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Kamboj A, Dumka S, Saxena MK, Singh Y, Kaur BP, da Silva SJR, Kumar S. A Comprehensive Review of Our Understanding and Challenges of Viral Vaccines against Swine Pathogens. Viruses 2024; 16:833. [PMID: 38932126 PMCID: PMC11209531 DOI: 10.3390/v16060833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Pig farming has become a strategically significant and economically important industry across the globe. It is also a potentially vulnerable sector due to challenges posed by transboundary diseases in which viral infections are at the forefront. Among the porcine viral diseases, African swine fever, classical swine fever, foot and mouth disease, porcine reproductive and respiratory syndrome, pseudorabies, swine influenza, and transmissible gastroenteritis are some of the diseases that cause substantial economic losses in the pig industry. It is a well-established fact that vaccination is undoubtedly the most effective strategy to control viral infections in animals. From the period of Jenner and Pasteur to the recent new-generation technology era, the development of vaccines has contributed significantly to reducing the burden of viral infections on animals and humans. Inactivated and modified live viral vaccines provide partial protection against key pathogens. However, there is a need to improve these vaccines to address emerging infections more comprehensively and ensure their safety. The recent reports on new-generation vaccines against swine viruses like DNA, viral-vector-based replicon, chimeric, peptide, plant-made, virus-like particle, and nanoparticle-based vaccines are very encouraging. The current review gathers comprehensive information on the available vaccines and the future perspectives on porcine viral vaccines.
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Affiliation(s)
- Aman Kamboj
- College of Veterinary and Animal Sciences, G. B. Pant University of Agriculture and Technology, Pantnagar 263145, Uttarakhand, India; (A.K.); (M.K.S.); (Y.S.)
| | - Shaurya Dumka
- Department of Biosciences and Bioengineering, Indian Institute of Technology, Guwahati 781039, Assam, India; (S.D.); (B.P.K.)
| | - Mumtesh Kumar Saxena
- College of Veterinary and Animal Sciences, G. B. Pant University of Agriculture and Technology, Pantnagar 263145, Uttarakhand, India; (A.K.); (M.K.S.); (Y.S.)
| | - Yashpal Singh
- College of Veterinary and Animal Sciences, G. B. Pant University of Agriculture and Technology, Pantnagar 263145, Uttarakhand, India; (A.K.); (M.K.S.); (Y.S.)
| | - Bani Preet Kaur
- Department of Biosciences and Bioengineering, Indian Institute of Technology, Guwahati 781039, Assam, India; (S.D.); (B.P.K.)
| | | | - Sachin Kumar
- Department of Biosciences and Bioengineering, Indian Institute of Technology, Guwahati 781039, Assam, India; (S.D.); (B.P.K.)
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Attreed SE, Silva C, Rodriguez-Calzada M, Mogulothu A, Abbott S, Azzinaro P, Canning P, Skidmore L, Nelson J, Knudsen N, Medina GN, de los Santos T, Díaz-San Segundo F. Prophylactic treatment with PEGylated bovine IFNλ3 effectively bridges the gap in vaccine-induced immunity against FMD in cattle. Front Microbiol 2024; 15:1360397. [PMID: 38638908 PMCID: PMC11024232 DOI: 10.3389/fmicb.2024.1360397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Foot-and-mouth disease (FMD) is a vesicular disease of cloven-hoofed animals with devastating economic implications. The current FMD vaccine, routinely used in enzootic countries, requires at least 7 days to induce protection. However, FMD vaccination is typically not recommended for use in non-enzootic areas, underscoring the need to develop new fast-acting therapies for FMD control during outbreaks. Interferons (IFNs) are among the immune system's first line of defense against viral infections. Bovine type III IFN delivered by a replication defective adenovirus (Ad) vector has effectively blocked FMD in cattle. However, the limited duration of protection-usually only 1-3 days post-treatment (dpt)-diminishes its utility as a field therapeutic. Here, we test whether polyethylene glycosylation (PEGylation) of recombinant bovine IFNλ3 (PEGboIFNλ3) can extend the duration of IFN-induced prevention of FMDV infection in both vaccinated and unvaccinated cattle. We treated groups of heifers with PEGboIFNλ3 alone or in combination with an adenovirus-based FMD O1Manisa vaccine (Adt-O1M) at either 3 or 5 days prior to challenge with homologous wild type FMDV. We found that pre-treatment with PEGboIFNλ3 was highly effective at preventing clinical FMD when administered at either time point, with or without co-administration of Adt-O1M vaccine. PEGboIFNλ3 protein was detectable systemically for >10 days and antiviral activity for 4 days following administration. Furthermore, in combination with Adt-O1M vaccine, we observed a strong induction of FMDV-specific IFNγ+ T cell response, demonstrating its adjuvanticity when co-administered with a vaccine. Our results demonstrate the promise of this modified IFN as a pre-exposure prophylactic therapy for use in emergency outbreak scenarios.
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Affiliation(s)
- Sarah E. Attreed
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
| | - Christina Silva
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
| | - Monica Rodriguez-Calzada
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
- Oak Ridge Institute for Science and Education Plum Island Animal Disease Center Research Participation Program, Oak Ridge, TN, United States
| | - Aishwarya Mogulothu
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States
| | - Sophia Abbott
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
- Animal Biosciences and Biotechnology Laboratory, Northeast Area, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, MD, United States
| | - Paul Azzinaro
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
| | | | | | - Jay Nelson
- Ambrx Biopharma, Inc., La Jolla, CA, United States
| | - Nick Knudsen
- Ambrx Biopharma, Inc., La Jolla, CA, United States
| | - Gisselle N. Medina
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
- National Bio-and Agro-Defense Facility, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Manhattan, KS, United States
| | - Teresa de los Santos
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
| | - Fayna Díaz-San Segundo
- Plum Island Animal Disease Center, Plains Area, Agricultural Research Service, U.S. Department of Agriculture, Greenport, NY, United States
- Office of Biodefense, Research Resources and Translational Research, National Institute of Allergy and Infectious Disease, Rockville, MD, United States
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Napper S, Schatzl HM. Oral vaccination as a potential strategy to manage chronic wasting disease in wild cervid populations. Front Immunol 2023; 14:1156451. [PMID: 37122761 PMCID: PMC10140515 DOI: 10.3389/fimmu.2023.1156451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
Prion diseases are a novel class of infectious disease based in the misfolding of the cellular prion protein (PrPC) into a pathological, self-propagating isoform (PrPSc). These fatal, untreatable neurodegenerative disorders affect a variety of species causing scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) in cattle, chronic wasting disease (CWD) in cervids, and Creutzfeldt-Jacob disease (CJD) in humans. Of the animal prion diseases, CWD is currently regarded as the most significant threat due its ongoing geographical spread, environmental persistence, uptake into plants, unpredictable evolution, and emerging evidence of zoonotic potential. The extensive efforts to manage CWD have been largely ineffective, highlighting the need for new disease management tools, including vaccines. Development of an effective CWD vaccine is challenged by the unique biology of these diseases, including the necessity, and associated dangers, of overcoming immune tolerance, as well the logistical challenges of vaccinating wild animals. Despite these obstacles, there has been encouraging progress towards the identification of safe, protective antigens as well as effective strategies of formulation and delivery that would enable oral delivery to wild cervids. In this review we highlight recent strategies for antigen selection and optimization, as well as considerations of various platforms for oral delivery, that will enable researchers to accelerate the rate at which candidate CWD vaccines are developed and evaluated.
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Affiliation(s)
- Scott Napper
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Hermann M. Schatzl
- Calgary Prion Research Unit, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
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Diaz-San Segundo F, Medina GN, Azzinaro P, Gutkoska J, Mogulothu A, Attreed SE, Lombardi KR, Shields J, Hudock TA, de Los Santos T. Use of Protein Pegylation to Prolong the Antiviral Effect of IFN Against FMDV. Front Microbiol 2021; 12:668890. [PMID: 34025625 PMCID: PMC8131870 DOI: 10.3389/fmicb.2021.668890] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Abstract
Interferons (IFNs) are considered the first line of defense against viral diseases. Due to their ability to modulate immune responses, they have become an attractive therapeutic option to control virus infections. In fact, like many other viruses, foot-and-mouth disease virus (FMDV), the most contagious pathogen of cloven-hoofed animals, is highly sensitive to the action of IFNs. Previous studies demonstrated that type I, II, and III IFNs, expressed using a replication defective human adenovirus 5 (Ad5) vector, can effectively block FMDV replication in vitro and can protect animals when challenged 1 day after Ad5-IFN treatment, in some cases providing sterile immunity. Rapidly spreading foot-and-mouth disease (FMD) is currently controlled with vaccination, although development of a protective adaptive immune response takes 5–7 days. Therefore, an optimal strategy to control FMD outbreaks is to block virus replication and spread through sustained IFN activity while the vaccine-stimulated adaptive immune response is developed. Challenges with methods of delivery and/or with the relative short IFN protein half-life in vivo, have halted the development of such approach to effectively control FMD in the animal host. One strategy to chemically improve drug pharmacodynamics is the use of pegylation. In this proof-of-concept study, we demonstrate that pegylated recombinant porcine (po)IFNα displays strong and long-lasting antiviral activity against FMDV in vitro and in vivo, completely protecting swine against FMD for at least five days after a single dose. These results highlight the potential of this biotherapeutics to use in combination with vaccines to fully control FMD in the field.
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Affiliation(s)
| | - Gisselle N Medina
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States.,Kansas State University College of Veterinary Medicine, Manhattan, KS, United States
| | - Paul Azzinaro
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States
| | - Joseph Gutkoska
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States
| | - Aishwarya Mogulothu
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States.,Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States
| | - Sarah E Attreed
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States.,ORISE-PIADC Research Participation Program, Oak Ridge, TN, United States
| | | | - Jacob Shields
- Elanco Animal Health, Inc., Greenfield, IN, United States
| | | | - Teresa de Los Santos
- Plum Island Animal Disease Center (PIADC), ARS, USDA, Greenport, NY, United States
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5
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Diaz-San Segundo F, Medina GN, Spinard E, Kloc A, Ramirez-Medina E, Azzinaro P, Mueller S, Rieder E, de Los Santos T. Use of Synonymous Deoptimization to Derive Modified Live Attenuated Strains of Foot and Mouth Disease Virus. Front Microbiol 2021; 11:610286. [PMID: 33552021 PMCID: PMC7861043 DOI: 10.3389/fmicb.2020.610286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Foot-and-mouth disease (FMD) is one of the most economically important viral diseases that can affect livestock. In the last 70 years, use of an inactivated whole antigen vaccine has contributed to the eradication of disease from many developed nations. However, recent outbreaks in Europe and Eastern Asia demonstrated that infection can spread as wildfire causing economic and social devastation. Therefore, it is essential to develop new control strategies that could confer early protection and rapidly stop disease spread. Live attenuated vaccines (LAV) are one of the best choices to obtain a strong early and long-lasting protection against viral diseases. In proof of concept studies, we previously demonstrated that “synonymous codon deoptimization” could be applied to the P1 capsid coding region of the viral genome to derive attenuated FMDV serotype A12 strains. Here, we demonstrate that a similar approach can be extended to the highly conserved non-structural P2 and P3 coding regions, providing a backbone for multiple serotype FMDV LAV development. Engineered codon deoptimized P2, P3 or P2, and P3 combined regions were included into the A24Cruzeiro infectious clone optimized for vaccine production, resulting in viable progeny that exhibited different degrees of attenuation in cell culture, in mice, and in the natural host (swine). Derived strains were thoroughly characterized in vitro and in vivo. Our work demonstrates that overall, the entire FMDV genome tolerates codon deoptimization, highlighting the potential of using this technology to derive novel improved LAV candidates.
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Affiliation(s)
- Fayna Diaz-San Segundo
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States
| | - Gisselle N Medina
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States.,Kansas State University College of Veterinary Medicine, Manhattan, KS, United States
| | - Edward Spinard
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States.,PIADC Research Participation Program, Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Anna Kloc
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States.,PIADC Research Participation Program, Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Elizabeth Ramirez-Medina
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States.,Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT, United States
| | - Paul Azzinaro
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States
| | | | - Elizabeth Rieder
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States
| | - Teresa de Los Santos
- Plum Island Animal Disease Center (PIADC), Agricultural Research Service, United States Department of Agriculture, Greenport, NY, United States
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Lee JH, Yun W, Oh HJ, An JS, Kim YG, Lee CG, Cho JH. Effects of dietary silicate levels on growth performance, nutrient digestibility, fecal microflora, odorous gas emissions, blood characteristics, and foot and mouth disease antibodies in weaning to finishing pigs. CANADIAN JOURNAL OF ANIMAL SCIENCE 2020. [DOI: 10.1139/cjas-2019-0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The goal of this study was to investigate effects of different levels of silicate supplementation in weaning to finishing pigs. A total of 96 piglets [(Landrace × Yorkshire) × Duroc] with initial body weight of 11.30 ± 0.02 kg were used for 16 wk (six replicate pens with four pigs per pen). Dietary treatment consisted of 0% (CON), 0.1% (T1), 0.5% (T2), and 1.0% (T3) silicate in the basal diet. Inclusion of 0.1% dietary silicate increased (P < 0.05) body weight, average daily gain, and gain-to-feed ratio in 0–16 wk. In addition, inclusion of 0.1% dietary silicate increased (P < 0.05) crude protein digestibility in 8 and 16 wk, whereas it decreased (P < 0.05) Escherichia coli count and ammonia emissions throughout the study period. Additionally, inclusion of dietary silicate increased (linear, P < 0.05) white blood cell in 4 wk, whereas it increased (quadratic, P < 0.05) white blood cell counts in 8 and 16 wk. Blood urea nitrogen decreased (quadratic, P < 0.05), and lymphocyte and foot and mouth antibodies increased (quadratic, P < 0.05) when silicate level increased. In conclusion, supplementation of 0.1% silicate in the diet showed positive effects in weaning to finishing pigs.
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Affiliation(s)
- Ji Hwan Lee
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
| | - Won Yun
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
| | - Han Jin Oh
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
| | - Ji Seon An
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
| | - Young Gwang Kim
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
| | | | - Jin Ho Cho
- Department of Animal Science, Chungbuk National University, Cheongju-si 361-763, Republic of Korea
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7
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Bliss CM, Parsons AJ, Nachbagauer R, Hamilton JR, Cappuccini F, Ulaszewska M, Webber JP, Clayton A, Hill AV, Coughlan L. Targeting Antigen to the Surface of EVs Improves the In Vivo Immunogenicity of Human and Non-human Adenoviral Vaccines in Mice. Mol Ther Methods Clin Dev 2020; 16:108-125. [PMID: 31934599 PMCID: PMC6953706 DOI: 10.1016/j.omtm.2019.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/12/2019] [Indexed: 12/25/2022]
Abstract
Adenoviral (Ad) vectors represent promising vaccine platforms for infectious disease. To overcome pre-existing immunity to commonly used human adenovirus serotype 5 (Ad5), vectors based on rare species or non-human Ads are being developed. However, these vectors often exhibit reduced potency compared with Ad5, necessitating the use of innovative approaches to augment the immunogenicity of the encoded antigen (Ag). To achieve this, we engineered model Ag, enhanced green fluorescent protein (EGFP), for targeting to the surface of host-derived extracellular vesicles (EVs), namely exosomes. Exosomes are nano-sized EVs that play important roles in cell-to-cell communication and in regulating immune responses. Directed targeting of Ag to the surface of EVs/exosomes is achieved by "exosome display," through fusion of Ag to the C1C2 domain of lactadherin, a protein highly enriched in exosomes. Herein, we engineered chimpanzee adenovirus ChAdOx1 and Ad5-based vaccines encoding EGFP, or EGFP targeted to EVs (EGFP_C1C2), and compared vaccine immunogenicity in mice. We determined that exosome display substantially increases Ag-specific humoral immunity following intramuscular and intranasal vaccination, improving the immunological potency of both ChAdOx1 and Ad5. We propose that this Ag-engineering approach could increase the immunogenicity of diverse Ad vectors that exhibit desirable manufacturing characteristics, but currently lack the potency of Ad5.
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Affiliation(s)
- Carly M. Bliss
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Andrea J. Parsons
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Raffael Nachbagauer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jennifer R. Hamilton
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Federica Cappuccini
- Nuffield Department of Medicine, The Jenner Institute, University of Oxford, ORCRB Roosevelt Drive, Headington, Oxford OX3 7DQ, UK
| | - Marta Ulaszewska
- Nuffield Department of Medicine, The Jenner Institute, University of Oxford, ORCRB Roosevelt Drive, Headington, Oxford OX3 7DQ, UK
| | - Jason P. Webber
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff CF14 2XN, UK
| | - Aled Clayton
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff CF14 2XN, UK
| | - Adrian V.S. Hill
- Nuffield Department of Medicine, The Jenner Institute, University of Oxford, ORCRB Roosevelt Drive, Headington, Oxford OX3 7DQ, UK
| | - Lynda Coughlan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
- Nuffield Department of Medicine, The Jenner Institute, University of Oxford, ORCRB Roosevelt Drive, Headington, Oxford OX3 7DQ, UK
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ADP-ribosylating enterotoxins as vaccine adjuvants. Curr Opin Pharmacol 2018; 41:42-51. [PMID: 29702466 DOI: 10.1016/j.coph.2018.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/30/2018] [Indexed: 01/18/2023]
Abstract
Most infections are caused by pathogens that access the body at mucosal sites. Hence, development of mucosal vaccines to prevent local infection or invasion of pathogens appears highly warranted, especially since only mucosal immunization will stimulate strong local IgA responses and tissue resident memory CD4 and CD8 T cells. The most significant obstacle to developing such vaccines is the lack of approved adjuvants that can effectively and safely enhance relevant mucosal and systemic immune responses. The most potent mucosal adjuvants known today are the adenosine diphosphate (ADP)-ribosylating bacterial enterotoxins cholera toxin (CT) and Escherichia coli heat-labile toxins (LTs). Unfortunately, these molecules are also very toxic, which precludes their clinical use. However, much effort has been devoted to developing derivatives of these enterotoxins with low or no toxicity and retained adjuvant activity. Although it is fair to say that we know more about how these toxins affect the immune system than ever before, we still lack a detailed understanding of how and why these toxins are effective adjuvants. In the present review, we provide a state-of-the-art overview of the mechanism of action of the holotoxins and the strategies used for improving the toxin-based adjuvants.
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9
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Taschuk R, Scruten E, Woodbury M, Cashman N, Potter A, Griebel P, Tikoo SK, Napper S. Induction of PrP Sc-specific systemic and mucosal immune responses in white-tailed deer with an oral vaccine for chronic wasting disease. Prion 2018; 11:368-380. [PMID: 28968152 PMCID: PMC5639826 DOI: 10.1080/19336896.2017.1367083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The ongoing epidemic of chronic wasting disease (CWD) within cervid populations indicates the need for novel approaches for disease management. A vaccine that either reduces susceptibility to infection or reduces shedding of prions by infected animals, or a combination of both, could be of benefit for disease control. The development of such a vaccine is challenged by the unique nature of prion diseases and the requirement for formulation and delivery in an oral format for application in wildlife settings. To address the unique nature of prions, our group targets epitopes, termed disease specific epitopes (DSEs), whose exposure for antibody binding depends on disease-associated misfolding of PrPC into PrPSc. Here, a DSE corresponding to the rigid loop (RL) region, which was immunogenic following parenteral vaccination, was translated into an oral vaccine. This vaccine consists of a replication-incompetent human adenovirus expressing a truncated rabies glycoprotein G recombinant fusion with the RL epitope (hAd5:tgG-RL). Oral immunization of white-tailed deer with hAd5:tgG-RL induced PrPSc-specific systemic and mucosal antibody responses with an encouraging safety profile in terms of no adverse health effects nor prolonged vector shedding. By building upon proven strategies of formulation for wildlife vaccines, these efforts generate a particular PrPSc-specific oral vaccine for CWD as well as providing a versatile platform, in terms of carrier protein and biological vector, for generation of other oral, peptide-based CWD vaccines.
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Affiliation(s)
- Ryan Taschuk
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada.,b School of Public Health, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Erin Scruten
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Murray Woodbury
- c Western College of Veterinary Medicine, University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Neil Cashman
- d Department of Neurology , University of British Columbia , Vancouver , BC , Canada
| | - Andrew Potter
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Philip Griebel
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada.,b School of Public Health, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Suresh K Tikoo
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada.,b School of Public Health, University of Saskatchewan , Saskatoon, Saskatchewan , Canada
| | - Scott Napper
- a Vaccine and Infectious Disease Organization, University of Saskatchewan , Saskatoon , Saskatchewan , Canada.,e Department of Biochemistry , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
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Xu H, Bao X, Lu Y, Liu Y, Deng B, Wang Y, Xu Y, Hou J. Immunogenicity of T7 bacteriophage nanoparticles displaying G-H loop of foot-and-mouth disease virus (FMDV). Vet Microbiol 2017. [PMID: 28622860 DOI: 10.1016/j.vetmic.2017.04.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals that causes severe economic losses worldwide. The G-H loop of the FMDV VP1 structural protein is the major neutralizing antigenic site. However, a fully protective G-H loop peptide vaccine requires the addition of promiscuous Th sites from a source outside VP1. Thus, we demonstrated the potential of T7 bacteriophage based nanoparticles displaying a genetically fused G-H loop peptide (T7-GH) as a FMDV vaccine candidate. Recombinant T7-GH phage was constructed by inserting the G-H loop coding region into the T7 Select 415-1b vector. Purified T7-GH phage nanoparticles were analyzed by SDS-PAGE, Western blot and Dot-ELISA. Pigs seronegative for FMDV exposure were immunized with T7-GH nanoparticles along with the adjuvant Montanide ISA206, and two commercially available FMDV vaccines (InactVac and PepVac). Humoral and cellular immune responses, as well as protection against virulent homologous virus challenge were assessed following single dose immunization. Pigs immunized T7-GH developed comparable anti-VP1 antibody titers to PepVac, although lower LPBE titers than was induced by InactVac. Antigen specific lymphocyte proliferation was detected in T7-GH group similar to that of PepVac group, however, weaker than InactVac group. Pigs immunized with T7-GH developed a neutralizing antibody response stronger than PepVac, but weaker than InactVac. Furthermore, 80% (4/5) of T7-GH immunized pigs were protected from challenge with virulent homologous virus. These findings demonstrate that the T7-GH phage nanoparticles were effective in eliciting antigen specific immune responses in pigs, highlighting the value of such an approach in the research and development of FMDV vaccines.
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Affiliation(s)
- Hai Xu
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, Jiangsu Province, China
| | - Xi Bao
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China
| | - Yu Lu
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, Jiangsu Province, China
| | - Yamei Liu
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China
| | - Bihua Deng
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China
| | - Yiwei Wang
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China
| | - Yue Xu
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China
| | - Jibo Hou
- National Research Center of Engineering and Technology for Veterinary Biologicals, Jiangsu Academy of Agricultural Science, Nanjing 210014, Jiangsu Province, China; Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, Jiangsu Province, China.
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11
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Lee JH, Kang IJ, Kim AR, Noh YS, Chung HC, Park BK. Increased humoral antibody response of foot-and-mouth disease virus vaccine in growing pigs pre-treated with poly-γ-glutamic acid. J Vet Sci 2017; 17:253-6. [PMID: 26645341 PMCID: PMC4921674 DOI: 10.4142/jvs.2016.17.2.253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/07/2015] [Accepted: 10/12/2015] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to determine if humoral antibody response of foot-and-mouth disease (FMD) vaccine improved in 8-week-old growing pigs born to well-vaccinated sows pre-treated with 60 mg of poly-γ-glutamic acid (γ-PGA) three days before vaccination. Antibody against FMD virus serotype O was measured 0, 2, 4 and 6 weeks post-vaccination, using a PrioCHECK FMDV type O ELISA kit. The results showed that positive antibody reactions against FMDV serotype O antigen among a component of the vaccine significantly increased in response to pre-injection with γ-PGA.
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Affiliation(s)
- Jee-Hoon Lee
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
| | - Ik-Jae Kang
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
| | - A-Reum Kim
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
| | - You-Sun Noh
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
| | - Hee-Chun Chung
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
| | - Bong-Kyun Park
- Department of Veterinary Medicine Virology, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Koreaiversity, Seoul 08826, Korea
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12
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Diaz-San Segundo F, Medina GN, Stenfeldt C, Arzt J, de Los Santos T. Foot-and-mouth disease vaccines. Vet Microbiol 2016; 206:102-112. [PMID: 28040311 DOI: 10.1016/j.vetmic.2016.12.018] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/04/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022]
Abstract
Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals. The disease affects many areas of the world, often causing extensive epizootics in livestock, mostly farmed cattle and swine, although sheep, goats and many wild species are also susceptible. In countries where food and farm animals are essential for subsistence agriculture, outbreaks of FMD seriously impact food security and development. In highly industrialized developed nations, FMD endemics cause economic and social devastation mainly due to observance of health measures adopted from the World Organization for Animal Health (OIE). High morbidity, complex host-range and broad genetic diversity make FMD prevention and control exceptionally challenging. In this article we review multiple vaccine approaches developed over the years ultimately aimed to successfully control and eradicate this feared disease.
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Affiliation(s)
- Fayna Diaz-San Segundo
- Foreign Animal Disease Research Unit (FADRU), Plum Island Animal Disease Center (PIADC), Agricultural Research Service (ARS), United States Department of Agriculture (USDA), Greenport, New York, USA; Department of Pathobiology and Veterinary Science, CANR, University of Connecticut, Storrs, CT 06269, USA.
| | - Gisselle N Medina
- Foreign Animal Disease Research Unit (FADRU), Plum Island Animal Disease Center (PIADC), Agricultural Research Service (ARS), United States Department of Agriculture (USDA), Greenport, New York, USA; PIADC Research Participation Program, Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Carolina Stenfeldt
- Foreign Animal Disease Research Unit (FADRU), Plum Island Animal Disease Center (PIADC), Agricultural Research Service (ARS), United States Department of Agriculture (USDA), Greenport, New York, USA; PIADC Research Participation Program, Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jonathan Arzt
- Foreign Animal Disease Research Unit (FADRU), Plum Island Animal Disease Center (PIADC), Agricultural Research Service (ARS), United States Department of Agriculture (USDA), Greenport, New York, USA
| | - Teresa de Los Santos
- Foreign Animal Disease Research Unit (FADRU), Plum Island Animal Disease Center (PIADC), Agricultural Research Service (ARS), United States Department of Agriculture (USDA), Greenport, New York, USA.
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13
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Zhang GG, Chen XY, Qian P, Chen HC, Li XM. Immunogenicity of a recombinant Sendai virus expressing the capsid precursor polypeptide of foot-and-mouth disease virus. Res Vet Sci 2016; 104:181-7. [DOI: 10.1016/j.rvsc.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 12/21/2022]
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14
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Synonymous Deoptimization of Foot-and-Mouth Disease Virus Causes Attenuation In Vivo while Inducing a Strong Neutralizing Antibody Response. J Virol 2015; 90:1298-310. [PMID: 26581977 DOI: 10.1128/jvi.02167-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/04/2015] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Codon bias deoptimization has been previously used to successfully attenuate human pathogens, including poliovirus, respiratory syncytial virus, and influenza virus. We have applied a similar technology to deoptimize the capsid-coding region (P1) of foot-and-mouth disease virus (FMDV). Despite the introduction of 489 nucleotide changes (19%), synonymous deoptimization of the P1 region rendered a viable FMDV progeny. The resulting strain was stable and reached cell culture titers similar to those obtained for wild-type (WT) virus, but at reduced specific infectivity. Studies in mice showed that 100% of animals inoculated with the FMDV A12 P1 deoptimized mutant (A12-P1 deopt) survived, even when the animals were infected at doses 100 times higher than the dose required to cause death by WT virus. All mice inoculated with the A12-P1 deopt mutant developed a strong antibody response and were protected against subsequent lethal challenge with WT virus at 21 days postinoculation. Remarkably, the vaccine safety margin was at least 1,000-fold higher for A12-P1 deopt than for WT virus. Similar patterns of attenuation were observed in swine, in which animals inoculated with A12-P1 deopt virus did not develop clinical disease until doses reached 1,000 to 10,000 times the dose required to cause severe disease in 2 days with WT A12. Consistently, high levels of antibody titers were induced, even at the lowest dose tested. These results highlight the potential use of synonymous codon pair deoptimization as a strategy to safely attenuate FMDV and further develop live attenuated vaccine candidates to control such a feared livestock disease. IMPORTANCE Foot-and-mouth disease (FMD) is one of the most feared viral diseases that can affect livestock. Although this disease appeared to be contained in developed nations by the end of the last century, recent outbreaks in Europe, Japan, Taiwan, South Korea, etc., have demonstrated that infection can spread rapidly, causing devastating economic and social consequences. The Global Foot-and-Mouth Disease Research Alliance (GFRA), an international organization launched in 2003, has set as part of their five main goals the development of next-generation control measures and strategies, including improved vaccines and biotherapeutics. Our work demonstrates that newly developed codon pair bias deoptimization technologies can be applied to FMD virus to obtain attenuated strains with potential for further development as novel live attenuated vaccine candidates that may rapidly control disease without reverting to virulence.
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15
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Srivastava A, Gowda DV, Madhunapantula SV, Shinde CG, Iyer M. Mucosal vaccines: a paradigm shift in the development of mucosal adjuvants and delivery vehicles. APMIS 2015; 123:275-88. [PMID: 25630573 DOI: 10.1111/apm.12351] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/05/2014] [Indexed: 12/25/2022]
Abstract
Mucosal immune responses are the first-line defensive mechanisms against a variety of infections. Therefore, immunizations of mucosal surfaces from which majority of infectious agents make their entry, helps to protect the body against infections. Hence, vaccinization of mucosal surfaces by using mucosal vaccines provides the basis for generating protective immunity both in the mucosal and systemic immune compartments. Mucosal vaccines offer several advantages over parenteral immunization. For example, (i) ease of administration; (ii) non-invasiveness; (iii) high-patient compliance; and (iv) suitability for mass vaccination. Despite these benefits, to date, only very few mucosal vaccines have been developed using whole microorganisms and approved for use in humans. This is due to various challenges associated with the development of an effective mucosal vaccine that can work against a variety of infections, and various problems concerned with the safe delivery of developed vaccine. For instance, protein antigen alone is not just sufficient enough for the optimal delivery of antigen(s) mucosally. Hence, efforts have been made to develop better prophylactic and therapeutic vaccines for improved mucosal Th1 and Th2 immune responses using an efficient and safe immunostimulatory molecule and novel delivery carriers. Therefore, in this review, we have made an attempt to cover the recent advancements in the development of adjuvants and delivery carriers for safe and effective mucosal vaccine production.
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Affiliation(s)
- Atul Srivastava
- Department of Pharmaceutics, JSS College of Pharmacy, JSS University, Mysore, India
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17
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Lee JA, Jung BG, Jung M, Kim TH, Yoo HS, Lee BJ. Dietary germanium biotite supplementation enhances the induction of antibody responses to foot-and-mouth disease virus vaccine in pigs. J Vet Sci 2014; 15:443-7. [PMID: 24690605 PMCID: PMC4178148 DOI: 10.4142/jvs.2014.15.3.443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/13/2014] [Indexed: 11/20/2022] Open
Abstract
We evaluated the potential ability of germanium biotite (GB) to stimulate the production of antibodies specific for foot-and-mouth disease virus (FMDV). To this aim, we measured the total FMDV-specific antibody responses and IgM production after vaccination against FMD both experimentally and in the field. GB supplementation with FMDV vaccination stimulated the production of anti-FMDV antibodies, and effectively increased IFN-γ and TNF-α levels. These results suggest that GB may be a novel alternative feed supplement that can serve as a boosting agent and an immunostimulator for increasing the efficacy of FMDV vaccination in pigs.
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Affiliation(s)
- Jin-A Lee
- Department of Veterinary Infectious Disease, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, Korea
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Kanagavelu S, Termini JM, Gupta S, Raffa FN, Fuller KA, Rivas Y, Philip S, Kornbluth RS, Stone GW. HIV-1 adenoviral vector vaccines expressing multi-trimeric BAFF and 4-1BBL enhance T cell mediated anti-viral immunity. PLoS One 2014; 9:e90100. [PMID: 24587225 PMCID: PMC3938597 DOI: 10.1371/journal.pone.0090100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/28/2014] [Indexed: 12/15/2022] Open
Abstract
Adenoviral vectored vaccines have shown considerable promise but could be improved by molecular adjuvants. Ligands in the TNF superfamily (TNFSF) are potential adjuvants for adenoviral vector (Ad5) vaccines based on their central role in adaptive immunity. Many TNFSF ligands require aggregation beyond the trimeric state (multi-trimerization) for optimal biological function. Here we describe Ad5 vaccines for HIV-1 Gag antigen (Ad5-Gag) adjuvanted with the TNFSF ligands 4-1BBL, BAFF, GITRL and CD27L constructed as soluble multi-trimeric proteins via fusion to Surfactant Protein D (SP-D) as a multimerization scaffold. Mice were vaccinated with Ad5-Gag combined with Ad5 expressing one of the SP-D-TNFSF constructs or single-chain IL-12p70 as adjuvant. To evaluate vaccine-induced protection, mice were challenged with vaccinia virus expressing Gag (vaccinia-Gag) which is known to target the female genital tract, a major route of sexually acquired HIV-1 infection. In this system, SP-D-4-1BBL or SP-D-BAFF led to significantly reduced vaccinia-Gag replication when compared to Ad5-Gag alone. In contrast, IL-12p70, SP-D-CD27L and SP-D-GITRL were not protective. Histological examination following vaccinia-Gag challenge showed a dramatic lymphocytic infiltration into the uterus and ovaries of SP-D-4-1BBL and SP-D-BAFF-treated animals. By day 5 post challenge, proinflammatory cytokines in the tissue were reduced, consistent with the enhanced control over viral replication. Splenocytes had no specific immune markers that correlated with protection induced by SP-D-4-1BBL and SP-D-BAFF versus other groups. IL-12p70, despite lack of anti-viral efficacy, increased the total numbers of splenic dextramer positive CD8+ T cells, effector memory T cells, and effector Gag-specific CD8+ T cells, suggesting that these markers are poor predictors of anti-viral immunity in this model. In conclusion, soluble multi-trimeric 4-1BBL and BAFF adjuvants led to strong protection from vaccinia-Gag challenge, but the protection was independent of standard immune markers. Soluble multi-trimeric SP-D-4-1BBL and SP-D-BAFF provide a novel technology to enhance adenoviral vector vaccines against HIV-1.
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Affiliation(s)
- Saravana Kanagavelu
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - James M. Termini
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Sachin Gupta
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Francesca N. Raffa
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Katherine A. Fuller
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Yaelis Rivas
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Sakhi Philip
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Richard S. Kornbluth
- Multimeric Biotherapeutics, Inc., La Jolla, California, United States of America
| | - Geoffrey W. Stone
- Department of Microbiology and Immunology, Miami Center for AIDS Research, and the Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
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