of Medical Sciences, Ilam, Iran
| | - Roya Ghanavati
- School of Paramedical Sciences, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Maryam Shirani
- Toxicology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Ghahramanpour
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - Aref Shariati
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Nourkhoda Sadeghifard
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
- *Correspondence: Mohsen Heidary,
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He X, Su J, Ma Y, Zhang W, Tang S. A comprehensive analysis of the efficacy and effectiveness of COVID-19 vaccines. Front Immunol 2022; 13:945930. [PMID: 36090988 PMCID: PMC9459021 DOI: 10.3389/fimmu.2022.945930] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
It is urgently needed to update the comprehensive analysis about the efficacy or effectiveness of COVID-19 vaccines especially during the COVID-19 pandemic caused by SARS-CoV-2 Delta and Omicron variants. In general, the current COVID-19 vaccines showed a cumulative efficacy of 66.4%, 79.7%, and 93.6% to prevent SARS-CoV-2 infection, symptomatic COVID-19, and severe COVID-19, respectively, but could not prevent the asymptomatic infection of SARS-CoV-2. Furthermore, the current COVID-19 vaccines could effectively prevent COVID-19 caused by the Delta variant although the incidence of breakthrough infection of the SARS-CoV-2 Delta variant increased when the intervals post full vaccination extended, suggesting the waning effectiveness of COVID-19 vaccines. In addition, one-dose booster immunization showed an effectiveness of 74.5% to prevent COVID-19 caused by the Delta variant. However, current COVID-19 vaccines could not prevent the infection of Omicron sub-lineage BA.1.1.529 and had about 50% effectiveness to prevent COVID-19 caused by Omicron sub-lineage BA.1.1.529. Furthermore, the effectiveness was 87.6% and 90.1% to prevent severe COVID-19 and COVID-19-related death caused by Omicron sub-lineage BA.2, respectively, while one-dose booster immunization could enhance the effectiveness of COVID-19 vaccines to prevent the infection and COVID-19 caused by Omicron sub-lineage BA.1.1.529 and sub-lineage BA.2. Two-dose booster immunization showed an increased effectiveness of 81.8% against severe COVID-19 caused by the Omicron sub-lineage BA.1.1.529 variant compared with one-dose booster immunization. The effectiveness of the booster immunization with RNA-based vaccine BNT162b2 or mRNA-1273 was over 75% against severe COVID-19 more than 17 weeks after booster immunization whereas the heterogenous booster immunization showed better effectiveness than homologous booster immunization. In summary, the current COVID-19 vaccines could effectively protect COVID-19 caused by Delta and Omicron variants but was less effective against Omicron variant infection. One-dose booster immunization could enhance protection capability, and two-dose booster immunization could provide additional protection against severe COVID-19.
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Affiliation(s)
- Xiaofeng He
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Jiao Su
- Department of biochemistry, Changzhi Medical College, Changzhi, China
| | - Yu’nan Ma
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Wenping Zhang
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Shixing Tang,
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Navarro AP, Pilkington V, Pepperrell T, Mirchandani M, Levi J, Hill A. Efficacy of Approved versus Unapproved Vaccines for SARS-CoV-2 Infection in Randomised Blinded Clinical Trials. Open Forum Infect Dis 2022; 9:ofac408. [PMID: 36092832 PMCID: PMC9452066 DOI: 10.1093/ofid/ofac408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Five severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are approved in North America and/or Europe: Pfizer/BioNTech, Moderna, Janssen, Oxford-AstraZeneca, and Novavax. Other vaccines have been developed, including Sinopharm, SinoVac, QazVac, Covaxin, Soberana, Zifivax, Medicago, Clover, and Cansino, but they are not approved in high-income countries. This meta-analysis compared the efficacy of US Food and Drug Administration (FDA)/European Medicines Agency (EMA)-approved and -unapproved vaccines in randomized clinical trials (RCTs). Methods A systematic review of trial registries identified RCTs of SARS-CoV-2 vaccines. Risk of bias was assessed using the Cochrane tool (RoB 2). In the meta-analysis, relative risks of symptomatic infection and severe disease were compared for each vaccine versus placebo, using Cochrane-Mantel Haenszel Tests (random effects method). Results Twenty-two RCTs were identified and 1 was excluded for high-risk of bias. Ten RCTs evaluated 5 approved vaccines and 11 RCTs evaluated 9 unapproved vaccines. In the meta-analysis, prevention of symptomatic infection was 84% (95% confidence interval [CI], 68%–92%) for approved vaccines versus 72% (95% CI, 66%–77%) for unapproved vaccines, with no significant difference between vaccine types (P = .12). Prevention of severe SARS-CoV-2 infection was 94% (95% CI, 75%–98%) for approved vaccines versus 86% (95% CI, 76%–92%) for unapproved vaccines (P = .33). The risk of serious adverse events was similar between vaccine types (P = .12). Conclusions This meta-analysis of 21 RCTs in 390 459 participants showed no significant difference in efficacy between the FDA/EMA-approved and -unapproved vaccines for symptomatic or severe infection. Differences in study design, endpoint definitions, variants, and infection prevalence may have influenced results. New patent-free vaccines could lower costs of worldwide SARS-CoV-2 vaccination campaigns significantly.
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Affiliation(s)
| | - Victoria Pilkington
- Oxford University Clinical Academic Graduate School, University of Oxford , United Kingdom
| | - Toby Pepperrell
- University of Edinburgh, School of Medicine and Veterinary Medicine , Edinburgh , UK
| | | | - Jacob Levi
- Royal Free University Hospital NHS Trust , London , UK
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool , Liverpool, L69 3GF , UK
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Qin Z, Sun Y, Zhang J, Zhou L, Chen Y, Huang C. Lessons from SARS‑CoV‑2 and its variants (Review). Mol Med Rep 2022; 26:263. [PMID: 35730623 PMCID: PMC9260876 DOI: 10.3892/mmr.2022.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has swept through mainland China by human-to-human transmission. The rapid spread of SARS-CoV-2 and its variants, including the currently prevalent Omicron strain, pose a serious threat worldwide. The present review summarizes epidemiological investigation and etiological analysis of genomic, epidemiological, and pathological characteristics of the original strain and its variants, as well as progress in diagnosis and treatment. Prevention and control measures used during the current Omicron pandemic are discussed to provide further knowledge of SARS-CoV-2.
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Affiliation(s)
- Ziwen Qin
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Yan Sun
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jian Zhang
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ling Zhou
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Yujuan Chen
- Department of Respiratory Diseases, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Chuanjun Huang
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
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Edwards DK, Carfi A. Messenger ribonucleic acid vaccines against infectious diseases: current concepts and future prospects. Curr Opin Immunol 2022; 77:102214. [PMID: 35671599 PMCID: PMC9612403 DOI: 10.1016/j.coi.2022.102214] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 01/06/2023]
Abstract
Over the past two decades, scientific
and technological advancements have revealed messenger ribonucleic acid
(mRNA)-based vaccines as a well-tolerated and effective platform to
combat infectious disease. The potential of mRNA-based vaccines was
epitomized during the severe acute respiratory syndrome coronavirus 2
pandemic, wherein mRNA-based vaccines were rapidly developed and found
highly efficacious with an acceptable safety profile. These properties
together with the capability to quickly address pathogens of pandemic
potential, pathogens with complex antigens, and multiple pathogens within
a single vaccine have revitalized the field, and multiple mRNA-based
vaccines have now entered clinical development. This review summarizes
current mRNA-based vaccine technology, perspectives on ongoing clinical
studies, and future prospects for the field.
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Affiliation(s)
| | - Andrea Carfi
- Moderna, Inc., 200 Technology Square, Cambridge, MA, USA.
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67
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Yang L, Tang L, Zhang M, Liu C. Recent Advances in the Molecular Design and Delivery Technology of mRNA for Vaccination Against Infectious Diseases. Front Immunol 2022; 13:896958. [PMID: 35928814 PMCID: PMC9345514 DOI: 10.3389/fimmu.2022.896958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
Vaccines can prevent many millions of illnesses against infectious diseases and save numerous lives every year. However, traditional vaccines such as inactivated viral and live attenuated vaccines cannot adapt to emerging pandemics due to their time-consuming development. With the global outbreak of the COVID-19 epidemic, the virus continues to evolve and mutate, producing mutants with enhanced transmissibility and virulence; the rapid development of vaccines against such emerging global pandemics becomes more and more critical. In recent years, mRNA vaccines have been of significant interest in combating emerging infectious diseases due to their rapid development and large-scale production advantages. However, their development still suffers from many hurdles such as their safety, cellular delivery, uptake, and response to their manufacturing, logistics, and storage. More efforts are still required to optimize the molecular designs of mRNA molecules with increased protein expression and enhanced structural stability. In addition, a variety of delivery systems are also needed to achieve effective delivery of vaccines. In this review, we highlight the advances in mRNA vaccines against various infectious diseases and discuss the molecular design principles and delivery systems of associated mRNA vaccines. The current state of the clinical application of mRNA vaccine pipelines against various infectious diseases and the challenge, safety, and protective effect of associated vaccines are also discussed.
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Affiliation(s)
- Lu Yang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Lin Tang
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Ming Zhang
- Department of Pathology, Peking University International Hospital, Beijing, China
- *Correspondence: Chaoyong Liu, ; Ming Zhang,
| | - Chaoyong Liu
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China
- *Correspondence: Chaoyong Liu, ; Ming Zhang,
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Sutton N, San Francisco Ramos A, Beales E, Smith D, Ikram S, Galiza E, Hsia Y, Heath PT. Comparing Reactogenicity of COVID-19 vaccines: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1301-1318. [PMID: 35796029 DOI: 10.1080/14760584.2022.2098719] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES A number of vaccines have now been developed against COVID-19. Differences in reactogenicity and safety profiles according to the vaccine technologies employed are becoming apparent from clinical trials. METHODS Five databases (Medline, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, London School of Hygiene and Tropical Medicine COVID-19 vaccine tracker) were searched for relevant randomised controlled trials between 1 January 2020 and 12 January 2022 according to predetermined criteria with no language limitations. RESULTS Forty-two datasets were identified, with 20 vaccines using four different technologies (viral vector, inactivated, mRNA and protein sub-unit). Adults and adolescents over 12 years were included. Control groups used saline placebos, adjuvants, and comparator vaccines. The most consistently reported solicited adverse events were fever, fatigue, headache, pain at injection site, redness, and swelling. Both doses of mRNA vaccines, the second dose of protein subunit and the first dose of adenovirus vectored vaccines were the most reactogenic, while the inactivated vaccines were the least reactogenic. CONCLUSIONS The different COVID-19 vaccines currently available appear to have distinct reactogenicity profiles, dependent on the vaccine technology employed. Awareness of these differences may allow targeted recommendations for specific populations. Greater standardization of methods for adverse event reporting will aid future research in this field.
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Affiliation(s)
- Natalina Sutton
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - Alberto San Francisco Ramos
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - Emily Beales
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - David Smith
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - Sabina Ikram
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - Eva Galiza
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
| | - Yingfen Hsia
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE.,Queen's University Belfast, School of Pharmacy 97 Lisburn Rd Belfast BT9 7BL Northern Ireland
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection & Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, Jenner Wing, Cranmer Terrace, London SW17 0RE
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Gómez-Aguado I, Rodríguez-Castejón J, Beraza-Millor M, Rodríguez-Gascón A, Del Pozo-Rodríguez A, Solinís MÁ. mRNA delivery technologies: Toward clinical translation. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 372:207-293. [PMID: 36064265 DOI: 10.1016/bs.ircmb.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Messenger RNA (mRNA)-therapies have recently taken a huge step toward clinic thanks to the first mRNA-based medicinal products marketed. mRNA features for clinical purposes are improved by chemical modifications, but the inclusion in a delivery system is a regular requirement. mRNA nanomedicines must be designed for the specific therapeutic purpose, protecting the nucleic acid and facilitating the overcoming of biological barriers. Polymers, polypeptides, and cationic lipids are the main used materials to design mRNA delivery systems. Among them, lipid nanoparticles (LNPs) are the most advanced ones, and currently they are at the forefront of preclinical and clinical evaluation in several fields, including immunotherapy (against infectious diseases and cancer), protein replacement, gene editing and regenerative medicine. This chapter includes an overview on mRNA delivery technologies, with special interest in LNPs, and the most recent advances in their clinical application. Liposomes are the mRNA delivery technology with the highest clinical translation among LNPs, whereas the first clinical trial of a therapeutic mRNA formulated in exosomes has been recently approved for protein replacement therapy. The first mRNA products approved by the regulatory agencies worldwide are LNP-based mRNA vaccines against viral infections, specifically against the 2019 coronavirus disease (COVID-19). The clinical translation of mRNA-therapies for cancer is mainly focused on three strategies: anti-cancer vaccination by means of delivering cancer antigens or acting as an adjuvant, mRNA-engineered chimeric antigen receptors (CARs) and T-cell receptors (TCRs), and expression of antibodies and immunomodulators. Cancer immunotherapy and, more recently, COVID-19 vaccines spearhead the advance of mRNA clinical use.
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Affiliation(s)
- Itziar Gómez-Aguado
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Julen Rodríguez-Castejón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Marina Beraza-Millor
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - Ana Del Pozo-Rodríguez
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain; Bioaraba, Microbiology, Infectious Disease, Antimicrobial Agents, and Gene Therapy, Vitoria-Gasteiz, Spain.
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Xu K, Fan C, Han Y, Dai L, Gao GF. Immunogenicity, efficacy and safety of COVID-19 vaccines: an update of data published by 31 December 2021. Int Immunol 2022; 34:595-607. [PMID: 35778913 PMCID: PMC9278184 DOI: 10.1093/intimm/dxac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused a disaster for public health in the last 2 years, without any sign of an ending. Various vaccines were developed rapidly as soon as the outbreak occurred. Clinical trials demonstrated the reactogenicity, immunogenicity and protection efficacy in humans, and some of the vaccines have been approved for clinical use. However, waves of infections such as the recently circulating Omicron variant still occur. Newly emerging variants, especially the variants of concern, and waning humoral responses pose serious challenges to the control of the COVID-19 pandemic. Previously, we summarized the humoral and cellular immunity, safety profiles and protection efficacy of COVID-19 vaccines with clinical data published by 21 May 2021. In this review, we summarize and update the published clinical data of COVID-19 vaccines and candidates up to 31 December 2021.
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Affiliation(s)
- Kun Xu
- Research Network of Immunity and Health (RNIH), Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China,Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Tropical Medicine and Laboratory Medicine, The First Affiliated Hospital, Hainan Medical University, Hainan, China
| | - Chunxiang Fan
- National Immunization Programme, Chinese Center for Diseases Control and Prevention, Beijing, China
| | - Yuxuan Han
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Lianpan Dai
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Tropical Medicine and Laboratory Medicine, The First Affiliated Hospital, Hainan Medical University, Hainan, China,Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China,CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
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71
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Sáez-Llorens X, Lanata C, Aranguren E, Celis CR, Cornejo R, DeAntonio R, Ecker L, Garrido D, I Gil A, Gonzales M, Hess-Holtz M, Leroux-Roels G, Junker H, Kays SK, Koch SD, Lazzaro S, Mann P, Quintini G, Srivastava B, Vahrenhorst D, von Eisenhart-Rothe P, Wolz OO, Oostvogels L. Safety and immunogenicity of mRNA-LNP COVID-19 vaccine CVnCoV in Latin American adults: a phase 2 randomized study. Vaccine X 2022; 11:100189. [PMID: 35791320 PMCID: PMC9247226 DOI: 10.1016/j.jvacx.2022.100189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Two 12 µg CVnCoV doses are immunogenic against S-protein in adults. Immune responses were lower in > 60 year-olds than 18–60 year-olds. Distinct neutralizing antibody and CD4 + T cell responses to S-protein were induced. Booster doses increased responses to S-protein showing immune memory was induced. Three 12 µg doses are well tolerated with mainly mild to moderate adverse events.
Background The COVID-19 vaccine candidate CVnCoV comprises sequence-optimized mRNA encoding SARS-CoV-2 S-protein encapsulated in lipid nanoparticles. In this phase 2a study, we assessed reactogenicity and immunogenicity of two or three doses in younger and older adults. Methods Younger (18–60 years) and older (>60 years) adults were enrolled in two sites in Panama and Peru to receive either 6 or 12 µg doses of CVnCoV or licensed control vaccines 28 days apart; subsets received a 12 µg booster dose on Day 57 or Day 180. Solicited adverse events (AE) were reported for 7 days and unsolicited AEs for 4 weeks after each vaccination, and serious AEs (SAE) throughout the study. Humoral immunogenicity was measured as neutralizing and receptor binding domain (RBD) IgG antibodies and cellular immunogenicity was assessed as CD4+/CD8 + T cell responses. Results A total of 668 participants were vaccinated (332 aged 18–60 years and 336 aged > 60 years) including 75 who received homologous booster doses. Vaccination was well tolerated with no vaccine-related SAEs. Solicited and unsolicited AEs were mainly mild to moderate and resolved spontaneously. Both age groups demonstrated robust immune responses as neutralizing antibodies or RBD-binding IgG, after two doses, with lower titers in the older age group than the younger adults. Neither group achieved levels observed in human convalescent sera (HCS), but did equal or surpass HCS levels following homologous booster doses. Following CVnCoV vaccination, robust SARS-CoV-2 S-protein-specific CD4 + T-cell responses were observed in both age groups with CD8 + T-cell responses in some individuals, consistent with observations in convalescing COVID-19 patients after natural infection. Conclusions We confirmed that two 12 µg doses of CVnCoV had an acceptable safety profile, and induced robust immune responses. Marked humoral immune responses to homologous boosters suggest two doses had induced immune memory.
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Affiliation(s)
| | | | | | | | | | | | - Lucie Ecker
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ana I Gil
- Instituto de Investigación Nutricional, La Molina, Peru
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72
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Dai L, Gao L, Tao L, Hadinegoro SR, Erkin M, Ying Z, He P, Girsang RT, Vergara H, Akram J, Satari HI, Khaliq T, Sughra U, Celi AP, Li F, Li Y, Jiang Z, Dalimova D, Tuychiev J, Turdikulova S, Ikram A, Flores Lastra N, Ding F, Suhardono M, Fadlyana E, Yan J, Hu Z, Li C, Abdurakhmonov IY, Gao GF. Efficacy and Safety of the RBD-Dimer-Based Covid-19 Vaccine ZF2001 in Adults. N Engl J Med 2022; 386:2097-2111. [PMID: 35507481 PMCID: PMC9127771 DOI: 10.1056/nejmoa2202261] [Citation(s) in RCA: 134] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The ZF2001 vaccine, which contains a dimeric form of the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 and aluminum hydroxide as an adjuvant, was shown to be safe, with an acceptable side-effect profile, and immunogenic in adults in phase 1 and 2 clinical trials. METHODS We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to investigate the efficacy and confirm the safety of ZF2001. The trial was performed at 31 clinical centers across Uzbekistan, Indonesia, Pakistan, and Ecuador; an additional center in China was included in the safety analysis only. Adult participants (≥18 years of age) were randomly assigned in a 1:1 ratio to receive a total of three 25-μg doses (30 days apart) of ZF2001 or placebo. The primary end point was the occurrence of symptomatic coronavirus disease 2019 (Covid-19), as confirmed on polymerase-chain-reaction assay, at least 7 days after receipt of the third dose. A key secondary efficacy end point was the occurrence of severe-to-critical Covid-19 (including Covid-19-related death) at least 7 days after receipt of the third dose. RESULTS Between December 12, 2020, and December 15, 2021, a total of 28,873 participants received at least one dose of ZF2001 or placebo and were included in the safety analysis; 25,193 participants who had completed the three-dose regimen, for whom there were approximately 6 months of follow-up data, were included in the updated primary efficacy analysis that was conducted at the second data cutoff date of December 15, 2021. In the updated analysis, primary end-point cases were reported in 158 of 12,625 participants in the ZF2001 group and in 580 of 12,568 participants in the placebo group, for a vaccine efficacy of 75.7% (95% confidence interval [CI], 71.0 to 79.8). Severe-to-critical Covid-19 occurred in 6 participants in the ZF2001 group and in 43 in the placebo group, for a vaccine efficacy of 87.6% (95% CI, 70.6 to 95.7); Covid-19-related death occurred in 2 and 12 participants, respectively, for a vaccine efficacy of 86.5% (95% CI, 38.9 to 98.5). The incidence of adverse events and serious adverse events was balanced in the two groups, and there were no vaccine-related deaths. Most adverse reactions (98.5%) were of grade 1 or 2. CONCLUSIONS In a large cohort of adults, the ZF2001 vaccine was shown to be safe and effective against symptomatic and severe-to-critical Covid-19 for at least 6 months after full vaccination. (Funded by the National Science and Technology Major Project and others; ClinicalTrials.gov number, NCT04646590.).
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Affiliation(s)
- Lianpan Dai
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Lidong Gao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Lifeng Tao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Sri R Hadinegoro
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Musabaev Erkin
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhifang Ying
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Peng He
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Rodman T Girsang
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Hugo Vergara
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Javed Akram
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Hindra I Satari
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Tanwir Khaliq
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ume Sughra
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ana P Celi
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Fangjun Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Yan Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhiwei Jiang
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Dilbar Dalimova
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Jaloliddin Tuychiev
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Shahlo Turdikulova
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Aamer Ikram
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Nancy Flores Lastra
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Fan Ding
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Mahendra Suhardono
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Eddy Fadlyana
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Jinghua Yan
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Zhongyu Hu
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Changgui Li
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - Ibrokhim Y Abdurakhmonov
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
| | - George F Gao
- From the CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (L.D., Y.L., J.Y., G.F.G.), the National Institute for Food and Drug Control (Z.Y., P.H., Z.H., C.L.), and Beijing Keytech Statistical Technology (Z.J.), Beijing, the Hunan Provincial Center for Disease Control and Prevention, Changsha (L.G., F.L.), and Anhui Zhifei Longcom Biopharmaceutical, Hefei (L.T., F.D.) - all in China; the Child Health Department, Faculty of Medicine, University of Indonesia, and Cipto Mangunkusumo Hospital (S.R.H., H.I.S.), and PT Jakarta Biopharmaceutical Industry (M.S.), Jakarta, and the Child Health Department, Faculty of Medicine, Padjadjaran University, and Hasan Sadikin General Hospital, Bandung (R.T.G., E.F.) - all in Indonesia; the Research Institute of Virology (M.E., J.T.), the Center for Advanced Technologies (D.D., S.T.), and the Center of Genomics and Bioinformatics (I.Y.A.) - all in Tashkent, Uzbekistan; Biodimed Unidad Alemania (H.V.), the Department of Infectiology, Novaclínica Santa Cecilia (A.P.C.), and Biodimed Unidad Eloy Alfaro (N.F.L.) - all in Quito, Ecuador; and University of Health Sciences Lahore, Lahore (J.A.), Shaheed Zulfiqar Ali Bhutto Medical University (T.K.) and the National Institute of Health (A.I.), Islamabad, and Al-Shifa Trust Eye Hospital, Rawalpindi (U.S.) - all in Pakistan
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Higdon MM, Wahl B, Jones CB, Rosen JG, Truelove SA, Baidya A, Nande AA, ShamaeiZadeh PA, Walter KK, Feikin DR, Patel MK, Deloria Knoll M, Hill AL. A Systematic Review of Coronavirus Disease 2019 Vaccine Efficacy and Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Disease. Open Forum Infect Dis 2022; 9:ofac138. [PMID: 35611346 PMCID: PMC9047227 DOI: 10.1093/ofid/ofac138] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 01/13/2023] Open
Abstract
Billions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered globally, dramatically reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence and severity in some settings. Many studies suggest vaccines provide a high degree of protection against infection and disease, but precise estimates vary and studies differ in design, outcomes measured, dosing regime, location, and circulating virus strains. In this study, we conduct a systematic review of COVID-19 vaccines through February 2022. We included efficacy data from Phase 3 clinical trials for 15 vaccines undergoing World Health Organization Emergency Use Listing evaluation and real-world effectiveness for 8 vaccines with observational studies meeting inclusion criteria. Vaccine metrics collected include protection against asymptomatic infection, any infection, symptomatic COVID-19, and severe outcomes including hospitalization and death, for partial or complete vaccination, and against variants of concern Alpha, Beta, Gamma, Delta, and Omicron. We additionally review the epidemiological principles behind the design and interpretation of vaccine efficacy and effectiveness studies, including important sources of heterogeneity.
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Affiliation(s)
- Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carli B Jones
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shaun A Truelove
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anurima Baidya
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anjalika A Nande
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Parisa A ShamaeiZadeh
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karoline K Walter
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel R Feikin
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Minal K Patel
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison L Hill
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Zeng B, Gao L, Zhou Q, Yu K, Sun F. Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: a systematic review and meta-analysis. BMC Med 2022; 20:200. [PMID: 35606843 PMCID: PMC9126103 DOI: 10.1186/s12916-022-02397-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It was urgent and necessary to synthesize the evidence for vaccine effectiveness (VE) against SARS-CoV-2 variants of concern (VOC). We conducted a systematic review and meta-analysis to provide a comprehensive overview of the effectiveness profile of COVID-19 vaccines against VOC. METHODS Published randomized controlled trials (RCTs), cohort studies, and case-control studies that evaluated the VE against VOC (Alpha, Beta, Gamma, Delta, or Omicron) were searched until 4 March 2022. Pooled estimates and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. VE was defined as (1-estimate). RESULTS Eleven RCTs (161,388 participants), 20 cohort studies (52,782,321 participants), and 26 case-control studies (2,584,732 cases) were included. Eleven COVID-19 vaccines (mRNA-1273, BNT162b2, ChAdOx1, Ad26.COV2.S, NVX-CoV2373, BBV152, CoronaVac, BBIBP-CorV, SCB-2019, CVnCoV, and HB02) were included in this analysis. Full vaccination was effective against Alpha, Beta, Gamma, Delta, and Omicron variants, with VE of 88.0% (95% CI, 83.0-91.5), 73.0% (95% CI, 64.3-79.5), 63.0% (95% CI, 47.9-73.7), 77.8% (95% CI, 72.7-82.0), and 55.9% (95% CI, 40.9-67.0), respectively. Booster vaccination was more effective against Delta and Omicron variants, with VE of 95.5% (95% CI, 94.2-96.5) and 80.8% (95% CI, 58.6-91.1), respectively. mRNA vaccines (mRNA-1273/BNT162b2) seemed to have higher VE against VOC over others; significant interactions (pinteraction < 0.10) were observed between VE and vaccine type (mRNA vaccines vs. not mRNA vaccines). CONCLUSIONS Full vaccination of COVID-19 vaccines is highly effective against Alpha variant, and moderate effective against Beta, Gamma, and Delta variants. Booster vaccination is more effective against Delta and Omicron variants. mRNA vaccines seem to have higher VE against Alpha, Beta, Gamma, and Delta variants over others.
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Affiliation(s)
- Baoqi Zeng
- Department of Science and Education, Peking University Binhai Hospital, Tianjin, China
| | - Le Gao
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Qingxin Zhou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Kai Yu
- Department of Science and Education, Peking University Binhai Hospital, Tianjin, China.
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China.
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Deviatkin AA, Simonov RA, Trutneva KA, Maznina AA, Khavina EM, Volchkov PY. Universal Flu mRNA Vaccine: Promises, Prospects, and Problems. Vaccines (Basel) 2022; 10:vaccines10050709. [PMID: 35632465 PMCID: PMC9145388 DOI: 10.3390/vaccines10050709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
The seasonal flu vaccine is, essentially, the only known way to prevent influenza epidemics. However, this approach has limited efficacy due to the high diversity of influenza viruses. Several techniques could potentially overcome this obstacle. A recent first-in-human study of a chimeric hemagglutinin-based universal influenza virus vaccine demonstrated promising results. The coronavirus pandemic triggered the development of fundamentally new vaccine platforms that have demonstrated their effectiveness in humans. Currently, there are around a dozen messenger RNA and self-amplifying RNA flu vaccines in clinical or preclinical trials. However, the applicability of novel approaches for a universal influenza vaccine creation remains unclear. The current review aims to cover the current state of this problem and to suggest future directions for RNA-based flu vaccine development.
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Affiliation(s)
- Andrei A. Deviatkin
- The National Medical Research Center for Endocrinology, 117036 Moscow, Russia; (A.A.D.); (K.A.T.)
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
| | - Ruslan A. Simonov
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
| | - Kseniya A. Trutneva
- The National Medical Research Center for Endocrinology, 117036 Moscow, Russia; (A.A.D.); (K.A.T.)
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
| | - Anna A. Maznina
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
| | - Elena M. Khavina
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
| | - Pavel Y. Volchkov
- The National Medical Research Center for Endocrinology, 117036 Moscow, Russia; (A.A.D.); (K.A.T.)
- Genome Engineering Lab, Life Sciences Research Center, Moscow Institute of Physics and Technology (National Research University), 141700 Dolgoprudniy, Russia; (R.A.S.); (A.A.M.); (E.M.K.)
- Correspondence:
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Izadpanah A, Rappaport J, Datta PK. Epitranscriptomics of SARS-CoV-2 Infection. Front Cell Dev Biol 2022; 10:849298. [PMID: 35465335 PMCID: PMC9032796 DOI: 10.3389/fcell.2022.849298] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Recent studies on the epitranscriptomic code of SARS-CoV-2 infection have discovered various RNA modifications, such as N6-methyladenosine (m6A), pseudouridine (Ψ), and 2′-O-methylation (Nm). The effects of RNA methylation on SARS-CoV-2 replication and the enzymes involved in this mechanism are emerging. In this review, we summarize the advances in this emerging field and discuss the role of various players such as readers, writers, and erasers in m6A RNA methylation, the role of pseudouridine synthase one and seven in epitranscriptomic modification Ψ, an isomer of uridine, and role of nsp16/nsp10 heterodimer in 2′-O-methylation of the ribose sugar of the first nucleotide of SARS-CoV-2 mRNA. We also discuss RNA expression levels of various enzymes involved in RNA modifications in blood cells of SARS-CoV-2 infected individuals and their impact on host mRNA modification. In conclusion, these observations will facilitate the development of novel strategies and therapeutics for targeting RNA modification of SARS-CoV-2 RNA to control SARS-CoV-2 infection.
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Affiliation(s)
- Amin Izadpanah
- Division of Comparative Pathology, Tulane National Primate Center, Covington, LA, United States
| | - Jay Rappaport
- Division of Comparative Pathology, Tulane National Primate Center, Covington, LA, United States
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Prasun K. Datta
- Division of Comparative Pathology, Tulane National Primate Center, Covington, LA, United States
- Department of Microbiology and Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
- *Correspondence: Prasun K. Datta,
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77
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Wambani J, Okoth P. Scope of SARS-CoV-2 variants, mutations, and vaccine technologies. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:34. [PMID: 35368846 PMCID: PMC8962228 DOI: 10.1186/s43162-022-00121-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is disseminated by respiratory aerosols. The virus uses the spike protein to target epithelial cells by binding to the ACE2 receptor on the host cells. As a result, effective vaccines must target the viral spike glycoprotein. However, the appearance of an Omicron variant with 32 mutations in its spike protein raises questions about the vaccine's efficacy. Vaccines are critical in boosting immunity, lowering COVID-19-related illnesses, reducing the infectious burden on the healthcare system, and reducing economic loss, according to current data. An efficient vaccination campaign is projected to increase innate and adaptive immune responses, offering better protection against SARS-CoV-2 variants. Main body The presence of altered SARS-CoV-2 variants circulating around the world puts the effectiveness of vaccines already on the market at risk. The problem is made even worse by the Omicron variant, which has 32 mutations in its spike protein. Experts are currently examining the potential consequences of commercial vaccines on variants. However, there are worries about the vaccines' safety, the protection they provide, and whether future structural changes are required for these vaccines to be more effective. As a result of these concerns, new vaccines based on modern technology should be developed to guard against the growing SARS-CoV-2 variations. Conclusion The choice of a particular vaccine is influenced by several factors including mode of action, storage conditions, group of the vaccinee, immune response mounted, cost, dosage protocol, age, and side effects. Currently, seven SARS-CoV-2 vaccine platforms have been developed. This comprises of inactivated viruses, messenger RNA (mRNA), DNA vaccines, protein subunits, nonreplicating and replicating vector viral-like particles (VLP), and live attenuated vaccines. This review focuses on the SARS-CoV-2 mutations, variants of concern (VOCs), and advances in vaccine technologies.
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Affiliation(s)
- Josephine Wambani
- Kenya Medical Research Institute (KEMRI) HIV Laboratory-Alupe, P.O Box 3-50400, Busia, Kenya
- Department of Medical Laboratory Sciences, School of Public Health, Biomedical Sciences and Technology, Masinde Muliro University of Science and Technology, P.O Box 190, Kakamega, 50100 Kenya
| | - Patrick Okoth
- Department of Biological Sciences, School of Natural Sciences, Masinde Muliro University of Science and Technology, P. O Box 190, Kakamega, 50100 Kenya
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Fang E, Liu X, Li M, Zhang Z, Song L, Zhu B, Wu X, Liu J, Zhao D, Li Y. Advances in COVID-19 mRNA vaccine development. Signal Transduct Target Ther 2022; 7:94. [PMID: 35322018 PMCID: PMC8940982 DOI: 10.1038/s41392-022-00950-y] [Citation(s) in RCA: 180] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
To date, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has determined 399,600,607 cases and 5,757,562 deaths worldwide. COVID-19 is a serious threat to human health globally. The World Health Organization (WHO) has declared COVID-19 pandemic a major public health emergency. Vaccination is the most effective and economical intervention for controlling the spread of epidemics, and consequently saving lives and protecting the health of the population. Various techniques have been employed in the development of COVID-19 vaccines. Among these, the COVID-19 messenger RNA (mRNA) vaccine has been drawing increasing attention owing to its great application prospects and advantages, which include short development cycle, easy industrialization, simple production process, flexibility to respond to new variants, and the capacity to induce better immune response. This review summarizes current knowledge on the structural characteristics, antigen design strategies, delivery systems, industrialization potential, quality control, latest clinical trials and real-world data of COVID-19 mRNA vaccines as well as mRNA technology. Current challenges and future directions in the development of preventive mRNA vaccines for major infectious diseases are also discussed.
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Affiliation(s)
- Enyue Fang
- National Institute for Food and Drug Control, Beijing, 102629, China
- Wuhan Institute of Biological Products, Co., Ltd., Wuhan, 430207, China
| | - Xiaohui Liu
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Miao Li
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Zelun Zhang
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Lifang Song
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Baiyu Zhu
- Texas A&M University, College Station, TX, 77843, USA
| | - Xiaohong Wu
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Jingjing Liu
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Danhua Zhao
- National Institute for Food and Drug Control, Beijing, 102629, China
| | - Yuhua Li
- National Institute for Food and Drug Control, Beijing, 102629, China.
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Günther M, Mörl F, Rockenfeller R. Where Have the Dead Gone? Front Med (Lausanne) 2022; 9:837287. [PMID: 35372379 PMCID: PMC8967171 DOI: 10.3389/fmed.2022.837287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Günther
- Computational Biophysics and Biorobotics, Institute for Modelling and Simulation of Biomechanical Systems, Universität Stuttgart, Stuttgart, Germany
- Friedrich–Schiller–Universität, Jena, Germany
| | - Falk Mörl
- Forschungsgesellschaft für Angewandte Systemsicherheit und Arbeitsmedizin mbH, AG Biomechanik & Ergonomie, Erfurt, Germany
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Mabrouk MT, Huang W, Martinez‐Sobrido L, Lovell JF. Advanced Materials for SARS-CoV-2 Vaccines. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2107781. [PMID: 34894000 PMCID: PMC8957524 DOI: 10.1002/adma.202107781] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/28/2021] [Indexed: 05/09/2023]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has killed untold millions worldwide and has hurtled vaccines into the spotlight as a go-to approach to mitigate it. Advances in virology, genomics, structural biology, and vaccine technologies have enabled a rapid and unprecedented rollout of COVID-19 vaccines, although much of the developing world remains unvaccinated. Several new vaccine platforms have been developed or deployed against SARS-CoV-2, with most targeting the large viral Spike immunogen. Those that safely induce strong and durable antibody responses at low dosages are advantageous, as well are those that can be rapidly produced at a large scale. Virtually all COVID-19 vaccines and adjuvants possess nanoscale or microscale dimensions and represent diverse and unique biomaterials. Viral vector vaccine platforms, lipid nanoparticle mRNA vaccines and multimeric display technologies for subunit vaccines have received much attention. Nanoscale vaccine adjuvants have also been used in combination with other vaccines. To deal with the ongoing pandemic, and to be ready for potential future ones, advanced vaccine technologies will continue to be developed in the near future. Herein, the recent use of advanced materials used for developing COVID-19 vaccines is summarized.
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Affiliation(s)
- Moustafa T. Mabrouk
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260USA
| | - Wei‐Chiao Huang
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260USA
| | - Luis Martinez‐Sobrido
- Division of Disease Intervention and PreventionTexas Biomedical Research InstituteSan AntonioTX78227USA
| | - Jonathan F. Lovell
- Department of Biomedical EngineeringUniversity at BuffaloState University of New YorkBuffaloNY14260USA
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81
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Zogg H, Singh R, Ro S. Current Advances in RNA Therapeutics for Human Diseases. Int J Mol Sci 2022; 23:ijms23052736. [PMID: 35269876 PMCID: PMC8911101 DOI: 10.3390/ijms23052736] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022] Open
Abstract
Following the discovery of nucleic acids by Friedrich Miescher in 1868, DNA and RNA were recognized as the genetic code containing the necessary information for proper cell functioning. In the years following these discoveries, vast knowledge of the seemingly endless roles of RNA have become better understood. Additionally, many new types of RNAs were discovered that seemed to have no coding properties (non-coding RNAs), such as microRNAs (miRNAs). The discovery of these new RNAs created a new avenue for treating various human diseases. However, RNA is relatively unstable and is degraded fairly rapidly once administered; this has led to the development of novel delivery mechanisms, such as nanoparticles to increase stability as well as to prevent off-target effects of these molecules. Current advances in RNA-based therapies have substantial promise in treating and preventing many human diseases and disorders through fixing the pathology instead of merely treating the symptomology similarly to traditional therapeutics. Although many RNA therapeutics have made it to clinical trials, only a few have been FDA approved thus far. Additionally, the results of clinical trials for RNA therapeutics have been ambivalent to date, with some studies demonstrating potent efficacy, whereas others have limited effectiveness and/or toxicity. Momentum is building in the clinic for RNA therapeutics; future clinical care of human diseases will likely comprise promising RNA therapeutics. This review focuses on the current advances of RNA therapeutics and addresses current challenges with their development.
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The Potential of Nanomedicine to Unlock the Limitless Applications of mRNA. Pharmaceutics 2022; 14:pharmaceutics14020460. [PMID: 35214191 PMCID: PMC8879057 DOI: 10.3390/pharmaceutics14020460] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 01/27/2023] Open
Abstract
The year 2020 was a turning point in the way society perceives science. Messenger RNA (mRNA) technology finally showed and shared its potential, starting a new era in medicine. However, there is no doubt that commercialization of these vaccines would not have been possible without nanotechnology, which has finally answered the long-term question of how to deliver mRNA in vivo. The aim of this review is to showcase the importance of this scientific milestone for the development of additional mRNA therapeutics. Firstly, we provide a full description of the marketed vaccine formulations and disclose LNPs’ pharmaceutical properties, including composition, structure, and manufacturing considerations Additionally, we review different types of lipid-based delivery technologies currently in preclinical and clinical development, namely lipoplexes and cationic nanoemulsions. Finally, we highlight the most promising clinical applications of mRNA in different fields such as vaccinology, immuno-oncology, gene therapy for rare genetic diseases and gene editing using CRISPR Cas9.
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Yuniar CT, Pratiwi B, Ihsan AF, Laksono BT, Risfayanti I, Fathadina A, Jeong Y, Kim E. Adverse Events Reporting Quality of Randomized Controlled Trials of COVID-19 Vaccine Using the CONSORT Criteria for Reporting Harms: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10020313. [PMID: 35214773 PMCID: PMC8875800 DOI: 10.3390/vaccines10020313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Assessing the quality of evidence from vaccine clinical trials is essential to ensure the safety and efficacy of the vaccine and further enhance public acceptance. This study aims to summarize and critically evaluate the quality of harm reporting on randomized controlled trials for the COVID-19 vaccine and determine the factors associated with reporting quality. Methods: We systematically searched the literature using PRISMA guidelines for randomized controlled trials (RCT) on COVID-19 Vaccine until 30 December 2021. Published articles were searched from electronic databases such as PubMed, Science Direct, Google Scholar, and Bibliovid. Bias analysis was performed using RoB-2 tools. The quality of reporting was assessed by the Consolidated Standards of Reporting Trials (CONSORT) harm extension modified into 21 items. Results: A total of 61 RCT studies (402,014 patients) were analyzed. Over half the studies demonstrated adequate reporting (59.02%), and 21 studies (34.4%) reported a low risk of bias. All studies reported death and serious adverse events (AEs), but only six studies mentioned how to handle the recurrent AEs. Reporting of AEs in subgroup analysis was also poor (25%). Conclusion: The RCTs on the COVID-19 vaccine were less biased with good quality on reporting harm based on the modified CONSORT harm extension. However, study quality must be considered, especially for a balance of information between effectivity and safety.
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Affiliation(s)
- Cindra Tri Yuniar
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Bhekti Pratiwi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Ardika Fajrul Ihsan
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Bambang Tri Laksono
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Iffa Risfayanti
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Annisa Fathadina
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Institut Teknologi Bandung, Bandung 40132, Indonesia; (C.T.Y.); (B.P.); (A.F.I.); (B.T.L.); (I.R.); (A.F.)
| | - Yeonseon Jeong
- Clinical Data Analysis, Evidence-Based Clinical Research Laboratory, Department of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea;
| | - Eunyoung Kim
- Clinical Data Analysis, Evidence-Based Clinical Research Laboratory, Department of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul 06974, Korea;
- Correspondence: ; Tel.: +82-2-820-5791
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Lipid Nanoparticle Delivery Systems to Enable mRNA-Based Therapeutics. Pharmaceutics 2022; 14:pharmaceutics14020398. [PMID: 35214130 PMCID: PMC8876479 DOI: 10.3390/pharmaceutics14020398] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 12/13/2022] Open
Abstract
The world raced to develop vaccines to protect against the rapid spread of SARS-CoV-2 infection upon the recognition of COVID-19 as a global pandemic. A broad spectrum of candidates was evaluated, with mRNA-based vaccines emerging as leaders due to how quickly they were available for emergency use while providing a high level of efficacy. As a modular technology, the mRNA-based vaccines benefitted from decades of advancements in both mRNA and delivery technology prior to the current global pandemic. The fundamental lessons of the utility of mRNA as a therapeutic were pioneered by Dr. Katalin Kariko and her colleagues, perhaps most notably in collaboration with Drew Weissman at University of Pennsylvania, and this foundational work paved the way for the development of the first ever mRNA-based therapeutic authorized for human use, COMIRNATY®. In this Special Issue of Pharmaceutics, we will be honoring Dr. Kariko for her great contributions to the mRNA technology to treat diseases with unmet needs. In this review article, we will focus on the delivery platform, the lipid nanoparticle (LNP) carrier, which allowed the potential of mRNA therapeutics to be realized. Similar to the mRNA technology, the development of LNP systems has been ongoing for decades before culminating in the success of the first clinically approved siRNA-LNP product, ONPATTRO®, a treatment for an otherwise fatal genetic disease called transthyretin amyloidosis. Lessons learned from the siRNA-LNP experience enabled the translation into the mRNA platform with the eventual authorization and approval of the mRNA-LNP vaccines against COVID-19. This marks the beginning of mRNA-LNP as a pharmaceutical option to treat genetic diseases.
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), emerged in China in December 2019 and quickly spread around the globe, killing more than 4 million people and causing a severe economic crisis. This extraordinary situation prompted entities in government, industry, and academia to work together at unprecedented speed to develop safe and effective vaccines. Indeed, vaccines of multiple types have been generated in record time, and many have been evaluated in clinical trials. Of these, messenger RNA (mRNA) vaccines have emerged as lead candidates due to their speed of development and high degree of safety and efficacy. To date, two mRNA vaccines have received approval for human use, providing proof of the feasibility of this next-generation vaccine modality. This review gives a detailed overview about the types of mRNA vaccines developed for SARS-CoV-2, discusses and compares preclinical and clinical data, gives a mechanistic overview about immune responses generated by mRNA vaccination, and speculates on the challenges and promising future of this emergent vaccine platform.
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Affiliation(s)
- Michael J Hogan
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA;
| | - Norbert Pardi
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA;
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Kumar S, Saikia D, Bankar M, Saurabh MK, Singh H, Varikasuvu SR, Maharshi V. Efficacy of COVID-19 vaccines: a systematic review and network meta-analysis of phase 3 randomized controlled trials. Pharmacol Rep 2022; 74:1228-1237. [PMID: 36342658 PMCID: PMC9640819 DOI: 10.1007/s43440-022-00429-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Several vaccines have been approved for the prevention of COVID-19. However, no head-to-head trials comparing their clinical efficacy have been performed. This network meta-analysis aims to identify those, among the competing existing vaccines, conferring the maximum protection against COVID-19. A literature search was done in Medline (via PubMed), Embase and Cochrane Library databases for phase 3 randomized controlled trials evaluating the efficacy of different COVID-19 vaccines. Search results were screened and eligible studies were included to perform a network meta-analysis in software 'R' version 4.1.2 using a random effect model. Cochrane's 'Risk of Bias tool (RoB2)' was used for quality assessment. Raw data from the included studies was used for network meta-analysis. Assessment of inconsistency was not possible as no study compared two or more vaccines directly. A forest plot for indirect comparison of various COVID-19 vaccines was obtained. Rankogram and 'P' scores were obtained to rank the vaccines based on the indirect evidence of their comparative efficacy. A total of 17 randomized controlled trials evaluating the efficacy of 16 COVID-19 vaccines, were included in the network meta-analysis. A total of 361,386 participants was included in this network meta-analysis. Overall risk of bias among included studies was of 'some concern'. All the COVID-19 vaccines had a statistically significant reduction of risk for contracting symptomatic SARS-CoV-2 in comparison to the placebo, however, the maximum protection (RR 0.05) was with BNT126b2. The indirect comparison also revealed BNT126b2 vaccine confers the highest protection against symptomatic SARS-CoV-2 infection in comparison to all others included, with a 'P' score of 0.9771 followed by mRNA-1273, rAD26 & rAD5 and NVX-CoV2373. The evidence generated from this network meta-analysis indicates the good efficacy of all the included vaccines in preventing symptomatic COVID-19 as compared to placebo. The BNT126b2 vaccine was found to provide the highest protection against symptomatic SARS-CoV-2 among all included followed by mRNA-1273, rAD26 & rAD5, NVX-CoV2373 and others.
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Affiliation(s)
- Subodh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
| | | | - Mangesh Bankar
- Department of Pharmacology, All India Institute of Medical Sciences, Raebareli, India
| | - Manoj Kumar Saurabh
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
| | - Harminder Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
| | | | - Vikas Maharshi
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
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Shoar S, Prada-Ruiz ACC, Patarroyo-Aponte G, Chaudhary A, Sadegh Asadi M. Immune Response to SARS-CoV-2 Vaccine among Heart Transplant Recipients: A Systematic Review. CLINICAL MEDICINE INSIGHTS: CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2022; 16:11795484221105327. [PMID: 35693423 PMCID: PMC9174554 DOI: 10.1177/11795484221105327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background Heart transplant (HTX) recipients are at a significantly higher risk of adverse clinical outcomes, due to chronic immunosuppression and co-existence of other chronic conditions, when contracting the SARS-CoV-2 infection. Although vaccination against SARS-CoV-2 is currently the most promising measure for the prevention of severe Coronavirus Disease 2019 (COVID-19) among solid organ transplant recipients, the extent of immune response and its protective efficacy among patients receiving HTX has not been sufficiently studied. Methods We performed a systematic review of the literature by inquiring PubMed/Medline to identify original studies among HTX recipients, who had received at least one dose of the SARS-CoV-2 vaccine. Data on the measured humoral or cellular immune response was collected from all the eligible studies. Factors associated with a poor immune response were further investigated within these studies. Results A total of 12 studies comprising 563 HTX recipients were included. The average age of the study participants was 60.8 years. Sixty four percent of the study population were male. Ninety percent of the patients had received an mRNA vaccine (Pfizer/ BNT162b2 or Moderna/mRNA-1273). A positive immune response to SARS-CoV-2 vaccine was variably reported in 0% to 100% of the patients. Older age (> 65 years), vaccine dose (first, second, or third), time since HTX to the first dose of the vaccine, the time interval between the latest dose of the vaccine and measurement of the immune response, and the type of immunosuppressive regimen were all indicated as potential determinants of a robust immune response to the SARS-CoV-2 vaccination. Conclusion HTX recipients demonstrate a weaker immune response to the vaccination against SARS-CoV-2 compared to the general population. Older age, anti-metabolite agents such as mycophenolate mofetil, and vaccination during the first year following the HTX have been indicated as potential determinants of a poor immune response.
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Affiliation(s)
- Saeed Shoar
- Department of Clinical Research, Scientific Collaborative Initiative, Houston, TX, USA
| | - Adriana C. Carolina Prada-Ruiz
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gabriel Patarroyo-Aponte
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ashok Chaudhary
- Department of Internal Medicine, Griffin Hospital, Derby, CT, USA
| | - Mohammad Sadegh Asadi
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Nitika, Wei J, Hui AM. The Development of mRNA Vaccines for Infectious Diseases: Recent Updates. Infect Drug Resist 2021; 14:5271-5285. [PMID: 34916811 PMCID: PMC8668227 DOI: 10.2147/idr.s341694] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
mRNA-based technologies have been of interest for the past few years to be used for therapeutics. Several mRNA vaccines for various diseases have been in preclinical and clinical stages. With the outbreak of the COVID-19 pandemic, the emergence of mRNA vaccines has transformed modern science. Recently, two major mRNA vaccines have been developed and approved by global health authorities for administration on the general population for protection against SARS-CoV-2. They have been proven to be successful in conferring protection against the ongoing SARS-CoV-2 and its emerging variants. This will draw attention to various mRNA vaccines against infectious diseases that are in the early stages of clinical trials. mRNA vaccines offer several advantages ranging from rapid design, generation, manufacturing, and administration and have strong potential to be used against various diseases in the future. Here, we summarize the mRNA-based vaccines in development against various infectious diseases.
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Affiliation(s)
- Nitika
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
| | - Jiao Wei
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
| | - Ai-Min Hui
- Fosun Pharma USA Inc., Boston, MA, USA.,Shanghai Fosun Pharmaceutical Industrial Development, Co., Ltd., Shanghai, People's Republic of China
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Kon E, Elia U, Peer D. Principles for designing an optimal mRNA lipid nanoparticle vaccine. Curr Opin Biotechnol 2021; 73:329-336. [PMID: 34715546 PMCID: PMC8547895 DOI: 10.1016/j.copbio.2021.09.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Abstract
mRNA Lipid nanoparticles (LNPs) have recently been propelled onto the center stage of therapeutic platforms due to the success of the SARS-CoV-2 mRNA LNP vaccines (mRNA-1273 and BNT162b2), with billions of mRNA vaccine doses already shipped worldwide. While mRNA vaccines seem like an overnight success to some, they are in fact a result of decades of scientific research. The advantage of mRNA-LNP vaccines lies in the modularity of the platform and the rapid manufacturing capabilities. However, there is a multitude of choices to be made when designing an optimal mRNA-LNP vaccine regarding efficacy, stability and toxicity. Herein, we provide a brief on what we consider to be the most important aspects to cover when designing mRNA-LNPs from what is currently known and how to optimize them. Lastly, we give our perspective on which of these aspects is most crucial and what we believe are the next steps required to advance the field.
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Affiliation(s)
- Edo Kon
- Laboratory of Precision NanoMedicine, Tel Aviv University, Tel Aviv 69978, Israel; The Shmunis School of Biomedicine and Cancer Research, George S Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; Department of Materials Sciences and Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel; Cancer Biology Research Center, Tel Aviv University, Tel Aviv 69978, Israel
| | - Uri Elia
- Laboratory of Precision NanoMedicine, Tel Aviv University, Tel Aviv 69978, Israel; The Shmunis School of Biomedicine and Cancer Research, George S Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; Department of Materials Sciences and Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel; Cancer Biology Research Center, Tel Aviv University, Tel Aviv 69978, Israel; Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona 76100, Israel
| | - Dan Peer
- Laboratory of Precision NanoMedicine, Tel Aviv University, Tel Aviv 69978, Israel; The Shmunis School of Biomedicine and Cancer Research, George S Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel; Department of Materials Sciences and Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel; Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv 69978, Israel; Cancer Biology Research Center, Tel Aviv University, Tel Aviv 69978, Israel.
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