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Amanna IJ, Thomas A, Engelmann F, Hammarlund E, Raué HP, Bailey AL, Poore EA, Quintel BK, Lewis AD, Axthelm MK, Johnson AL, Colgin LMA, Diamond MS, Messaoudi I, Slifka MK. Development of a hydrogen peroxide-inactivated vaccine that protects against viscerotropic yellow fever in a non-human primate model. Cell Rep Med 2024; 5:101655. [PMID: 39019010 DOI: 10.1016/j.xcrm.2024.101655] [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: 11/13/2023] [Revised: 03/06/2024] [Accepted: 06/19/2024] [Indexed: 07/19/2024]
Abstract
Yellow fever virus (YFV) is endemic in >40 countries and causes viscerotropic disease with up to 20%-60% mortality. Successful live-attenuated yellow fever (YF) vaccines were developed in the mid-1930s, but their use is restricted or formally contraindicated in vulnerable populations including infants, the elderly, and people with compromised immune systems. In these studies, we describe the development of a next-generation hydrogen peroxide-inactivated YF vaccine and determine immune correlates of protection based on log neutralizing index (LNI) and neutralizing titer-50% (NT50) studies. In addition, we compare neutralizing antibody responses and protective efficacy of hydrogen peroxide-inactivated YF vaccine candidates to live-attenuated YFV-17D (YF-VAX) in a rhesus macaque model of viscerotropic YF. Our results indicate that an optimized, inactivated YF vaccine elicits protective antibody responses that prevent viral dissemination and lethal infection in rhesus macaques and may be a suitable alternative for vaccinating vulnerable populations who are not eligible to receive replicating live-attenuated YF vaccines.
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Affiliation(s)
- Ian J Amanna
- Najít Technologies, Inc., Beaverton, OR 97006, USA
| | - Archana Thomas
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Flora Engelmann
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY 40506, USA
| | - Erika Hammarlund
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Hans-Peter Raué
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Adam L Bailey
- Department of Pathology & Laboratory Medicine, University of Wisconsin - Madison, Madison, WI 53706, USA
| | | | | | - Anne D Lewis
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Michael K Axthelm
- Division of Pathobiology & Immunology, Oregon National Primate Research Center, and The Vaccine & Gene Therapy Institute, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Amanda L Johnson
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Lois M A Colgin
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA
| | - Michael S Diamond
- Departments of Medicine, Molecular Microbiology, Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ilhem Messaoudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, College of Medicine, Lexington, KY 40506, USA
| | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, USA.
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2
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Wu B, Qi Z, Qian X. Recent Advancements in Mosquito-Borne Flavivirus Vaccine Development. Viruses 2023; 15:813. [PMID: 37112794 PMCID: PMC10143207 DOI: 10.3390/v15040813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Lately, the global incidence of flavivirus infection has been increasing dramatically and presents formidable challenges for public health systems around the world. Most clinically significant flaviviruses are mosquito-borne, such as the four serotypes of dengue virus, Zika virus, West Nile virus, Japanese encephalitis virus and yellow fever virus. Until now, no effective antiflaviviral drugs are available to fight flaviviral infection; thus, a highly immunogenic vaccine would be the most effective weapon to control the diseases. In recent years, flavivirus vaccine research has made major breakthroughs with several vaccine candidates showing encouraging results in preclinical and clinical trials. This review summarizes the current advancement, safety, efficacy, advantages and disadvantages of vaccines against mosquito-borne flaviviruses posing significant threats to human health.
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Affiliation(s)
| | - Zhongtian Qi
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China;
| | - Xijing Qian
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China;
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3
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Huo X, Yan Y, Chang J, Su J. Astragalus polysaccharide or β-glucan combined with inactivated vaccine markedly prevent CyHV-2 infection in Carassius auratus gibelio. AQUACULTURE AND FISHERIES 2023. [DOI: 10.1016/j.aaf.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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4
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Slifka DK, Raué HP, Weber WC, Andoh TF, Kreklywich CN, DeFilippis VR, Streblow DN, Slifka MK, Amanna IJ. Development of a next-generation chikungunya virus vaccine based on the HydroVax platform. PLoS Pathog 2022; 18:e1010695. [PMID: 35788221 PMCID: PMC9286250 DOI: 10.1371/journal.ppat.1010695] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/15/2022] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Chikungunya virus (CHIKV) is an emerging/re-emerging mosquito-borne pathogen responsible for explosive epidemics of febrile illness characterized by debilitating polyarthralgia and the risk of lethal infection among the most severe cases. Despite the public health risk posed by CHIKV, no vaccine is currently available. Using a site-directed hydrogen peroxide-based inactivation approach, we developed a new CHIKV vaccine, HydroVax-CHIKV. This vaccine technology was compared to other common virus inactivation approaches including β-propiolactone (BPL), formaldehyde, heat, and ultraviolet (UV) irradiation. Heat, UV, and BPL were efficient at inactivating CHIKV-181/25 but caused substantial damage to neutralizing epitopes and failed to induce high-titer neutralizing antibodies in vaccinated mice. HydroVax-CHIKV and formaldehyde-inactivated CHIKV retained intact neutralizing epitopes similar to live virus controls but the HydroVax-CHIKV approach demonstrated a more rapid rate of virus inactivation. HydroVax-CHIKV vaccination induced high neutralizing responses to homologous and heterologous CHIKV clades as well as to other alphaviruses including Mayaro virus, O’nyong’nyong virus, and Una virus. Following heterologous infection with CHIKV-SL15649, HydroVax-CHIKV-immunized mice were protected against viremia, CHIKV-associated arthritic disease, and lethal CHIKV infection by an antibody-dependent mechanism. In contrast, animals vaccinated with Heat- or UV-inactivated virus showed no protection against viremia in addition to demonstrating significantly exacerbated CD4+ T cell-mediated footpad swelling after CHIKV infection. Together, these results demonstrate the risks associated with using suboptimal inactivation methods that fail to elicit protective neutralizing antibody responses and show that HydroVax-CHIKV represents a promising new vaccine candidate for prevention of CHIKV-associated disease. Chikungunya virus (CHIKV) is a mosquito-borne virus that has gained significant attention due to its ability to cause large epidemics and to spread beyond endemic countries through international travelers. Despite substantial efforts over the course of many years, a licensed CHIKV vaccine remains unavailable for protecting at-risk populations. Our research group has established an advanced site-directed oxidation system, termed HydroVax, for the development of new vaccines. Here, we describe a novel CHIKV vaccine that utilizes this peroxide-based vaccine platform and demonstrates greatly improved antiviral immunity compared to other traditional virus inactivation approaches as well as complete protection against viremia, CHIKV-associated arthritic disease and lethal CHIKV infection in robust preclinical mouse models. The HydroVax-CHIKV vaccine not only induced neutralizing antibodies to geographically diverse strains of CHIKV, but also elicited neutralizing antibody responses to other clinically important alphaviruses including, Mayaro, O’nyong’nyong, and Una virus. Together, this indicates that this vaccine not only protects against CHIKV infection but may potentially provide immunity across a broader range of virulent alphaviruses as well.
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Affiliation(s)
- Dawn K. Slifka
- Najít Technologies, Incorporated, Beaverton, Oregon, United States of America
| | - Hans-Peter Raué
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Whitney C. Weber
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Takeshi F. Andoh
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Craig N. Kreklywich
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Victor R. DeFilippis
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Daniel N. Streblow
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon, United States of America
- Division of Pathobiology and Immunology, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Mark K. Slifka
- Najít Technologies, Incorporated, Beaverton, Oregon, United States of America
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Oregon, United States of America
| | - Ian J. Amanna
- Najít Technologies, Incorporated, Beaverton, Oregon, United States of America
- * E-mail:
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5
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He C, Yang J, Zhao H, Liu M, Wu D, Liu B, He S, Chen Z. Vaccination with a Brucella ghost developed through a double inactivation strategy provides protection in Guinea pigs and cattle. Microb Pathog 2021; 162:105363. [PMID: 34919994 DOI: 10.1016/j.micpath.2021.105363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 01/19/2023]
Abstract
Vaccination can prevent and control animal brucellosis. Currently, live attenuated vaccines are extensively used to prevent Brucella infection. However, traditional vaccines such as live attenuated vaccines are associated with biological safety risks for both humans and animals. The bacterial ghost (BG) is a new form of vaccine with great prospects. However, bacterial cells cannot be completely inactivated by biological lysis, conferring a safety risk associated with the vaccine. In this study, we developed a Brucella abortus A19 bacterial ghost (A19BG) through a double inactivation strategy with sequential biological lysis and hydrogen peroxide treatment. This strategy resulted in 100% inactivation of Brucella, such that viable bacterial cells were not detected even at an ultrahigh concentration of 1010 colony-forming units/mL. Furthermore, A19BG had a typical BG morphology and good genetic stability. Moreover, it did not induce adverse reactions in guinea pigs. The levels of antibodies, interferon-γ, interleukin-4, and CD4+ T cells in guinea pigs inoculated with the A19BG vaccine were similar to those inoculated with the existing A19 vaccine. Immunization with A19BG conferred a similar level of protection with that of A19 against Brucella melitensis M28 in both guinea pigs and cattle. In conclusion, the combination of biological lysis and H2O2-mediated inactivation is a safe and effective strategy that can serve as a reference for the preparation of BG vaccines.
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Affiliation(s)
- Chuanyu He
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Liaoning Province, Shenyang, 110866, PR China; Tecon Biological Co, Ltd, Urumqi, 830011, PR China
| | - Jianghua Yang
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Liaoning Province, Shenyang, 110866, PR China
| | - Hailong Zhao
- Tecon Biological Co, Ltd, Urumqi, 830011, PR China
| | - Mengzhi Liu
- Tecon Biological Co, Ltd, Urumqi, 830011, PR China
| | - Dongling Wu
- Tecon Biological Co, Ltd, Urumqi, 830011, PR China
| | - Baoshan Liu
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Liaoning Province, Shenyang, 110866, PR China.
| | - Sun He
- Tecon Biological Co, Ltd, Urumqi, 830011, PR China.
| | - Zeliang Chen
- Key Laboratory of Livestock Infectious Diseases in Northeast China, Ministry of Education, College of Animal Science and Veterinary Medicine, Shenyang Agricultural University, Liaoning Province, Shenyang, 110866, PR China; Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, PR China; Brucellosis Prevention and Treatment Engineering Technology Research Center of Inner Mongolia Autonomous Region, Inner Mongolia University for Nationalities, Tongliao, 028000, PR China; School of Public Health, Sun Yat-sen University, Guangzhou, 510275, PR China.
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6
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Chitrakar B, Zhang M, Bhandari B. Improvement strategies of food supply chain through novel food processing technologies during COVID-19 pandemic. Food Control 2021; 125:108010. [PMID: 33679006 PMCID: PMC7914018 DOI: 10.1016/j.foodcont.2021.108010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Coronavirus disease-19 (COVID-19) is a contagious disease caused by a novel corona virus (SARS-CoV-2). No medical intervention has yet succeeded, though vaccine success is expected soon. However, it may take months or years to reach the vaccine to the whole population of the world. Therefore, the technological preparedness is worth to discuss for the smooth running of food processing activities. We have explained the impact of the COVID-19 pandemic on the food supply chain (FSC) and then discussed the technological interventions to overcome these impacts. The novel and smart technologies during food processing to minimize human-to-human and human-to-food contact were compiled. The potential virus-decontamination technologies were also discussed. Finally, we concluded that these technologies would make food processing activities smarter, which would ultimately help to run the FSC smoothly during COVID-19 pandemic.
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Affiliation(s)
- Bimal Chitrakar
- State Key Laboratory of Food Science and Technology, Jiangnan University, 214122, Wuxi, Jiangsu, China
| | - Min Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, 214122, Wuxi, Jiangsu, China.,International Joint Laboratory on Food Safety, Jiangnan University, 214122, Wuxi, Jiangsu, China
| | - Bhesh Bhandari
- School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
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7
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Dussupt V, Modjarrad K, Krebs SJ. Landscape of Monoclonal Antibodies Targeting Zika and Dengue: Therapeutic Solutions and Critical Insights for Vaccine Development. Front Immunol 2021; 11:621043. [PMID: 33664734 PMCID: PMC7921836 DOI: 10.3389/fimmu.2020.621043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/14/2020] [Indexed: 01/23/2023] Open
Abstract
The unprecedented 2015-2016 Zika outbreak in the Americas sparked global concern and drove the rapid deployment of vaccine and therapeutic countermeasures against this re-emerging pathogen. Alongside vaccine development, a number of potent neutralizing antibodies against Zika and related flaviviruses have been identified in recent years. High-throughput antibody isolation approaches have contributed to a better understanding of the B cell responses elicited following infection and/or vaccination. Structure-based approaches have illuminated species-specific and cross-protective epitopes of therapeutic value. This review will highlight previously described monoclonal antibodies with the best therapeutic potential against ZIKV and related flaviviruses, and discuss their implications for the rational design of better vaccine strategies.
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Affiliation(s)
- Vincent Dussupt
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Shelly J. Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
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8
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Hobson-Peters J, Harrison JJ, Watterson D, Hazlewood JE, Vet LJ, Newton ND, Warrilow D, Colmant AMG, Taylor C, Huang B, Piyasena TBH, Chow WK, Setoh YX, Tang B, Nakayama E, Yan K, Amarilla AA, Wheatley S, Moore PR, Finger M, Kurucz N, Modhiran N, Young PR, Khromykh AA, Bielefeldt-Ohmann H, Suhrbier A, Hall RA. A recombinant platform for flavivirus vaccines and diagnostics using chimeras of a new insect-specific virus. Sci Transl Med 2020; 11:11/522/eaax7888. [PMID: 31826984 DOI: 10.1126/scitranslmed.aax7888] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
Abstract
Flaviviruses such as dengue, yellow fever, Zika, West Nile, and Japanese encephalitis virus present substantial global health burdens. New vaccines are being sought to address safety and manufacturing issues associated with current live attenuated vaccines. Here, we describe a new insect-specific flavivirus, Binjari virus, which was found to be remarkably tolerant for exchange of its structural protein genes (prME) with those of the aforementioned pathogenic vertebrate-infecting flaviviruses (VIFs). Chimeric BinJ/VIF-prME viruses remained replication defective in vertebrate cells but replicated with high efficiency in mosquito cells. Cryo-electron microscopy and monoclonal antibody binding studies illustrated that the chimeric BinJ/VIF-prME virus particles were structurally and immunologically similar to their parental VIFs. Pilot manufacturing in C6/36 cells suggests that high yields can be reached up to 109.5 cell culture infectious dose/ml or ≈7 mg/liter. BinJ/VIF-prME viruses showed utility in diagnostic (microsphere immunoassays and ELISAs using panels of human and equine sera) and vaccine applications (illustrating protection against Zika virus challenge in murine IFNAR-/- mouse models). BinJ/VIF-prME viruses thus represent a versatile, noninfectious (for vertebrate cells), high-yield technology for generating chimeric flavivirus particles with low biocontainment requirements.
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Affiliation(s)
- Jody Hobson-Peters
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
| | - Jessica J Harrison
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Daniel Watterson
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Jessamine E Hazlewood
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | - Laura J Vet
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Natalee D Newton
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - David Warrilow
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Agathe M G Colmant
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Carmel Taylor
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Bixing Huang
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Thisun B H Piyasena
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Weng Kong Chow
- Australian Defence Force Malaria and Infectious Disease Institute, Gallipoli Barracks, Queensland, Australia
| | - Yin Xiang Setoh
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Bing Tang
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | - Eri Nakayama
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kexin Yan
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | - Alberto A Amarilla
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Sarah Wheatley
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Peter R Moore
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Mitchell Finger
- Public Health Virology Laboratory, Department of Health, Queensland Government, PO Box 594, Archerfield, Queensland, Australia
| | - Nina Kurucz
- Centre for Disease Control, Health Protection Division, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Naphak Modhiran
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Paul R Young
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Alexander A Khromykh
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia
| | - Helle Bielefeldt-Ohmann
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.,School of Veterinary Science, University of Queensland Gatton Campus, Queensland 4343, Australia
| | - Andreas Suhrbier
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.,Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | - Roy A Hall
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St. Lucia, Queensland, Australia.
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Trovato M, Sartorius R, D’Apice L, Manco R, De Berardinis P. Viral Emerging Diseases: Challenges in Developing Vaccination Strategies. Front Immunol 2020; 11:2130. [PMID: 33013898 PMCID: PMC7494754 DOI: 10.3389/fimmu.2020.02130] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
In the last decades, a number of infectious viruses have emerged from wildlife or re-emerged, generating serious threats to the global health and to the economy worldwide. Ebola and Marburg hemorrhagic fevers, Lassa fever, Dengue fever, Yellow fever, West Nile fever, Zika, and Chikungunya vector-borne diseases, Swine flu, Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the recent Coronavirus disease 2019 (COVID-19) are examples of zoonoses that have spread throughout the globe with such a significant impact on public health that the scientific community has been called for a rapid intervention in preventing and treating emerging infections. Vaccination is probably the most effective tool in helping the immune system to activate protective responses against pathogens, reducing morbidity and mortality, as proven by historical records. Under health emergency conditions, new and alternative approaches in vaccine design and development are imperative for a rapid and massive vaccination coverage, to manage a disease outbreak and curtail the epidemic spread. This review gives an update on the current vaccination strategies for some of the emerging/re-emerging viruses, and discusses challenges and hurdles to overcome for developing efficacious vaccines against future pathogens.
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MESH Headings
- Animals
- Antibody-Dependent Enhancement/immunology
- Betacoronavirus/immunology
- COVID-19
- COVID-19 Vaccines
- Communicable Diseases, Emerging/prevention & control
- Communicable Diseases, Emerging/virology
- Coronavirus Infections/immunology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Coronavirus Infections/virology
- Cross Reactions/immunology
- Humans
- Immunization, Passive
- Pandemics/prevention & control
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- Pneumonia, Viral/virology
- SARS-CoV-2
- Vaccination
- Vaccines, Attenuated/immunology
- Vaccines, DNA/immunology
- Vaccines, Inactivated/immunology
- Vaccines, Subunit/immunology
- Viral Vaccines/immunology
- COVID-19 Serotherapy
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Affiliation(s)
- Maria Trovato
- Institute of Biochemistry and Cell Biology, National Research Council, Naples, Italy
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10
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Nguyen W, Nakayama E, Yan K, Tang B, Le TT, Liu L, Cooper TH, Hayball JD, Faddy HM, Warrilow D, Allcock RJN, Hobson-Peters J, Hall RA, Rawle DJ, Lutzky VP, Young P, Oliveira NM, Hartel G, Howley PM, Prow NA, Suhrbier A. Arthritogenic Alphavirus Vaccines: Serogrouping Versus Cross-Protection in Mouse Models. Vaccines (Basel) 2020; 8:vaccines8020209. [PMID: 32380760 PMCID: PMC7349283 DOI: 10.3390/vaccines8020209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/12/2022] Open
Abstract
Chikungunya virus (CHIKV), Ross River virus (RRV), o’nyong nyong virus (ONNV), Mayaro virus (MAYV) and Getah virus (GETV) represent arthritogenic alphaviruses belonging to the Semliki Forest virus antigenic complex. Antibodies raised against one of these viruses can cross-react with other serogroup members, suggesting that, for instance, a CHIKV vaccine (deemed commercially viable) might provide cross-protection against antigenically related alphaviruses. Herein we use human alphavirus isolates (including a new human RRV isolate) and wild-type mice to explore whether infection with one virus leads to cross-protection against viremia after challenge with other members of the antigenic complex. Persistently infected Rag1-/- mice were also used to assess the cross-protective capacity of convalescent CHIKV serum. We also assessed the ability of a recombinant poxvirus-based CHIKV vaccine and a commercially available formalin-fixed, whole-virus GETV vaccine to induce cross-protective responses. Although cross-protection and/or cross-reactivity were clearly evident, they were not universal and were often suboptimal. Even for the more closely related viruses (e.g., CHIKV and ONNV, or RRV and GETV), vaccine-mediated neutralization and/or protection against the intended homologous target was significantly more effective than cross-neutralization and/or cross-protection against the heterologous virus. Effective vaccine-mediated cross-protection would thus likely require a higher dose and/or more vaccinations, which is likely to be unattractive to regulators and vaccine manufacturers.
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Affiliation(s)
- Wilson Nguyen
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Eri Nakayama
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
- Department of Virology I, National Institute of Infectious Diseases, Tokyo 162-0052, Japan
| | - Kexin Yan
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Bing Tang
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Thuy T. Le
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Liang Liu
- Experimental Therapeutics Laboratory, School of Pharmacy & Medical Sciences, University of South Australia Cancer Research Institute, SA 5000, Australia; (L.L.); (T.H.C.); (J.D.H.)
| | - Tamara H. Cooper
- Experimental Therapeutics Laboratory, School of Pharmacy & Medical Sciences, University of South Australia Cancer Research Institute, SA 5000, Australia; (L.L.); (T.H.C.); (J.D.H.)
| | - John D. Hayball
- Experimental Therapeutics Laboratory, School of Pharmacy & Medical Sciences, University of South Australia Cancer Research Institute, SA 5000, Australia; (L.L.); (T.H.C.); (J.D.H.)
| | - Helen M. Faddy
- Research and Development Laboratory, Australian Red Cross Lifeblood, Kelvin Grove, Qld 4059, Australia;
| | - David Warrilow
- Public Health Virology Laboratory, Queensland Health Forensic and Scientific Services, PO Box 594, Archerfield, Qld 4108, Australia;
| | - Richard J. N. Allcock
- School of Biomedical Sciences, University of Western Australia, Crawley 6009, Australia;
| | - Jody Hobson-Peters
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Qld 4072, Australia; (J.H.-P.); (R.A.H.); (P.Y.)
| | - Roy A. Hall
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Qld 4072, Australia; (J.H.-P.); (R.A.H.); (P.Y.)
- Australian Infectious Disease Research Centre, Brisbane, Qld 4027 & 4072, Australia
| | - Daniel J. Rawle
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Viviana P. Lutzky
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
| | - Paul Young
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Qld 4072, Australia; (J.H.-P.); (R.A.H.); (P.Y.)
- Australian Infectious Disease Research Centre, Brisbane, Qld 4027 & 4072, Australia
| | - Nidia M. Oliveira
- Deptartment of Microbiology, University of Western Australia, Perth, WA 6009, Australia;
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Qld 4029, Australia;
| | | | - Natalie A. Prow
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
- Experimental Therapeutics Laboratory, School of Pharmacy & Medical Sciences, University of South Australia Cancer Research Institute, SA 5000, Australia; (L.L.); (T.H.C.); (J.D.H.)
- Australian Infectious Disease Research Centre, Brisbane, Qld 4027 & 4072, Australia
- Correspondence: (N.A.P.); (A.S.)
| | - Andreas Suhrbier
- Inflammation Biology Group, QIMR Berghofer Medical Research Institute, Brisbane 4029, Australia; (W.N.); (E.N.); (K.Y.); (B.T.); (T.T.L.); (D.J.R.); (V.P.L.)
- Australian Infectious Disease Research Centre, Brisbane, Qld 4027 & 4072, Australia
- Correspondence: (N.A.P.); (A.S.)
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11
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Gore MM. Vaccines Against Dengue and West Nile Viruses in India: The Need of the Hour. Viral Immunol 2020; 33:423-433. [PMID: 32320353 DOI: 10.1089/vim.2019.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The circulation of flaviviruses, dengue (DEN), Japanese encephalitis (JE) and West Nile (WN) viruses, and others, is generating a major concern in many countries. Both JE along with DEN have been endemic in large regions of India. WN virus infection, although circulating in southern regions for many years, in recent years, WN encephalitis patients have been demonstrated. While vaccines against JE have been developed and decrease outbreaks, in case of DEN and WN, vaccines are still in developing level, especially, it has been difficult to achieve the long-term protective immune response. The first licensed DEN vaccine, which is a live attenuated vaccine, was administered in countries where the virus is endemic, and has a potential to cause serious side effects, especially when administered to younger population as observed in the Philippines vaccination drive. In the case of WN, although the purified inactivated virion-based vaccine worked effectively as a veterinary vaccine for horses, no effective vaccine has yet been licensed for humans. The induction of CD4+ and CD8+ T cell responses is essential to complete protection by these viruses, as evidenced by responses to asymptomatic infections. Many studies have shown that neutralizing antibody (NAb) response is against surface structural proteins; CD4+ and CD8+ responses are mainly directed against nonstructural proteins rather than NAb response. New data suggest that encapsulating virus vaccines in nanoparticles (NPs) will direct antigen in cytoplasmic compartment by antigen-presenting cells, which will improve presentation to CD4+ and CD8+ T cells. Since tissue culture-derived, purified inactivated viruses are easier to manufacture and safer than developing live virus vaccines, inclusion of NP provides an attractive alternative for generating robust flaviviral vaccines that are affordable with long-lived protection.
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Affiliation(s)
- Milind M Gore
- Emeritus Scientist, ICMR-National Institute of Virology, Pune, India
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12
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Liu Y, Xiao J, Zhang B, Shelite TR, Su Z, Chang Q, Judy B, Li X, Drelich A, Bei J, Zhou Y, Zheng J, Jin Y, Rossi SL, Tang SJ, Wakamiya M, Saito T, Ksiazek T, Kaphalia B, Gong B. Increased talin-vinculin spatial proximities in livers in response to spotted fever group rickettsial and Ebola virus infections. J Transl Med 2020; 100:1030-1041. [PMID: 32238906 PMCID: PMC7111589 DOI: 10.1038/s41374-020-0420-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022] Open
Abstract
Talin and vinculin, both actin-cytoskeleton-related proteins, have been documented to participate in establishing bacterial infections, respectively, as the adapter protein to mediate cytoskeleton-driven dynamics of the plasma membrane. However, little is known regarding the potential role of the talin-vinculin complex during spotted fever group rickettsial and Ebola virus infections, two dreadful infectious diseases in humans. Many functional properties of proteins are determined by their participation in protein-protein complexes, in a temporal and/or spatial manner. To resolve the limitation of application in using mouse primary antibodies on archival, multiple formalin-fixed mouse tissue samples, which were collected from experiments requiring high biocontainment, we developed a practical strategic proximity ligation assay (PLA) capable of employing one primary antibody raised in mouse to probe talin-vinculin spatial proximal complex in mouse tissue. We observed an increase of talin-vinculin spatial proximities in the livers of spotted fever Rickettsia australis or Ebola virus-infected mice when compared with mock mice. Furthermore, using EPAC1-knockout mice, we found that deletion of EPAC1 could suppress the formation of spatial proximal complex of talin-vinculin in rickettsial infections. In addition, we observed increased colocalization between spatial proximity of talin-vinculin and filamentous actin-specific phalloidin staining in single survival mouse from an ordinarily lethal dose of rickettsial or Ebola virus infection. These findings may help to delineate a fresh insight into the mechanisms underlying liver specific pathogenesis during infection with spotted fever rickettsia or Ebola virus in the mouse model.
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Affiliation(s)
- Yakun Liu
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Jie Xiao
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Ben Zhang
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Thomas R. Shelite
- 0000 0001 1547 9964grid.176731.5Department of Internal Medicine, Infectious Diseases, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Zhengchen Su
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Qing Chang
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Barbara Judy
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Xiang Li
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Aleksandra Drelich
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Jiani Bei
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA ,0000 0004 0532 1428grid.265231.1Present Address: Life Science Department, Tunghai University, Taichung City, Taiwan
| | - Yixuan Zhou
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA ,0000 0004 0369 1599grid.411525.6Present Address: Department of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Junying Zheng
- 0000 0001 1547 9964grid.176731.5Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Yang Jin
- 0000 0004 1936 7558grid.189504.1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Boston University Medical Campus, Boston, MA USA
| | - Shannan L. Rossi
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Shao-Jun Tang
- 0000 0001 1547 9964grid.176731.5Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Maki Wakamiya
- 0000 0001 1547 9964grid.176731.5Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Tais Saito
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Thomas Ksiazek
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Bhupendra Kaphalia
- 0000 0001 1547 9964grid.176731.5Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Bin Gong
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, 77555, USA.
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13
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Kaiser JA, Barrett ADT. Twenty Years of Progress Toward West Nile Virus Vaccine Development. Viruses 2019; 11:E823. [PMID: 31491885 PMCID: PMC6784102 DOI: 10.3390/v11090823] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Although West Nile virus (WNV) has been a prominent mosquito-transmitted infection in North America for twenty years, no human vaccine has been licensed. With a cumulative number of 24,714 neurological disease cases and 2314 deaths in the U.S. since 1999, plus a large outbreak in Europe in 2018 involving over 2000 human cases in 15 countries, a vaccine is essential to prevent continued morbidity, mortality, and economic burden. Currently, four veterinary vaccines are licensed, and six vaccines have progressed into clinical trials in humans. All four veterinary vaccines require multiple primary doses and annual boosters, but for a human vaccine to be protective and cost effective in the most vulnerable older age population, it is ideal that the vaccine be strongly immunogenic with only a single dose and without subsequent annual boosters. Of six human vaccine candidates, the two live, attenuated vaccines were the only ones that elicited strong immunity after a single dose. As none of these candidates have yet progressed beyond phase II clinical trials, development of new candidate vaccines and improvement of vaccination strategies remains an important area of research.
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Affiliation(s)
- Jaclyn A Kaiser
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alan D T Barrett
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA.
- Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA.
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14
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Woods CW, Sanchez AM, Swamy GK, McClain MT, Harrington L, Freeman D, Poore EA, Slifka DK, Poer DeRaad DE, Amanna IJ, Slifka MK, Cai S, Shahamatdar V, Wierzbicki MR, Amegashie C, Walter EB. An observer blinded, randomized, placebo-controlled, phase I dose escalation trial to evaluate the safety and immunogenicity of an inactivated West Nile virus Vaccine, HydroVax-001, in healthy adults. Vaccine 2019; 37:4222-4230. [PMID: 30661836 PMCID: PMC6640644 DOI: 10.1016/j.vaccine.2018.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/08/2023]
Abstract
Background West Nile virus (WNV) is the most common mosquito-borne infection in the United States. HydroVax-001 WNV is a hydrogen peroxide inactivated, whole virion (WNV-Kunjin strain) vaccine adjuvanted with aluminum hydroxide. Methods We performed a phase 1, randomized, placebo-controlled, double-blind (within dosing group), dose escalation clinical trial of the HydroVax-001 WNV vaccine administered via intramuscular injection. This trial evaluated 1 mcg and 4 mcg dosages of HydroVax-001 WNV vaccine given intramuscularly on day 1 and day 29 in healthy adults. The two dosing groups of HydroVax-001 were enrolled sequentially and each group consisted of 20 individuals who received HydroVax-001 and 5 who received placebo. Safety was assessed at all study days (days 1, 2, 4 and 15 post dose 1, and days 1, 2, 4, 15, 29, 57, 180 and 365 post dose 2), and reactogenicity was assessed for 14 days after administration of each dose. Immunogenicity was measured by WNV-specific plaque reduction neutralization tests (PRNT50) in the presence or absence of added complement or by WNV-specific enzyme-linked immunosorbent assays (ELISA). Results HydroVax-001 was safe and well-tolerated as there were no serious adverse events or concerning safety signals. At the 1 mcg dose, HydroVax-001 was not immunogenic by PRNT50 but elicited up to 41% seroconversion by WNV-specific ELISA in the per-protocol population (PP) after the second dose. At the 4 mcg dose, HydroVax-001 elicited neutralizing antibody responses in 31% of the PP following the second dose. In the presence of added complement, PRNT50 seroconversion rates increased to 50%, and 75% seroconversion was observed by WNV-specific ELISA. Conclusions The HydroVax-001 WNV vaccine was found to be modestly immunogenic and welltolerated at all dose levels.
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Affiliation(s)
- Christopher W Woods
- Duke Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Ana M Sanchez
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Geeta K Swamy
- Duke Department of Gynecology and Obstetrics, Duke University School of Medicine, Durham, NC, USA
| | - Micah T McClain
- Duke Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lynn Harrington
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
| | - Debra Freeman
- Duke Early Phase Research Unit, Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | - Mark K Slifka
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Shu Cai
- National Institutes of Health, Division of Microbiology and Infectious Diseases, Bethesda, MD, USA
| | - Venus Shahamatdar
- National Institutes of Health, Division of Microbiology and Infectious Diseases, Bethesda, MD, USA
| | | | | | - Emmanuel B Walter
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA
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