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Song KR, Chapagain RH, Tamrakar D, Shrestha R, Kanodia P, Chaudhary S, Wartel TA, Yang JS, Kim DR, Lee J, Park EL, Cho H, Lee J, Thaisrivichai P, Vemula S, Kim BM, Gupta B, Saluja T, Pansuriya RK, Ganapathy R, Baik YO, Lee YJ, Jeon S, Park Y, Her HL, Park Y, Lynch JA. Safety and immunogenicity of the Euvichol-S oral cholera vaccine for prevention of Vibrio cholerae O1 infection in Nepal: an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial. Lancet Glob Health 2024; 12:e826-e837. [PMID: 38614631 PMCID: PMC11027156 DOI: 10.1016/s2214-109x(24)00059-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND In October, 2017, WHO launched a strategy to eliminate cholera by 2030. A primary challenge in meeting this goal is the limited global supply capacity of oral cholera vaccine and the worsening of cholera outbreaks since 2021. To help address the current shortage of oral cholera vaccine, a WHO prequalified oral cholera vaccine, Euvichol-Plus was reformulated by reducing the number of components and inactivation methods. We aimed to evaluate the immunogenicity and safety of Euvichol-S (EuBiologics, Seoul, South Korea) compared with an active control vaccine, Shanchol (Sanofi Healthcare India, Telangana, India) in participants of various ages in Nepal. METHODS We did an observer-blind, active-controlled, randomised, non-inferiority, phase 3 trial at four hospitals in Nepal. Eligible participants were healthy individuals aged 1-40 years without a history of cholera vaccination. Individuals with a history of hypersensitivity reactions to other preventive vaccines, severe chronic disease, previous cholera vaccination, receipt of blood or blood-derived products in the past 3 months or other vaccine within 4 weeks before enrolment, and pregnant or lactating women were excluded. Participants were randomly assigned (1:1:1:1) by block randomisation (block sizes of two, four, six, or eight) to one of four groups (groups A-D); groups C and D were stratified by age (1-5, 6-17, and 18-40 years). Participants in groups A-C were assigned to receive two 1·5 mL doses of Euvichol-S (three different lots) and participants in group D were assigned to receive the active control vaccine, Shanchol. All participants and site staff (with the exception of those who prepared and administered the study vaccines) were masked to group assignment. The primary immunogenicity endpoint was non-inferiority of immunogenicity of Euvichol-S (group C) versus Shanchol (group D) at 2 weeks after the second vaccine dose, measured by the seroconversion rate, defined as the proportion of participants who had achieved seroconversion (defined as ≥four-fold increase in V cholerae O1 Inaba and Ogawa titres compared with baseline). The primary immunogenicity endpoint was assessed in the per-protocol analysis set, which included all participants who received all their planned vaccine administrations, had no important protocol deviations, and who provided blood samples for all immunogenicity assessments. The primary safety endpoint was the number of solicited adverse events, unsolicited adverse events, and serious adverse events after each vaccine dose in all ages and each age stratum, assessed in all participants who received at least one dose of the Euvichol-S or Shanchol. Non-inferiority of Euvichol-S compared with Shanchol was shown if the lower limit of the 95% CI for the difference between the seroconversion rates in Euvichol-S group C versus Shanchol group D was above the predefined non-inferiority margin of -10%. The trial was registered at ClinicalTrials.gov, NCT04760236. FINDINGS Between Oct 6, 2021, and Jan 19, 2022, 2529 healthy participants (1261 [49·9%] males; 1268 [50·1%] females), were randomly assigned to group A (n=330; Euvichol-S lot number ES-2002), group B (n=331; Euvichol-S ES-2003), group C (n=934; Euvichol-S ES-2004]), or group D (n=934; Shanchol). Non-inferiority of Euvichol-S versus Shanchol in seroconversion rate for both serotypes at 2 weeks after the second dose was confirmed in all ages (difference in seroconversion rate for V cholerae O1 Inaba -0·00 [95% CI -1·86 to 1·86]; for V cholerae O1 Ogawa -1·62 [-4·80 to 1·56]). Treatment-emergent adverse events were reported in 244 (9·7%) of 2529 participants in the safety analysis set, with a total of 403 events; 247 events were reported among 151 (9·5%) of 1595 Euvichol-S recipients and 156 events among 93 (10·0%) of 934 Shanchol recipients. Pyrexia was the most common adverse event in both groups (57 events among 56 [3·5%] of 1595 Euvichol-S recipients and 37 events among 35 [3·7%] of 934 Shanchol recipients). No serious adverse events were deemed to be vaccine-related. INTERPRETATION A two-dose regimen of Euvichol-S vaccine was non-inferior to the active control vaccine, Shanchol, in terms of seroconversion rates 2 weeks after the second dose. The simplified formulation and production requirements of the Euvichol-S vaccine have the potential to increase the supply of oral cholera vaccine and reduce the gap between the current oral cholera vaccine supply and demand. FUNDING The Bill & Melinda Gates Foundation. TRANSLATION For the Nepali translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Katerina Rok Song
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea.
| | - Ram Hari Chapagain
- Department of Pediatric Medicine, Kanti Children's Hospital, Kathmandu, Nepal
| | - Dipesh Tamrakar
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Center for Clinical Trial Studies, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Piush Kanodia
- Department of Pediatrics and Neonatology, Nepalgunj Medical College, Nepalgunj, Nepal
| | - Shipra Chaudhary
- Department of Pediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - T Anh Wartel
- International Vaccine Institute, Stockholm, Sweden
| | - Jae Seung Yang
- Science Unit, International Vaccine Institute, Seoul, South Korea
| | - Deok Ryun Kim
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jinae Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Eun Lyeong Park
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Haeun Cho
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | - Jiyoung Lee
- Department of Biostatistics and Data Management, International Vaccine Institute, Seoul, South Korea
| | | | - Sridhar Vemula
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Bo Mi Kim
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Birendra Gupta
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Tarun Saluja
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
| | - Ruchir Kumar Pansuriya
- Vaccine Process Development Unit, International Vaccine Institute, Seoul, South Korea; Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Ravi Ganapathy
- Research and Development, Hilleman Laboratories, Singapore
| | - Yeong Ok Baik
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Young Jin Lee
- Research and Development Division, EuBiologics, Seoul, South Korea
| | - Suhi Jeon
- Production Division, EuBiologics, Seoul, South Korea
| | | | - Howard L Her
- Research and Development Division, EuBiologics, Seoul, South Korea
| | | | - Julia A Lynch
- Clinical, Assessment, Regulatory, Evaluation Unit, International Vaccine Institute, Seoul, South Korea
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Barai L, Hasan MR, Haq JA, Ahsan CR. Salmonellacidal antibody response to Salmonella enterica serovar Typhi in enteric fever and after vaccination with Vi capsular polysaccharide. Int J Infect Dis 2022; 121:120-125. [PMID: 35568365 DOI: 10.1016/j.ijid.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/08/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Serum salmonellacidal (bactericidal) antibody could be used to detect functional capacity of antibody in patients with enteric fever and after typhoid vaccination. METHODS Salmonellacidal antibody response was measured by colorimetric serum salmonellacidal assay from 70 acute and 11 convalescence sera of patients infected with Salmonella Typhi and Paratyphi A and also from 15 control and 6 Vi capsular polysaccharide vaccinated volunteer's sera. RESULTS Sera from patients with typhoid and paratyphoid A showed significant (p < 0.05) levels of salmonellacidal antibody titer (549.9 ± 108.5 and 528.7 ± 187.3) compared with control (0.133 ± 0.1). Moreover, this titer increased significantly (p <0.05) in sera collected between 7 and 10 days and between 11 and 25 days of fever (titer 535.7 ± 119.2 and 794.6 ± 235.6) compared with sera collected from patients with fever for less than 7 days (136.4 ± 52.7). The mean titer significantly (p < 0.05) decreased to 5.5 ± 2.1 after 6-8 weeks onset of illness. Although, very low salmonellacidal titers (2.5 ± 1.5 and 2.3 ± 1.5) were detected after Vi CPS vaccine among the human volunteers, but mean titer was raised 15-fold from pre- to postvaccinated sera (0.166-2.5). CONCLUSION The serum salmonellacidal antibody by colorimetric salmonellacidal assay could be used to detect acute typhoidal cases and also to monitor immune response of typhoid vaccine.
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Affiliation(s)
- Lovely Barai
- Department of Microbiology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh.
| | - Md Rokibul Hasan
- Department of Microbiology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
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Honda-Okubo Y, Cartee RT, Thanawastien A, Seung Yang J, Killeen KP, Petrovsky N. A typhoid fever protein capsular matrix vaccine candidate formulated with Advax-CpG adjuvant induces a robust and durable anti-typhoid Vi polysaccharide antibody response in mice, rabbits and nonhuman primates. Vaccine 2022; 40:4625-4634. [PMID: 35750538 DOI: 10.1016/j.vaccine.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Typhax is an investigational typhoid fever vaccine candidate that is comprised of Vi polysaccharide from Salmonella enterica serovar typhi (S. Typhi) non-covalently entrapped in a glutaraldehyde catalyzed, cross-linked α-poly-L-lysine and CRM197 protein matrix. A previous Phase 1 trial of an aluminum phosphate adjuvanted Typhax formulation showed it induced Vi IgG after a single dose but that subsequent doses failed to further boost Vi IgG levels. The current study asked whether Advax-CpG adjuvant might instead be able to overcome polysaccharide-induced immune inhibition and improve Typhax immunogenicity. Advax-CpG adjuvanted Typhax elicited high and sustained Vi IgG responses in mice, rabbits and non-human primates (NHP) with levels being boosted by repeated immunization. High Vi antibody responses were lost in CD4 + T cell depleted mice confirming that despite the lack of conjugation of the polysaccharide to the carrier protein, Typhax nevertheless acts in a T cell dependent manner, explaining its ability to induce long-term B cell memory responses to Vi capable of being boosted. In NHP, Advax-CpG adjuvanted Typhax induced up to 100-fold higher Vi IgG levels than the commercial Typhim Vi polysaccharide vaccine. Typhax induced high and sustained serum bactericidal activity against S. Typhi and stimulated robust Vi IgG responses even in animals previously primed with a pure polysaccharide vaccine. Hence Advax-CpG adjuvanted Typhax vaccine is a highly promising candidate to provide robust and durable protection against typhoid fever.
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Affiliation(s)
- Yoshikazu Honda-Okubo
- Vaxine Pty Ltd, 11 Walkley Avenue, Warradale, Adelaide, Australia; School of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert T Cartee
- Matrivax Research & Development Corporation, Boston, MA, USA
| | | | - Jae Seung Yang
- Clinical Immunology, International Vaccine Institute (IVI), South Korea
| | - Kevin P Killeen
- Matrivax Research & Development Corporation, Boston, MA, USA
| | - Nikolai Petrovsky
- Vaxine Pty Ltd, 11 Walkley Avenue, Warradale, Adelaide, Australia; School of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Xian TH, Sinniah K, Yean CY, Krishnamoorthy V, Bahari MB, Ravichandran M, Prabhakaran G. Immunogenicity and protective efficacy of a live, oral cholera vaccine formulation stored outside-the-cold-chain for 140 days. BMC Immunol 2020; 21:29. [PMID: 32450807 PMCID: PMC7249306 DOI: 10.1186/s12865-020-00360-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/20/2020] [Indexed: 01/29/2023] Open
Abstract
Background Cholera, an acute watery diarrhoeal disease caused by Vibrio cholerae serogroup O1 and O139 across the continents. Replacing the existing WHO licensed killed multiple-dose oral cholera vaccines that demand ‘cold chain supply’ at 2–8 °C with a live, single-dose and cold chain-free vaccine would relieve the significant bottlenecks and cost determinants in cholera vaccination campaigns. In this direction, a prototype cold chain-free live attenuated cholera vaccine formulation (LACV) was developed against the toxigenic wild-type (WT) V. cholerae O139 serogroup. LACV was found stable and retained its viability (5 × 106 CFU/mL), purity and potency at room temperature (25 °C ± 2 °C, and 60% ± 5% relative humidity) for 140 days in contrast to all the existing WHO licensed cold-chain supply (2–8 °C) dependent killed oral cholera vaccines. Results The LACV was evaluated for its colonization potential, reactogenicity, immunogenicity and protective efficacy in animal models after its storage at room temperature for 140 days. In suckling mice colonization assay, the LACV recorded the highest recovery of (7.2 × 107 CFU/mL) compared to those of unformulated VCUSM14P (5.6 × 107 CFU/mL) and the WT O139 strain (3.5 × 107 CFU/mL). The LACV showed no reactogenicity even at an inoculation dose of 104–106 CFU/mL in a rabbit ileal loop model. The rabbits vaccinated with the LACV or unformulated VCUSM14P survived a challenge with WT O139 and showed no signs of diarrhoea or death in the reversible intestinal tie adult rabbit diarrhoea (RITARD) model. Vaccinated rabbits recorded a 275-fold increase in anti-CT IgG and a 15-fold increase in anti-CT IgA antibodies compared to those of rabbits vaccinated with unformulated VCUSM14P. Vibriocidal antibodies were increased by 31-fold with the LACV and 14-fold with unformulated VCUSM14P. Conclusion The vaccine formulation mimics a natural infection, is non-reactogenic and highly immunogenic in vivo and protects animals from lethal wild-type V. cholerae O139 challenge. The single dose LACV formulation was found to be stable at room temperature (25 ± 2 °C) for 140 days and it would result in significant cost savings during mass cholera vaccination campaigns.
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Affiliation(s)
- Tew Hui Xian
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Kurunathan Sinniah
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Chan Yean Yean
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | | | - Mohd Baidi Bahari
- Faculty of Pharmacy, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Manickam Ravichandran
- Centre of Excellence for Omics-Driven Computational Biodiscovery, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia
| | - Guruswamy Prabhakaran
- Department of Biotechnology, Faculty of Applied Sciences, AIMST University, 08100, Semeling, Kedah, Malaysia.
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Lee EY, Lee S, Rho S, Kim JO, Choi SK, Lee YJ, Park JY, Song M, Yang JS. Immunogenicity of a bivalent killed thimerosal-free oral cholera vaccine, Euvichol, in an animal model. Clin Exp Vaccine Res 2018; 7:104-110. [PMID: 30112349 PMCID: PMC6082675 DOI: 10.7774/cevr.2018.7.2.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE An oral cholera vaccine (OCV), Euvichol, with thimerosal (TM) as preservative, was prequalified by the World Health Organization (WHO) in 2015. In recent years, public health services and regulatory bodies recommended to eliminate TM in vaccines due to theoretical safety concerns. In this study, we examined whether TM-free Euvichol induces comparable immunogenicity to its TM-containing formulation in animal model. MATERIALS AND METHODS To evaluate and compare the immunogenicity of the two variations of OCV, mice were immunized with TM-free or TM-containing Euvichol twice at 2-week interval by intranasal or oral route. One week after the last immunization, mice were challenged with Vibrio cholerae O1 and daily monitored to examine the protective immunity against cholera infection. In addition, serum samples were obtained from mice to measure vibriocidal activity and vaccine-specific IgG, IgM, and IgA antibodies using vibriocidal assay and enzyme-linked immunosorbent assay, respectively. RESULTS No significant difference in immunogenicity, including vibriocidal activity and vaccine-specific IgG, IgM, and IgA in serum, was observed between mice groups administered with TM-free and -containing Euvichol, regardless of immunization route. However, intranasally immunized mice elicited higher levels of serum antibodies than those immunized via oral route. Moreover, intranasal immunization completely protected mice against V. cholerae challenge but not oral immunization. There was no significant difference in protection between two Euvichol variations. CONCLUSION These results suggested that TM-free Euvichol could provide comparable immunogenicity to the WHO prequalified Euvichol containing TM as it was later confirmed in a clinical study. The pulmonary mouse cholera model can be considered useful to examine in vivo the potency of OCVs.
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Affiliation(s)
- Eun Young Lee
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
| | - Sena Lee
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
| | - Semi Rho
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
| | - Jae-Ouk Kim
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
| | | | | | | | - Manki Song
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
| | - Jae Seung Yang
- Clinical Research Laboratory, Sciences Unit, International Vaccine Institute, Seoul, Korea
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Russo P, Ligsay AD, Olveda R, Choi SK, Kim DR, Park JY, Park JY, Syed KA, Dey A, Kim YH, Lee SH, Kim J, Chon Y, Digilio L, Kim CW, Excler JL. A randomized, observer-blinded, equivalence trial comparing two variations of Euvichol®, a bivalent killed whole-cell oral cholera vaccine, in healthy adults and children in the Philippines. Vaccine 2018; 36:4317-4324. [PMID: 29895500 PMCID: PMC6026293 DOI: 10.1016/j.vaccine.2018.05.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/12/2022]
Abstract
Bridging study demonstrating the equivalence of two variations of Euvichol®. The 600L thimerosal-free Euvichol® is safe and immunogenic in adults and children. The scale-up of Euvichol® allows expanding global access to oral cholera vaccine.
Background To contribute to the global demand for oral cholera vaccine (OCV), the production of Euvichol® was scaled up with elimination of thimerosal. To demonstrate the equivalence of the variations, a study was carried out in the Philippines. Methods Healthy male and female adults and children in Manila were randomized to receive two doses of Euvichol® two weeks apart from either the 100L (Comparator) or the 600L (Test) variation. Primary and secondary immunogenicity endpoints were respectively geometric mean titer (GMT) of vibriocidal antibodies (two weeks post second dose) and seroconversion rate (two weeks after each dose) against O1 Inaba, Ogawa, and O139 serogroups. The GMT of vibriocidal antibodies against O1 Inaba, Ogawa, and O139 two weeks post first dose was also measured. To show the equivalence of two variations of Euvichol®, the ratio of GMT and the difference of seroconversion rate between Test and Comparator vaccines were tested with equivalence margin of [0.5, 2.0] for GMT ratio and of 15% for seroconversion rate, respectively. Safety assessment included solicited reactogenicity within 6 days after each dose and unsolicited and serious adverse events. Results A total of 442 participants were enrolled. For the overall population, equivalence between Test and Comparator was demonstrated for vibriocidal antibody response against O1 Inaba and Ogawa serotypes and O139 serogroup in both modified intention-to-treat (mITT) and per protocol analysis, since the 95% confidence intervals (CI) of GMT to any serotypes were within the lower and upper boundary [0.5, 2.0]. Seroconversion rates after two doses also showed equivalence for O1 Inaba, Ogawa, and O139. The vaccine was safe and well tolerated, similarly between the two groups. Conclusion The study results support the equivalence of the 600L Euvichol® to the 100L formulation in healthy children and adults. The 600L Euvichol® is safe and immunogenic in adults and children. ClinicalTrials.gov registration number: NCT02502331.
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Affiliation(s)
- Paola Russo
- Clinical Development & Regulatory, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea.
| | | | - Remigio Olveda
- Research Institute for Tropical Medicine, Manila, Philippines
| | - Seuk Keun Choi
- EuBiologics Co., Ltd., Seoul, Republic of Korea; Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Deok Ryun Kim
- Biostatistics & Data Management, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Ju Yeon Park
- Biostatistics & Data Management, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Ju Yeong Park
- Translational Immunology Laboratory, Science Unit, International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ayan Dey
- Translational Immunology Laboratory, Science Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Yang Hee Kim
- Clinical Development & Regulatory, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | | | - Jayoung Kim
- Program Management, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Yun Chon
- Biostatistics & Data Management, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Laura Digilio
- Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Chan Wha Kim
- Department of Biotechnology, Korea University, Seoul, Republic of Korea
| | - Jean-Louis Excler
- Clinical Development & Regulatory, Development & Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
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Sim JR, Kang SS, Lee D, Yun CH, Han SH. Killed Whole-Cell Oral Cholera Vaccine Induces CCL20 Secretion by Human Intestinal Epithelial Cells in the Presence of the Short-Chain Fatty Acid, Butyrate. Front Immunol 2018; 9:55. [PMID: 29434590 PMCID: PMC5796904 DOI: 10.3389/fimmu.2018.00055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/09/2018] [Indexed: 01/09/2023] Open
Abstract
Short-chain fatty acids (SCFAs), such as acetate, butyrate, and propionate, modulate immune responses in the gut. However, the effect of SCFAs on mucosal vaccine-induced immune cell migration is poorly understood. Here, we investigated whether SCFAs modulate chemokine expression induced by the killed whole-cell oral cholera vaccine, Shanchol™, in human intestinal epithelial cells. Shanchol™ induced expression of CCL2, CCL5, CCL20, and CXCL10 at the mRNA level, but not at the protein level. Interestingly, CCL20 secretion was substantially increased by co-stimulation with Shanchol™ and butyrate, while neither acetate nor propionate showed such effect. Enhanced CCL20 secretion was associated with GPR109A activation, and histone deacetylase (HDAC) inhibition. In addition, co-treatment with Shanchol™ and butyrate synergistically increased the secretion of adenosine triphosphate (ATP). Moreover, CCL20 secretion was decreased by inhibiting the extracellular ATP receptor P2X7. However, neither inflammasomes nor caspases were involved in CCL20 production. The culture supernatant of cells treated with Shanchol™ and butyrate augmented human immature dendritic cell migration. Collectively, these results suggest that butyrate enhances Shanchol™-induced CCL20 production in human intestinal epithelial cells via HDAC inhibition and ATP-P2X7 signaling by activating GPR109A. These effects potentially enhance the mucosal immune responses in the gut induced by this oral cholera vaccine.
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Affiliation(s)
- Ju-Ri Sim
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Seok-Seong Kang
- Department of Food Science and Biotechnology, Dongguk University Seoul, Goyang, South Korea
| | - Daesang Lee
- The 5th R&D Institute, Agency for Defense Development, Daejeon, South Korea
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, South Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, South Korea
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Iyer AS, Azman AS, Bouhenia M, Deng LO, Anderson CP, Graves M, Kováč P, Xu P, Ryan ET, Harris JB, Sack DA, Luquero FJ, Leung DT. Dried Blood Spots for Measuring Vibrio cholerae-specific Immune Responses. PLoS Negl Trop Dis 2018; 12:e0006196. [PMID: 29377882 PMCID: PMC5805362 DOI: 10.1371/journal.pntd.0006196] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 02/08/2018] [Accepted: 12/28/2017] [Indexed: 02/03/2023] Open
Abstract
Background Vibrio cholerae causes over 2 million cases of cholera and 90,000 deaths each year. Serosurveillance can be a useful tool for estimating the intensity of cholera transmission and prioritizing populations for cholera control interventions. Current methods involving venous blood draws and downstream specimen storage and transport methods pose logistical challenges in most settings where cholera strikes. To overcome these challenges, we developed methods for determining cholera-specific immune responses from dried blood spots (DBS). Methodology/principal findings As conventional vibriocidal assay methods were unsuitable for DBS eluates from filter paper, we adopted a drop-plate culture method. We show that DBS collected from volunteers in South Sudan, and stored for prolonged periods in field conditions, retained functional vibriocidal antibodies, the titers of which correlated with paired serum titers determined by conventional spectrophotometric methods (r = 0.94, p = 0.00012). We also showed that eluates from DBS Serum Separator cards could be used with conventional spectrophotometric vibriocidal methods, and that they correlated with paired serum at a wide range of titers (r = 0.96, p<0.0001). Similarly, we used ELISA methods to show that V. cholerae O-specific polysaccharide antibody responses from DBS eluates correlated with results from paired serum for IgG (r = 0.85, p = 0.00006), IgM (r = 0.79, p = 0.00049) and IgA (r = 0.73, p = 0.0019), highlighting its potential for use in determination of isotype-specific responses. Storage of DBS cards at a range of temperatures did not change antibody responses. Conclusion In conclusion, we have developed and demonstrated a proof-of-concept for assays utilizing DBS for assessing cholera-specific immune responses. Cholera remains a major public health issue among underprivileged populations in the developing world. Current methods of disease surveillance are inadequate for identifying key populations at highest risk of cholera. Serosurveillance can provide accurate measurements of an individual or population’s exposure to cholera infection or oral cholera vaccine (OCV) induced immunity, though they require venous blood draw and stringent processing needs. Dried blood spots (DBS) overcome these challenges, acting as a portable surveillance tool suitable for field use. We developed a drop-plate culture method for evaluating vibriocidal and cholera-specific isotype responses using DBS from OCV-immunized volunteers from South Sudan. Blood equivalent to only two drops were spotted on Whatman Protein Saver (WPS) DBS cards. Vibriocidal titers from WPS eluates determined by drop-plate culture methods correlated well with serum based assays. In addition, by using DBS cards capable of automatic separation of serum from blood, we demonstrate that vibriocidal titers and V. cholerae polysaccharide antibody responses could be measured by conventional spectrophotometric methods and that these responses are stable over a range of storage temperatures. In summary, we show that cholera-specific immune responses can be measured using DBS, providing a potential tool for large-scale serosurveillance field studies for cholera.
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Affiliation(s)
- Anita S. Iyer
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Andrew S. Azman
- Department of Epidemiology, John Hopkins University, Baltimore, MD, United States of America
- Médecins Sans Frontières, Geneva, Switzerland
| | - Malika Bouhenia
- Department of Pandemic and Epidemic Diseases, World Health Organization, Juba, South Sudan
| | - Lul O. Deng
- National Public Health Laboratory, Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Cole P. Anderson
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Michael Graves
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Pavol Kováč
- National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), Laboratory of Bioorganic Chemistry (LBC), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peng Xu
- National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), Laboratory of Bioorganic Chemistry (LBC), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - David A. Sack
- Department of International Health, John Hopkins University, Baltimore, MD, United States
| | - Francisco J. Luquero
- Department of International Health, John Hopkins University, Baltimore, MD, United States
- Epicentre, Paris, France
| | - Daniel T. Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Microbiology & Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- * E-mail:
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9
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Guinea pig complement potently measures vibriocidal activity of human antibodies in response to cholera vaccines. J Microbiol 2017; 55:973-978. [DOI: 10.1007/s12275-017-7478-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
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10
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Capeding MRZ, Gonzales MLAM, Dhingra MS, D'Cor NA, Midde VJ, Patnaik BN, Thollot Y, Desauziers E. Safety and immunogenicity of the killed bivalent (O1 and O139) whole-cell cholera vaccine in the Philippines. Hum Vaccin Immunother 2017; 13:2232-2239. [PMID: 28910563 PMCID: PMC5975480 DOI: 10.1080/21645515.2017.1342908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 10/25/2022] Open
Abstract
The killed bivalent (O1 and O139) whole cell oral cholera vaccine (OCV) (Shanchol™) was first licensed in India in 2009 and World Health Organization pre-qualified in 2011. We assessed the safety and immunogenicity of this OCV in the Philippines. This was a phase IV, single-arm, descriptive, open-label study. We recruited 336 participants from 2 centers: 112 participants in each age group (1-4, 5-14 and ≥ 15 years). Participants received 2 OCV doses 14 d apart. Safety was monitored throughout the trial. Blood samples were collected at baseline (pre-vaccination) and 14 d after each dose. Serum vibriocidal antibody titers to V. cholerae O1 (El Tor Inaba and El Tor Ogawa) and O139 strains were assessed, with seroconversion defined as ≥ 4-fold increase from baseline in titers. No immediate unsolicited systemic adverse events/reactions were observed. Unsolicited systemic adverse events were mostly grade 1 intensity. One serious adverse event occurred after the first dose, but was unrelated to vaccination. High seroconversion rates (range 69-92%) were achieved against the O1 serotypes with a trend toward higher rates in the 1-4 y (86-92%) and 5-14 y (86-88%) age groups than the ≥ 15 y age group (69-83%). Lower seroconversion rates were achieved against the O139 serotype (35-70%), particularly in those aged ≥ 15 y (35-42%). The 2-dose regimen of the killed bivalent whole cell OCV was well-tolerated in this study conducted in the Philippines, a cholera-endemic country. Robust immune responses were observed even after a single-dose.
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Affiliation(s)
| | | | | | | | - Venkat Jayanth Midde
- Shantha Biotechnics Private Limited (A Sanofi Company), Hyderabad, Telangana, India
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11
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Necchi F, Saul A, Rondini S. Development of a high-throughput method to evaluate serum bactericidal activity using bacterial ATP measurement as survival readout. PLoS One 2017; 12:e0172163. [PMID: 28192483 PMCID: PMC5305226 DOI: 10.1371/journal.pone.0172163] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Serum Bactericidal Activity (SBA) assay is the method of choice to evaluate the complement-mediated functional activity of both infection- and vaccine-induced antibodies. To perform a typical SBA assay, serial dilutions of sera are incubated with target bacterial strains and complement. The conventional SBA assay is based on plating on agar the SBA reaction mix and counting the surviving bacterial colony forming units (CFU) at each serum dilution. Even with automated colony counting, it is labor-intensive, time-consuming and not amenable for large-scale studies. Here, we have developed a luminescence-based SBA (L-SBA) method able to detect surviving bacteria by measuring their ATP. At the end of the SBA reaction, a single commercially available reagent is added to each well of the SBA plate, and the resulting luminescence signal is measured in a microplate reader. The signal obtained is proportional to the ATP present, which is directly proportional to the number of viable bacteria. Bactericidal activity is subsequently calculated. We demonstrated the applicability of L-SBA with multiple bacterial serovars, from 5 species: Citrobacter freundii, Salmonella enterica serovars Typhimurium and Enteritidis, Shigella flexneri serovars 2a and 3a, Shigella sonnei and Neisseria meningitidis. Serum bactericidal titers obtained by the luminescence readout method strongly correlate with the data obtained by the conventional agar plate-based assay, and the new assay is highly reproducible. L-SBA considerably shortens assay time, facilitates data acquisition and analysis and reduces the operator dependency, avoiding the plating and counting of CFUs. Our results demonstrate that L-SBA is a useful high-throughput bactericidal assay.
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Affiliation(s)
- Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Allan Saul
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Simona Rondini
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
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12
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Kim HW, Kim KH, Kim J, Nahm MH. A high throughput serum bactericidal assay for antibodies to Haemophilus influenzae type b. BMC Infect Dis 2016; 16:473. [PMID: 27595992 PMCID: PMC5011942 DOI: 10.1186/s12879-016-1808-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The protective capacities of antibodies induced with Haemophilus influenzae type b (Hib) vaccines can be directly assessed in vitro with a Hib-specific serum bactericidal assay (SBA). However, the conventional SBA requires several tedious steps including manual counting of bacterial colonies, and therefore, it is seldom used. METHODS To overcome these limitations, we have improved the conventional SBA by using frozen target bacteria and by developing an automated colony counting method based on agar plates with the chromogenic dye 2, 3, 5-triphenyl tetrazolium chloride (TTC). RESULTS These changes enabled us to analyze about 100 serum samples per day per person by SBA. When the intra- and inter-assay precisions were studied, this assay showed a coefficient of variation (CV) ranging from 1 to 38 %. To monitor the long term assay stability for assays involving different bacteria lots, complement lots, and operators, we analyzed bactericidal indices of quality control samples obtained over a 6 year period and found the CV to be about 35-50 %. Lastly, our SBA results were compared with the ELISA results obtained using 90 serum samples from children. We showed that the bactericidal index correlated with IgG anti-Hib antibody levels (r = 0.84), with a bactericidal index of 10 corresponding approximately to 0.15 μg/mL IgG, the widely accepted protective level of antibody. CONCLUSION We describe a simple high throughput SBA for anti-Hib antibodies that would be useful for evaluating various Hib vaccines. While additional work will be needed to standardize the assay, this SBA should greatly facilitate studies of Hib vaccines.
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Affiliation(s)
- Han Wool Kim
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kyung-Hyo Kim
- Center for Vaccine Evaluation and Study, Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - JiHye Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Moon H. Nahm
- Department of Pathology and Microbiology, University of Alabama at Birmingham, Birmingham, AL USA
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13
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Jang MS, Sahastrabuddhe S, Yun CH, Han SH, Yang JS. Serum bactericidal assay for the evaluation of typhoid vaccine using a semi-automated colony-counting method. Microb Pathog 2016; 97:19-26. [PMID: 27216239 PMCID: PMC4944902 DOI: 10.1016/j.micpath.2016.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/22/2022]
Abstract
Typhoid fever, mainly caused by Salmonella enterica serovar Typhi (S. Typhi), is a life-threatening disease, mostly in developing countries. Enzyme-linked immunosorbent assay (ELISA) is widely used to quantify antibodies against S. Typhi in serum but does not provide information about functional antibody titers. Although the serum bactericidal assay (SBA) using an agar plate is often used to measure functional antibody titers against various bacterial pathogens in clinical specimens, it has rarely been used for typhoid vaccines because it is time-consuming and labor-intensive. In the present study, we established an improved SBA against S. Typhi using a semi-automated colony-counting system with a square agar plate harboring 24 samples. The semi-automated SBA efficiently measured bactericidal titers of sera from individuals immunized with S. Typhi Vi polysaccharide vaccines. The assay specifically responded to S. Typhi Ty2 but not to other irrelevant enteric bacteria including Vibrio cholerae and Shigella flexneri. Baby rabbit complement was more appropriate source for the SBA against S. Typhi than complements from adult rabbit, guinea pig, and human. We also examined the correlation between SBA and ELISA for measuring antibody responses against S. Typhi using pre- and post-vaccination sera from 18 human volunteers. The SBA titer showed a good correlation with anti-Vi IgG quantity in the serum as determined by Spearman correlation coefficient of 0.737 (P < 0.001). Taken together, the semi-automated SBA might be efficient, accurate, sensitive, and specific enough to measure functional antibody titers against S. Typhi in sera from human subjects immunized with typhoid vaccines. Improved SBA against S. Typhi was developed using a colony counting system. The improved SBA was specific to S. Typhi but not to other gram-negative bacteria. There was a good correlation between SBA and anti-Vi IgG titers in vaccinee’s sera. This SBA would be useful for the clinical immuno-monitoring of typhoid vaccines.
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Affiliation(s)
- Mi Seon Jang
- Clinical Immunology, Sciences Unit, International Vaccine Institute, Seoul, Republic of Korea; Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | | | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
| | - Jae Seung Yang
- Clinical Immunology, Sciences Unit, International Vaccine Institute, Seoul, Republic of Korea.
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14
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Desai SN, Akalu Z, Teshome S, Teferi M, Yamuah L, Kim DR, Yang JS, Hussein J, Park JY, Jang MS, Mesganaw C, Taye H, Beyene D, Bedru A, Singh AP, Wierzba TF, Aseffa A. A Randomized, Placebo-Controlled Trial Evaluating Safety and Immunogenicity of the Killed, Bivalent, Whole-Cell Oral Cholera Vaccine in Ethiopia. Am J Trop Med Hyg 2015; 93:527-533. [PMID: 26078323 PMCID: PMC4559691 DOI: 10.4269/ajtmh.14-0683] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/22/2015] [Indexed: 11/07/2022] Open
Abstract
Killed whole-cell oral cholera vaccine (OCV) has been a key component of a comprehensive package including water and sanitation measures for recent cholera epidemics. The vaccine, given in a two-dose regimen, has been evaluated in a large number of human volunteers in India, Vietnam, and Bangladesh, where it has demonstrated safety, immunogenicity, and clinical efficacy. We conducted a double-blind randomized placebo-controlled trial in Ethiopia, where we evaluated the safety and immunogenicity of the vaccine in 216 healthy adults and children. OCV was found to be safe and elicited a robust immunological response against Vibrio cholerae O1, with 81% adults and 77% children demonstrating seroconversion 14 days after the second dose of vaccine. This is the first study to evaluate safety and immunogenicity of the vaccine in a population outside Asia using a placebo-controlled, double-blind, randomized study design.
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Affiliation(s)
- Sachin N. Desai
- *Address correspondence to Sachin N. Desai, International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul, Korea 151-919. E-mail:
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15
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Kanungo S, Desai SN, Saha J, Nandy RK, Sinha A, Kim DR, Bannerjee B, Manna B, Yang JS, Ali M, Sur D, Wierzba TF. An Open Label Non-inferiority Trial Assessing Vibriocidal Response of a Killed Bivalent Oral Cholera Vaccine Regimen following a Five Year Interval in Kolkata, India. PLoS Negl Trop Dis 2015; 9:e0003809. [PMID: 26023778 PMCID: PMC4449043 DOI: 10.1371/journal.pntd.0003809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The bivalent killed oral cholera vaccine (OCV) provides 65% cumulative protection over five years. It remains unknown whether a boosting regimen can maintain protection in previously immunized populations. This study examines the immunogenicity and safety of an OCV regimen given five years following initial dosing. METHODOLOGY/PRINCIPAL FINDINGS An open label controlled trial was conducted in 426 healthy Indian participants previously enrolled in a large efficacy trial. To assess whether an OCV regimen given after five years can elicit an antibody response equal to that of a primary series, we compared vibriocidal antibody titers in previously immunized participants receiving a two dose booster regimen to participants receiving a primary two dose immunization series. Among participants receiving a two dose primary series of OCV (n = 186), 69% (95% CI 62%-76%) seroconverted. In the intervention arm (n = 184), 66% (95% CI 59%-73%) seroconverted following a two dose boosting schedule given five years following the initial series. Following a single boosting dose, 71% (95% CI 64%-77%) seroconverted. Children demonstrated 79% (95% CI 69%-86%) and 82% (95% CI 73%-88%) seroconversion after primary and boosting regimens, respectively. CONCLUSIONS/SIGNIFICANCE Administration of an OCV boosting regimen elicits an immune response similar to those receiving a primary series in endemic areas. Though a single boosting dose induces a strong immune response, further investigations are needed to measure if these findings translate to clinical protection.
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Affiliation(s)
- Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Jayanta Saha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Anuradha Sinha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Mohammad Ali
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
- PATH India Office, New Delhi, India
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16
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Kanungo S, Desai SN, Nandy RK, Bhattacharya MK, Kim DR, Sinha A, Mahapatra T, Yang JS, Lopez AL, Manna B, Bannerjee B, Ali M, Dhingra MS, Chandra AM, Clemens JD, Sur D, Wierzba TF. Flexibility of oral cholera vaccine dosing-a randomized controlled trial measuring immune responses following alternative vaccination schedules in a cholera hyper-endemic zone. PLoS Negl Trop Dis 2015; 9:e0003574. [PMID: 25764513 PMCID: PMC4357440 DOI: 10.1371/journal.pntd.0003574] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/28/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A bivalent killed whole cell oral cholera vaccine has been found to be safe and efficacious for five years in the cholera endemic setting of Kolkata, India, when given in a two dose schedule, two weeks apart. A randomized controlled trial revealed that the immune response was not significantly increased following the second dose compared to that after the first dose. We aimed to evaluate the impact of an extended four week dosing schedule on vibriocidal response. METHODOLOGY/PRINCIPAL FINDINGS In this double blind randomized controlled non-inferiority trial, 356 Indian, non-pregnant residents aged 1 year or older were randomized to receive two doses of oral cholera vaccine at 14 and 28 day intervals. We compared vibriocidal immune responses between these schedules. Among adults, no significant differences were noted when comparing the rates of seroconversion for V. cholerae O1 Inaba following two dose regimens administered at a 14 day interval (55%) vs the 28 day interval (58%). Similarly, no differences in seroconversion were demonstrated in children comparing the 14 (80%) and 28 day intervals (77%). Following 14 and 28 day dosing intervals, vibriocidal response rates against V. cholerae O1 Ogawa were 45% and 49% in adults and 73% and 72% in children respectively. Responses were lower for V. cholerae O139, but similar between dosing schedules for adults (20%, 20%) and children (28%, 20%). CONCLUSIONS/SIGNIFICANCE Comparable immune responses and safety profiles between the two dosing schedules support the option for increased flexibility of current OCV dosing. Further operational research using a longer dosing regimen will provide answers to improve implementation and delivery of cholera vaccination in endemic and epidemic outbreak scenarios.
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Affiliation(s)
- Suman Kanungo
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sachin N. Desai
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Ranjan Kumar Nandy
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mihir Kumar Bhattacharya
- Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Anuradha Sinha
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Tanmay Mahapatra
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jae Seung Yang
- Laboratory Science Division, International Vaccine Institute, Seoul, Republic of Korea
| | - Anna Lena Lopez
- University of the Philippines Manila, National Institutes of Health, Manila, Philippines
| | - Byomkesh Manna
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Barnali Bannerjee
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mohammad Ali
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Mandeep Singh Dhingra
- Clinical Research and Development, Shantha Biotechnics Private Limited, Hyderabad, India
| | | | - John D. Clemens
- Office of the Executive Director, International Centre for Diarrheal Disease Research, Bangladesh
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, United States of America
| | - Dipika Sur
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
- Office of the Scientific Director, PATH India Office, New Delhi, India
| | - Thomas F. Wierzba
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
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17
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Evaluation of anticoagulants for serologic assays of cholera vaccination. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:854-8. [PMID: 24717970 DOI: 10.1128/cvi.00012-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Blood collected with an anticoagulant is beneficial for simultaneous evaluation of immune cells and humoral components such as antibodies. However, it is critical that the anticoagulant does not affect quantitative and qualitative analyses of antibodies. In the present study, we examined the potential interference of the widely used anticoagulants heparin, EDTA, and acid citrate dextrose (ACD) on vibriocidal antibody activities and Vibrio cholerae lipopolysaccharide (LPS)-specific IgG, IgM, and IgA levels in the plasma and sera obtained from cholera patients or vaccinees. Serum vibriocidal antibody titer was inhibited in the presence of EDTA or ACD but not in the presence of heparin. Moreover, 100% (8/8) of the vibriocidal antibody titers of plasma samples obtained from the vaccinees in tubes containing heparin were identical to the titers of matched sera when compared with 37.5% (3/8) and 50% (4/8) of the plasma samples prepared with EDTA and ACD, respectively. Among LPS-specific Igs, the Pearson correlation coefficient (r) for IgA in serum and plasma was low (r = 0.716), and the coefficients for IgG and IgM were relatively high (r = 0.997 and r = 0.945, respectively) in heparinized plasma samples compared with the coefficient for IgG and IgM of EDTA- and ACD-treated plasma. Our results suggest that heparin is an appropriate anticoagulant for the collection of blood when measuring vibriocidal activities and antibody levels in plasma samples.
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18
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Kang SS, Yang JS, Kim KW, Yun CH, Holmgren J, Czerkinsky C, Han SH. Anti-bacterial and anti-toxic immunity induced by a killed whole-cell-cholera toxin B subunit cholera vaccine is essential for protection against lethal bacterial infection in mouse pulmonary cholera model. Mucosal Immunol 2013; 6:826-37. [PMID: 23187318 DOI: 10.1038/mi.2012.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The lack of appropriate animal model for studying protective immunity has limited vaccine development against cholera. Here, we demonstrate a pulmonary cholera model conferred by intranasal administration of mice with live Vibrio cholerae. The bacterial components, but not cholera toxin, caused lethal and acute pneumonia by inducing massive inflammation. Intranasal immunization with Dukoral, comprising killed whole bacteria and recombinant cholera toxin B subunit (rCTB), developed both mucosal and systemic antibody responses with protection against the lethal challenge. Either rCTB-free Dukoral or rCTB alone partially protected the mice against the challenge. However, reconstitution of rCTB-free Dukoral with rCTB restored full protection. Parenteral immunization with Dukoral evoked strong systemic immunity without induction of mucosal immunity or protection from the challenge. These results suggest that both anti-bacterial and anti-toxic immunity are required for protection against V. cholerae-induced pneumonia, and this animal model is useful for pre-clinical evaluation of candidate cholera vaccines.
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Affiliation(s)
- S-S Kang
- Laboratory Sciences Division, International Vaccine Institute, Seoul, Republic of Korea
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Son MS, Taylor RK. Vibriocidal assays to determine the antibody titer of patient sera samples. ACTA ACUST UNITED AC 2012; Chapter 6:Unit6A.3. [PMID: 22045586 DOI: 10.1002/9780471729259.mc06a03s23] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The vibriocidal titer assay can be used to detect antibodies against Vibrio cholerae in serum samples, serving as an indicator of prior infection and potential protection against cholera. The assay can be utilized in research and clinical settings to test the effectiveness of vaccines, and also in epidemiological studies relevant to cholera transmission and surveillance. This unit outlines the steps involved in conducting an easily interpreted colorimetric vibriocidal titer assay with a relatively short turnaround time for results of around 8 hr, with final result observations in 24 hr. The assay can also be easily scaled up or down to accommodate as many or as few serum samples available and is not V. cholerae strain specific.
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Affiliation(s)
- Mike S Son
- Dartmouth Medical School, Hanover, New Hampshire, USA
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Clarke ML, Burton RL, Hill AN, Litorja M, Nahm MH, Hwang J. Low-cost, high-throughput, automated counting of bacterial colonies. Cytometry A 2010; 77:790-7. [PMID: 20140968 PMCID: PMC2909336 DOI: 10.1002/cyto.a.20864] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Research involving bacterial pathogens often requires enumeration of bacteria colonies. Here, we present a low-cost, high-throughput colony counting system consisting of colony counting software and a consumer-grade digital camera or document scanner. We demonstrate that this software, called "NICE" (NIST's Integrated Colony Enumerator), can count bacterial colonies as part of a high-throughput multiplexed opsonophagocytic killing assay used to characterize pneumococcal vaccine efficacy. The results obtained with NICE correlate well with the results obtained from manual counting, with a mean difference of less than 3%. NICE is also rapid; it can count colonies from multiple reaction wells within minutes and export the results to a spreadsheet for data processing. As this program is freely available from NIST, NICE should be helpful in bacteria colony enumeration required in many microbiological studies, and in standardizing colony counting methods.
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Affiliation(s)
- Matthew L. Clarke
- Optical Technology Division, Physics Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899 USA
| | - Robert L. Burton
- Departments of Pathology and Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - A. Nayo Hill
- Optical Technology Division, Physics Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899 USA
| | - Maritoni Litorja
- Optical Technology Division, Physics Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899 USA
| | - Moon H. Nahm
- Departments of Pathology and Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Jeeseong Hwang
- Optical Technology Division, Physics Laboratory, National Institute of Standards and Technology, Gaithersburg, MD 20899 USA
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Yang JS, Choi S, Kim DD, Kang SS, Yun CH, Lee K, Han SH. A duplex vibriocidal assay to simultaneously measure bactericidal antibody titers against Vibrio cholerae O1 Inaba and Ogawa serotypes. J Microbiol Methods 2009; 79:289-94. [PMID: 19796659 DOI: 10.1016/j.mimet.2009.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 09/15/2009] [Accepted: 09/18/2009] [Indexed: 11/27/2022]
Abstract
Currently available cholera vaccines are formulated with killed-whole cells of Vibrio cholerae O1 Inaba and Ogawa serotypes. A serum vibriocidal assay has been widely used to evaluate the immunogenicity of cholera vaccines in clinical trials. In this study, we developed a duplex vibriocidal assay to obtain vibriocidal antibody titers against both serotypes simultaneously. Initially, serial dilutions of serum from vaccinees were incubated with guinea pig complements along with both streptomycin-resistant Inaba and ampicillin-resistant Ogawa strains for 1h. The mixture was then inoculated on separate agar plates containing each antibiotic to selectively culture each corresponding serotype and incubated at 37 degrees C for 16 to 20h. Bacterial colonies were enumerated using an automated colony counting system to obtain the vibriocidal antibody titers defined by the reciprocal of serum dilution inhibiting bacterial growth by 50%. Performance of the duplex vibriocidal assay was examined by comparison with a single serotype vibriocidal assay using 20 clinical sera consisting of ten-paired sera prepared at pre- and post-vaccination. Both assays showed a good correlation for vibriocidal titers against the two serotypes, respectively, as determined by Pearson correlation coefficient (r) and regression coefficient (beta) analyses; r=0.998, beta=1.003 for Inaba and r=0.997, beta=0.999 for Ogawa, respectively. The duplex vibriocidal assay can diminish the amount of sera required for the assay and enhance assay efficiency in terms of time, labor intensity, and expenditure.
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Affiliation(s)
- Jae Seung Yang
- Laboratory Sciences Division, International Vaccine Institute, Seoul 151-600, Republic of Korea
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