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Keating SM, Higgins BW. New technologies in therapeutic antibody development: The next frontier for treating infectious diseases. Antiviral Res 2024; 227:105902. [PMID: 38734210 DOI: 10.1016/j.antiviral.2024.105902] [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: 01/29/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
Adaptive immunity to viral infections requires time to neutralize and clear viruses to resolve infection. Fast growing and pathogenic viruses are quickly established, are highly transmissible and cause significant disease burden making it difficult to mount effective responses, thereby prolonging infection. Antibody-based passive immunotherapies can provide initial protection during acute infection, assist in mounting an adaptive immune response, or provide protection for those who are immune suppressed or immune deficient. Historically, plasma-derived antibodies have demonstrated some success in treating diseases caused by viral pathogens; nonetheless, limitations in access to product and antibody titer reduce success of this treatment modality. Monoclonal antibodies (mAbs) have proven an effective alternative, as it is possible to manufacture highly potent and specific mAbs against viral targets on an industrial scale. As a result, innovative technologies to discover, engineer and manufacture specific and potent antibodies have become an essential part of the first line of treatment in pathogenic viral infections. However, a mAb targeting a specific epitope will allow escape variants to outgrow, causing new variant strains to become dominant and resistant to treatment with that mAb. Methods to mitigate escape have included combining mAbs into cocktails, creating bi-specific or antibody drug conjugates but these strategies have also been challenged by the potential development of escape mutations. New technologies in developing antibodies made as recombinant polyclonal drugs can integrate the strength of poly-specific antibody responses to prevent mutational escape, while also incorporating antibody engineering to prevent antibody dependent enhancement and direct adaptive immune responses.
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Affiliation(s)
- Sheila M Keating
- GigaGen, Inc. (A Grifols Company), 75 Shoreway Road, San Carlos, CA, 94070, USA.
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Terheyden P, Sunderkötter C, Söhngen FD, Golle L, Schimo S, Baron R, Maihöfner C, Binder A, Pönisch W. Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series. Dermatol Ther (Heidelb) 2023; 13:2461-2471. [PMID: 37704912 PMCID: PMC10539245 DOI: 10.1007/s13555-023-01019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Immunocompromised patients are at increased risk for herpes zoster (HZ)-associated complications. Despite standard therapy with systemic antiviral drugs and analgesics, complications are frequently encountered, including generalization of lesions or persistent neuropathic pain, so-called post-herpetic neuralgia (PHN). Given the scarcity of literature and awareness of therapeutic options to improve patient outcomes, especially for vulnerable patient groups, here we describe a strategy based on early intensification of treatment with a varicella zoster virus-specific hyperimmunoglobulin (VZV-IgG), which is approved in the adjuvant treatment of HZ. METHODS For this case series, we selected four cases of HZ in patients with impaired immunity due to hemato-oncologic disease or immunosuppressive treatment who presented with either existing generalized lesions and/or severe pain or with other risk factors for a complicated HZ course such as PHN. They were considered to be representative examples of different patient profiles eligible for intensification of treatment by the addition of VZV-IgG to virostatic therapy. CASE REPORT All patients showed a rapid response to combined treatment with VZV-IgG and a virostatic agent. In two patients who had generalized lesions, the formation of new lesions ceased 1 day after VZV-IgG infusion. One patient, with mantle cell lymphoma, achieved complete healing of the lesions 9 days after diagnosis of HZ, a rare occurrence compared to similar cases or cohorts. A patient with HZ in the cervical region showed a good response after a single dose of VZV-IgG. None of the patients developed post-zoster-related complications. Combination therapy of a virostatic agent and VZV-IgG was well tolerated in these four cases. CONCLUSION This case series demonstrates highly satisfactory treatment effectiveness and tolerability for VZV-IgG in the adjuvant treatment of immunocompromised HZ patients and supports early intensification of HZ therapy in patients at high risk of severe disease progression.
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Affiliation(s)
| | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Franz-Dietmar Söhngen
- Department of Hematology and Oncology, Hospital Altenburger Land GmbH, Altenburg, Germany
| | - Linda Golle
- Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sonja Schimo
- Biotest AG, Landsteinerstraße 5, 63303, Dreieich, Hessen, Germany.
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christian Maihöfner
- Department of Neurology, General Fürth Hospital, University of Erlangen, Fürth, Germany
| | - Andreas Binder
- Department of Neurology, Hospital Saarbrücken gGmbH, Saarbrücken, Germany
| | - Wolfram Pönisch
- Hematology and Cell Therapy, Medical Clinic and Policlinic 1, University Hospital Leipzig, University of Leipzig, Leipzig, Germany
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He X, He C, Hong W, Yang J, Wei X. Research progress in spike mutations of SARS-CoV-2 variants and vaccine development. Med Res Rev 2023. [PMID: 36929527 DOI: 10.1002/med.21941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 09/27/2022] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic can hardly end with the emergence of different variants over time. In the past 2 years, several variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), such as the Delta and Omicron variants, have emerged with higher transmissibility, immune evasion and drug resistance, leading to higher morbidity and mortality in the population. The prevalent variants of concern (VOCs) share several mutations on the spike that can affect virus characteristics, including transmissibility, antigenicity, and immune evasion. Increasing evidence has demonstrated that the neutralization capacity of sera from COVID-19 convalescent or vaccinated individuals is decreased against SARS-CoV-2 variants. Moreover, the vaccine effectiveness of current COVID-19 vaccines against SARS-CoV-2 VOCs is not as high as that against wild-type SARS-CoV-2. Therefore, more attention might be paid to how the mutations impact vaccine effectiveness. In this review, we summarized the current studies on the mutations of the SARS-CoV-2 spike, particularly of the receptor binding domain, to elaborate on how the mutations impact the infectivity, transmissibility and immune evasion of the virus. The effects of mutations in the SARS-CoV-2 spike on the current therapeutics were highlighted, and potential strategies for future vaccine development were suggested.
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Affiliation(s)
- Xuemei He
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cai He
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingyun Yang
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mizrahi RA, Lin WY, Gras A, Niedecken AR, Wagner EK, Keating SM, Ikon N, Manickam VA, Asensio MA, Leong J, Medina-Cucurella AV, Benzie E, Carter KP, Chiang Y, Edgar RC, Leong R, Lim YW, Simons JF, Spindler MJ, Stadtmiller K, Wayham N, Büscher D, Terencio JV, Germanio CD, Chamow SM, Olson C, Pino PA, Park JG, Hicks A, Ye C, Garcia-Vilanova A, Martinez-Sobrido L, Torrelles JB, Johnson DS, Adler AS. GMP Manufacturing and IND-Enabling Studies of a Recombinant Hyperimmune Globulin Targeting SARS-CoV-2. Pathogens 2022; 11:806. [PMID: 35890050 PMCID: PMC9320065 DOI: 10.3390/pathogens11070806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Conventionally, hyperimmune globulin drugs manufactured from pooled immunoglobulins from vaccinated or convalescent donors have been used in treating infections where no treatment is available. This is especially important where multi-epitope neutralization is required to prevent the development of immune-evading viral mutants that can emerge upon treatment with monoclonal antibodies. Using microfluidics, flow sorting, and a targeted integration cell line, a first-in-class recombinant hyperimmune globulin therapeutic against SARS-CoV-2 (GIGA-2050) was generated. Using processes similar to conventional monoclonal antibody manufacturing, GIGA-2050, comprising 12,500 antibodies, was scaled-up for clinical manufacturing and multiple development/tox lots were assessed for consistency. Antibody sequence diversity, cell growth, productivity, and product quality were assessed across different manufacturing sites and production scales. GIGA-2050 was purified and tested for good laboratory procedures (GLP) toxicology, pharmacokinetics, and in vivo efficacy against natural SARS-CoV-2 infection in mice. The GIGA-2050 master cell bank was highly stable, producing material at consistent yield and product quality up to >70 generations. Good manufacturing practices (GMP) and development batches of GIGA-2050 showed consistent product quality, impurity clearance, potency, and protection in an in vivo efficacy model. Nonhuman primate toxicology and pharmacokinetics studies suggest that GIGA-2050 is safe and has a half-life similar to other recombinant human IgG1 antibodies. These results supported a successful investigational new drug application for GIGA-2050. This study demonstrates that a new class of drugs, recombinant hyperimmune globulins, can be manufactured consistently at the clinical scale and presents a new approach to treating infectious diseases that targets multiple epitopes of a virus.
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Affiliation(s)
- Rena A. Mizrahi
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Wendy Y. Lin
- Alira Health, Inc., Framingham, MA 01702, USA; (W.Y.L.); (S.M.C.); (C.O.)
| | - Ashley Gras
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Ariel R. Niedecken
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Ellen K. Wagner
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Sheila M. Keating
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Nikita Ikon
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Vishal A. Manickam
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Michael A. Asensio
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Jackson Leong
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Angelica V. Medina-Cucurella
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Emily Benzie
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Kyle P. Carter
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Yao Chiang
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Robert C. Edgar
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Renee Leong
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Yoong Wearn Lim
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Jan Fredrik Simons
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Matthew J. Spindler
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Kacy Stadtmiller
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Nicholas Wayham
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Dirk Büscher
- Grifols S.A., 08174 Sant Cugat del Vallès, Spain; (D.B.); (J.V.T.)
| | | | | | - Steven M. Chamow
- Alira Health, Inc., Framingham, MA 01702, USA; (W.Y.L.); (S.M.C.); (C.O.)
| | - Charles Olson
- Alira Health, Inc., Framingham, MA 01702, USA; (W.Y.L.); (S.M.C.); (C.O.)
| | - Paula A. Pino
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (P.A.P.); (A.H.); (A.G.-V.); (L.M.-S.); (J.B.T.)
| | - Jun-Gyu Park
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (J.-G.P.); (C.Y.)
| | - Amberlee Hicks
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (P.A.P.); (A.H.); (A.G.-V.); (L.M.-S.); (J.B.T.)
| | - Chengjin Ye
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (J.-G.P.); (C.Y.)
| | - Andreu Garcia-Vilanova
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (P.A.P.); (A.H.); (A.G.-V.); (L.M.-S.); (J.B.T.)
| | - Luis Martinez-Sobrido
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (P.A.P.); (A.H.); (A.G.-V.); (L.M.-S.); (J.B.T.)
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (J.-G.P.); (C.Y.)
| | - Jordi B. Torrelles
- Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (P.A.P.); (A.H.); (A.G.-V.); (L.M.-S.); (J.B.T.)
- Disease Intervention and Prevention Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA; (J.-G.P.); (C.Y.)
| | - David S. Johnson
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
| | - Adam S. Adler
- GigaGen, Inc., South San Francisco, CA 94080, USA; (R.A.M.); (A.G.); (A.R.N.); (E.K.W.); (S.M.K.); (N.I.); (V.A.M.); (M.A.A.); (J.L.); (A.V.M.-C.); (E.B.); (K.P.C.); (Y.C.); (R.C.E.); (R.L.); (Y.W.L.); (J.F.S.); (M.J.S.); (K.S.); (N.W.); (D.S.J.)
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Schmidt AE, Vogel P, Chastain CA, Barnes T, Roth NJ, Simon TL. Analysis of 52 240 source plasma donors of convalescent COVID-19 plasma: Sex, ethnicity, and age association with initial antibody levels and rate of dissipation. J Clin Apher 2022; 37:449-459. [PMID: 35815776 PMCID: PMC9350246 DOI: 10.1002/jca.21998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Background COVID‐19 convalescent plasma (CCP) was approved under emergency authorization to treat critically ill patients with COVID‐19 in the United States in 2020. We explored the demographics of donors contributing plasma for a hyperimmune, plasma‐derived therapy to evaluate factors that may be associated with anti‐SARS‐CoV‐2 antibody response variability and, subsequently, antibody titers. Study Design An electronic search of CCP donors was performed across 282 US plasma donation centers. Donations were screened for nucleocapsid protein‐binding‐IgG using the Abbott SARS‐CoV‐2 IgG assay. Results Overall, 52 240 donors donated 418 046 units of CCP. Donors were of various ethnicities: 43% Caucasian, 34% Hispanic, 17% African American, 2% Native American, 1% Asian, and 3% other. Females had higher initial mean anti‐SARS‐CoV‐2 antibody titers but an overall faster rate of decline (P < .0001). Initial antibody titers increased with age: individuals aged 55 to 66 years had elevated anti‐SARS‐CoV‐2 titers for longer periods compared with other ages (P = .0004). African American donors had the lowest initial antibody titers but a slower rate of decline (P < .0001), while Caucasian (P = .0088) and Hispanic (P = .0193) groups had the fastest rates of decline. Most donor antibody levels decreased below the inclusion criteria (≥1.50) within 30 to 100 days of first donation, but donation frequency did not appear to be associated with rate of decline. Conclusion Several factors may be associated with anti‐SARS‐CoV‐2 antibody response including donor age and sex. Evaluating these factors during development of future hyperimmune globulin products may help generation of therapies with optimal efficacy.
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Tharmalingam T, Han X, Wozniak A, Saward L. Polyclonal hyper immunoglobulin: A proven treatment and prophylaxis platform for passive immunization to address existing and emerging diseases. Hum Vaccin Immunother 2022; 18:1886560. [PMID: 34010089 PMCID: PMC9090292 DOI: 10.1080/21645515.2021.1886560] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Passive immunization with polyclonal hyper immunoglobulin (HIG) therapy represents a proven strategy by transferring immunoglobulins to patients to confer immediate protection against a range of pathogens including infectious agents and toxins. Distinct from active immunization, the protection is passive and the immunoglobulins will clear from the system; therefore, administration of an effective dose must be maintained for prophylaxis or treatment until a natural adaptive immune response is mounted or the pathogen/agent is cleared. The current review provides an overview of this technology, key considerations to address different pathogens, and suggested improvements. The review will reflect on key learnings from development of HIGs in the response to public health threats due to Zika, influenza, and severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Tharmala Tharmalingam
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
| | - Xiaobing Han
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
- Department of Immunology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ashley Wozniak
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
| | - Laura Saward
- Therapeutics Business Unit, Emergent BioSolutions Incorporated, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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7
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Siemieniuk RA, Bartoszko JJ, Díaz Martinez JP, Kum E, Qasim A, Zeraatkar D, Izcovich A, Mangala S, Ge L, Han MA, Agoritsas T, Arnold D, Ávila C, Chu DK, Couban R, Cusano E, Darzi AJ, Devji T, Foroutan F, Ghadimi M, Khamis A, Lamontagne F, Loeb M, Miroshnychenko A, Motaghi S, Murthy S, Mustafa RA, Rada G, Rochwerg B, Switzer C, Vandvik PO, Vernooij RW, Wang Y, Yao L, Guyatt GH, Brignardello-Petersen R. Antibody and cellular therapies for treatment of covid-19: a living systematic review and network meta-analysis. BMJ 2021; 374:n2231. [PMID: 34556486 PMCID: PMC8459162 DOI: 10.1136/bmj.n2231] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of antiviral antibody therapies and blood products for the treatment of novel coronavirus disease 2019 (covid-19). DESIGN Living systematic review and network meta-analysis, with pairwise meta-analysis for outcomes with insufficient data. DATA SOURCES WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, and six Chinese databases (up to 21 July 2021). STUDY SELECTION Trials randomising people with suspected, probable, or confirmed covid-19 to antiviral antibody therapies, blood products, or standard care or placebo. Paired reviewers determined eligibility of trials independently and in duplicate. METHODS After duplicate data abstraction, we performed random effects bayesian meta-analysis, including network meta-analysis for outcomes with sufficient data. We assessed risk of bias using a modification of the Cochrane risk of bias 2.0 tool. The certainty of the evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We meta-analysed interventions with ≥100 patients randomised or ≥20 events per treatment arm. RESULTS As of 21 July 2021, we identified 47 trials evaluating convalescent plasma (21 trials), intravenous immunoglobulin (IVIg) (5 trials), umbilical cord mesenchymal stem cells (5 trials), bamlanivimab (4 trials), casirivimab-imdevimab (4 trials), bamlanivimab-etesevimab (2 trials), control plasma (2 trials), peripheral blood non-haematopoietic enriched stem cells (2 trials), sotrovimab (1 trial), anti-SARS-CoV-2 IVIg (1 trial), therapeutic plasma exchange (1 trial), XAV-19 polyclonal antibody (1 trial), CT-P59 monoclonal antibody (1 trial) and INM005 polyclonal antibody (1 trial) for the treatment of covid-19. Patients with non-severe disease randomised to antiviral monoclonal antibodies had lower risk of hospitalisation than those who received placebo: casirivimab-imdevimab (odds ratio (OR) 0.29 (95% CI 0.17 to 0.47); risk difference (RD) -4.2%; moderate certainty), bamlanivimab (OR 0.24 (0.06 to 0.86); RD -4.1%; low certainty), bamlanivimab-etesevimab (OR 0.31 (0.11 to 0.81); RD -3.8%; low certainty), and sotrovimab (OR 0.17 (0.04 to 0.57); RD -4.8%; low certainty). They did not have an important impact on any other outcome. There was no notable difference between monoclonal antibodies. No other intervention had any meaningful effect on any outcome in patients with non-severe covid-19. No intervention, including antiviral antibodies, had an important impact on any outcome in patients with severe or critical covid-19, except casirivimab-imdevimab, which may reduce mortality in patients who are seronegative. CONCLUSION In patients with non-severe covid-19, casirivimab-imdevimab probably reduces hospitalisation; bamlanivimab-etesevimab, bamlanivimab, and sotrovimab may reduce hospitalisation. Convalescent plasma, IVIg, and other antibody and cellular interventions may not confer any meaningful benefit. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol established a priori is included as a data supplement. FUNDING This study was supported by the Canadian Institutes of Health Research (grant CIHR- IRSC:0579001321). READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Interim updates and additional study data will be posted on our website (www.covid19lnma.com).
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Affiliation(s)
- Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Joint first authors
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Juan Pablo Díaz Martinez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Elena Kum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Ariel Izcovich
- Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina
| | - Sophia Mangala
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Donald Arnold
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Ellen Cusano
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Tahira Devji
- Medical school, University of Toronto, Toronto, ON, Canada
| | - Farid Foroutan
- Ted Rogers Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Assem Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sharhzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | | | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Charlotte Switzer
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ying Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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8
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Keating SM, Mizrahi RA, Adams MS, Asensio MA, Benzie E, Carter KP, Chiang Y, Edgar RC, Gautam BK, Gras A, Leong J, Leong R, Lim YW, Manickam VA, Medina-Cucurella AV, Niedecken AR, Saini J, Simons JF, Spindler MJ, Stadtmiller K, Tinsley B, Wagner EK, Wayham N, Tracy L, Lundberg CV, Büscher D, Terencio JV, Roalfe L, Pearce E, Richardson H, Goldblatt D, Ramjag AT, Carrington CVF, Simmons G, Muench MO, Chamow SM, Monroe B, Olson C, Oguin TH, Lynch H, Jeanfreau R, Mosher RA, Walch MJ, Bartley CR, Ross CA, Meyer EH, Adler AS, Johnson DS. Generation of recombinant hyperimmune globulins from diverse B-cell repertoires. Nat Biotechnol 2021; 39:989-999. [PMID: 33859400 PMCID: PMC8355030 DOI: 10.1038/s41587-021-00894-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
Plasma-derived polyclonal antibody therapeutics, such as intravenous immunoglobulin, have multiple drawbacks, including low potency, impurities, insufficient supply and batch-to-batch variation. Here we describe a microfluidics and molecular genomics strategy for capturing diverse mammalian antibody repertoires to create recombinant multivalent hyperimmune globulins. Our method generates of diverse mixtures of thousands of recombinant antibodies, enriched for specificity and activity against therapeutic targets. Each hyperimmune globulin product comprised thousands to tens of thousands of antibodies derived from convalescent or vaccinated human donors or from immunized mice. Using this approach, we generated hyperimmune globulins with potent neutralizing activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in under 3 months, Fc-engineered hyperimmune globulins specific for Zika virus that lacked antibody-dependent enhancement of disease, and hyperimmune globulins specific for lung pathogens present in patients with primary immune deficiency. To address the limitations of rabbit-derived anti-thymocyte globulin, we generated a recombinant human version and demonstrated its efficacy in mice against graft-versus-host disease.
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Affiliation(s)
| | | | - Matthew S Adams
- GigaGen Inc., South San Francisco, CA, USA
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | | | | | | | - Yao Chiang
- GigaGen Inc., South San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lucy Roalfe
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Emma Pearce
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Hayley Richardson
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - David Goldblatt
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Anushka T Ramjag
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Christine V F Carrington
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | | | | | | | | | | | - Thomas H Oguin
- Regional Biocontainment Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Heather Lynch
- Regional Biocontainment Laboratory, Duke University Medical Center, Durham, NC, USA
| | | | - Rachel A Mosher
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | - Matthew J Walch
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | | | - Carl A Ross
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | - Everett H Meyer
- Stanford Diabetes Research Center, Stanford University Medical Center, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, CA, USA
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9
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Jacque E, Chottin C, Laubreton D, Nogre M, Ferret C, de Marcos S, Baptista L, Drajac C, Mondon P, De Romeuf C, Rameix-Welti MA, Eléouët JF, Chtourou S, Riffault S, Perret G, Descamps D. Hyper-Enriched Anti-RSV Immunoglobulins Nasally Administered: A Promising Approach for Respiratory Syncytial Virus Prophylaxis. Front Immunol 2021; 12:683902. [PMID: 34163482 PMCID: PMC8215542 DOI: 10.3389/fimmu.2021.683902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a public health concern that causes acute lower respiratory tract infection. So far, no vaccine candidate under development has reached the market and the only licensed product to prevent RSV infection in at-risk infants and young children is a monoclonal antibody (Synagis®). Polyclonal human anti-RSV hyper-immune immunoglobulins (Igs) have also been used but were superseded by Synagis® owing to their low titer and large infused volume. Here we report a new drug class of immunoglobulins, derived from human non hyper-immune plasma that was generated by an innovative bioprocess, called Ig cracking, combining expertises in plasma-derived products and affinity chromatography. By using the RSV fusion protein (F protein) as ligand, the Ig cracking process provided a purified and concentrated product, designated hyper-enriched anti-RSV IgG, composed of at least 15-20% target-specific-antibodies from normal plasma. These anti-RSV Ig displayed a strong in vitro neutralization effect on RSV replication. Moreover, we described a novel prophylactic strategy based on local nasal administration of this unique hyper-enriched anti-RSV IgG solution using a mouse model of infection with bioluminescent RSV. Our results demonstrated that very low doses of hyper-enriched anti-RSV IgG can be administered locally to ensure rapid and efficient inhibition of virus infection. Thus, the general hyper-enriched Ig concept appeared a promising approach and might provide solutions to prevent and treat other infectious diseases.
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Affiliation(s)
| | - Claire Chottin
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Daphné Laubreton
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | - Cécile Ferret
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | | | - Carole Drajac
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | | | | | - Marie-Anne Rameix-Welti
- Université Paris-Saclay, UVSQ, Inserm, Infection et inflammation, U1173, Montigny-Le-Bretonneux, France.,AP-HP, Hôpital Ambroise Paré, Laboratoire de Microbiologie, Boulogne-Billancourt, France
| | | | | | - Sabine Riffault
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
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10
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Kanj S, Al-Omari B. Convalescent Plasma Transfusion for the Treatment of COVID-19 in Adults: A Global Perspective. Viruses 2021; 13:849. [PMID: 34066932 PMCID: PMC8148438 DOI: 10.3390/v13050849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
More than one year into the novel coronavirus disease 2019 (COVID-19) pandemic, healthcare systems across the world continue to be overwhelmed with soaring daily cases. The treatment spectrum primarily includes ventilation support augmented with repurposed drugs and/or convalescent plasma transfusion (CPT) from recovered COVID-19 patients. Despite vaccine variants being recently developed and administered in several countries, challenges in global supply chain logistics limit their timely availability to the wider world population, particularly in developing countries. Given the measured success of conventional CPT in treating several infections over the past decade, recent studies have reported its effectiveness in decreasing the duration and severity of COVID-19 symptoms. In this review, we conduct a literature search of published studies investigating the use of CPT to treat COVID-19 patients from January 2020 to January 2021. The literature search identified 181 records of which 39 were included in this review. A random-effects model was used to aggregate data across studies, and mortality rates of 17 vs. 32% were estimated for the CPT and control patient groups, respectively, with an odds ratio (OR) of 0.49. The findings indicate that CPT shows potential in reducing the severity and duration of COVID-19 symptoms. However, early intervention (preferably within 3 days), recruitment of donors, and plasma potency introduce major challenges for its scaled-up implementation. Given the low number of existing randomized clinical trials (RCTs, four with a total of 319 patients), unanticipated risks to CPT recipients are highlighted and discussed. Nevertheless, CPT remains a promising COVID-19 therapeutic option that merits internationally coordinated RCTs to achieve a scientific risk-benefit consensus.
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Affiliation(s)
| | - Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates;
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11
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Serra A, Marzo N, Pons B, Maduell P, López M, Grancha S. Characterization of antibodies in human immunoglobulin products from different regions worldwide. Int J Infect Dis 2021; 104:610-616. [PMID: 33524620 PMCID: PMC7844383 DOI: 10.1016/j.ijid.2021.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/31/2022] Open
Abstract
AIM The antibody levels against a broad spectrum of pathogens were assessed in commercial intravenous immunoglobulin (IVIG) manufactured from pooled plasma obtained from different global regions. METHODS Twenty-four IVIG commercial lots from eight manufacturers corresponding to 12 brands were analyzed. The plasma was collected in 10 countries/regions. Depending on each pathogen, antibody levels were measured using specific commercial IgG-specific enzyme immunoassay kits or by cell culture neutralization test and guinea pig skin neutralization test. A principal component analysis was performed. RESULTS For polio and diphtheria (reference markers of the US authorities), all IVIGs had relevant titers in accordance with reference levels. IVIGs from Canada, Australia, and the USA were positive for titers against globally distributed pathogens or those under vaccination programs in the developed world (parainfluenza, Epstein-Barr, varicella-zoster, influenza B, parvovirus B19, and measles viruses). IVIG from Taiwan and Hong Kong showed low antibody titers for these pathogens but high titers for Pseudomonas aeruginosa. IVIG from India had high titers for pathogens frequently found in developing countries (West Nile, dengue, chikungunya, and hepatitis E viruses and Streptococcus pneumoniae). IVIGs from Argentina, Spain, Israel, and Czechia showed intermediate antibody concentrations. CONCLUSION The antibody profile in IVIG was greatly influenced by regional characteristics including climate, vaccination programs, and the prevalence of pathogens in the different countries and regions.
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Affiliation(s)
| | - Núria Marzo
- Grifols, Research and Development, Barcelona, Spain.
| | - Berta Pons
- Grifols, Research and Development, Barcelona, Spain
| | - Pau Maduell
- Grifols, Research and Development, Barcelona, Spain
| | - Maite López
- Grifols, Research and Development, Barcelona, Spain
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12
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Díez JM, Romero C, Vergara-Alert J, Belló-Perez M, Rodon J, Honrubia JM, Segalés J, Sola I, Enjuanes L, Gajardo R. Cross-neutralization activity against SARS-CoV-2 is present in currently available intravenous immunoglobulins. Immunotherapy 2020; 12:1247-1255. [PMID: 32900263 PMCID: PMC7480323 DOI: 10.2217/imt-2020-0220] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Cross-reactivity against human coronaviruses with Flebogamma® DIF and Gamunex®-C, two available intravenous immunoglobulins (IVIG), has been reported. In this study, these IVIG were tested for neutralization activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV and Middle East respiratory syndrome CoV (MERS-CoV). Materials & methods: Neutralization capacity of lots of IVIG manufactured prior to COVID-19 pandemic was assessed against these viruses in cell culture. Infectivity neutralization was quantified by percent reduction in plaque-forming units and/or cytopathic/cytotoxic methods. Results: All IVIG preparations showed neutralization of SARS-CoV-2 isolates. All IVIG lots produced neutralization of SARS-CoV. No IVIG preparation showed significant neutralizing activity against MERS-CoV. Conclusion: The tested IVIG contain antibodies with significant in vitro cross-neutralization capacity against SARS-CoV-2 and SARS-CoV, but not MERS-CoV. These preparations are currently under evaluation as potential therapies for COVID-19.
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Affiliation(s)
- José María Díez
- Bioscience Research & Development, Grifols, Barcelona, Spain
| | - Carolina Romero
- Bioscience Research & Development, Grifols, Barcelona, Spain
| | - Júlia Vergara-Alert
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Melissa Belló-Perez
- Laboratorio Coronavirus. Departamento de Biología Molecular y Celular, CNB-CSIC, Madrid, Spain
| | - Jordi Rodon
- IRTA, Centre de Recerca en Sanitat Animal (CReSA, IRTA-UAB), Campus de la Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - José Manuel Honrubia
- Laboratorio Coronavirus. Departamento de Biología Molecular y Celular, CNB-CSIC, Madrid, Spain
| | - Joaquim Segalés
- UAB, CReSA (IRTA-UAB), Campus de la Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
- Departament de Sanitat i Anatomia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Isabel Sola
- Laboratorio Coronavirus. Departamento de Biología Molecular y Celular, CNB-CSIC, Madrid, Spain
| | - Luis Enjuanes
- Laboratorio Coronavirus. Departamento de Biología Molecular y Celular, CNB-CSIC, Madrid, Spain
| | - Rodrigo Gajardo
- Bioscience Research & Development, Grifols, Barcelona, Spain
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13
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Ezzikouri S, Nourlil J, Benjelloun S, Kohara M, Tsukiyama-Kohara K. Coronavirus disease 2019-Historical context, virology, pathogenesis, immunotherapy, and vaccine development. Hum Vaccin Immunother 2020; 16:2992-3000. [PMID: 32755425 PMCID: PMC8641599 DOI: 10.1080/21645515.2020.1787068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/20/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023] Open
Abstract
The current Coronavirus Disease 2019 (COVID-19) pandemic is causing great alarm around the world. The pathogen for COVID-19 - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - is the seventh known coronavirus to cause pneumonia in humans. While much remains unknown about SARS-CoV-2, physicians and researchers have begun to publish relevant findings, and much evidence is available on coronaviruses previously circulating in human and animal populations. In this review, we situate COVID-19 in its context as a transboundary viral disease, and provide a comprehensive discussion focused on the discovery, spread, virology, pathogenesis, and clinical features of this disease, its causative coronaviral pathogen, and approaches to combating the disease through immunotherapies and other treatments and vaccine development. An epidemiological survey revealed a potentially large number of asymptomatic SARS-CoV-2 carriers within the population, which may hamper efforts against COVID-19. Finally, we emphasize that vaccines against SARS-CoV-2, which may be developed by 2021, will be essential for prevention of COVID-19.
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Affiliation(s)
- Sayeh Ezzikouri
- Virology Unit¸ Viral Hepatitis Laboratory, Institut Pasteur Du Maroc, Casablanca, Morocco
- Transboundary Animal Diseases Centre, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - Jalal Nourlil
- Medical Virology and BSL3 Laboratory, Institut Pasteur Du Maroc, Casablanca, Morocco
| | - Soumaya Benjelloun
- Virology Unit¸ Viral Hepatitis Laboratory, Institut Pasteur Du Maroc, Casablanca, Morocco
| | - Michinori Kohara
- Department of Microbiology and Cell Biology, The Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kyoko Tsukiyama-Kohara
- Transboundary Animal Diseases Centre, Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
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14
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Low-dose corticosteroid combined with immunoglobulin reverses deterioration in severe cases with COVID-19. Signal Transduct Target Ther 2020; 5:276. [PMID: 33235253 PMCID: PMC7683873 DOI: 10.1038/s41392-020-00407-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
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Wooding DJ, Bach H. Treatment of COVID-19 with convalescent plasma: lessons from past coronavirus outbreaks. Clin Microbiol Infect 2020; 26:1436-1446. [PMID: 32791241 PMCID: PMC7417293 DOI: 10.1016/j.cmi.2020.08.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/18/2020] [Accepted: 08/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is currently no treatment known to alter the course of coronavirus disease 2019 (COVID-19). Convalescent plasma has been used to treat a number of infections during pandemics, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle Eastern respiratory syndrome coronavirus (MERS-CoV) and now severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). OBJECTIVES To summarize the existing literature and registered clinical trials on the efficacy and safety of convalescent plasma for treating coronaviruses, and discuss issues of feasibility, and donor and patient selection. SOURCES A review of articles published in PubMed was performed on 13 July 2020 to summarize the currently available evidence in human studies for convalescent plasma as a treatment for coronaviruses. The World Health Organization International Clinical Trials Registry and clinicaltrials.gov were searched to summarize the currently registered randomized clinical trials for convalescent plasma in COVID-19. CONTENT There were sixteen COVID-19, four MERS and five SARS reports describing convalescent plasma use in humans. There were two randomized control trials, both of which were for COVID-19 and were terminated early. Most COVID-19 reports described a potential benefit of convalescent plasma on clinical outcomes in severe or critically ill patients with few immediate adverse events. However, there were a number of limitations, including the concurrent use of antivirals, steroids and other treatments, small sample sizes, lack of randomization or control groups, and short follow-up time. Data from SARS and COVID-19 suggest that earlier administration probably yields better outcomes. The ideal candidates for recipients and donors are not known. Still, experience with previous coronaviruses tells us that antibodies in convalescent patients are probably short-lived. Patients who had more severe disease and who are earlier in their course of recovery may be more likely to have adequate titres. Finally, a number of practical challenges were identified. IMPLICATIONS There is currently no effective treatment for COVID-19, and preliminary trials for convalescent plasma suggest that there may be some benefits. However, research to date is at high risk of bias, and randomized control trials are desperately needed to determine the efficacy and safety of this therapeutic option.
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Affiliation(s)
- Denise J Wooding
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Horacio Bach
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
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16
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Díez JM, Romero C, Gajardo R. Currently available intravenous immunoglobulin contains antibodies reacting against severe acute respiratory syndrome coronavirus 2 antigens. Immunotherapy 2020; 12:571-576. [PMID: 32397847 PMCID: PMC7222542 DOI: 10.2217/imt-2020-0095] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: There is a critical need for effective therapies that are immediately available to control the spread of COVID-19 disease. Material & methods: Gamunex®-C and Flebogamma® DIF (Grifols) intravenous immunoglobulin (IVIG) products were tested using ELISA techniques for antibodies against several antigens of human common betacoronaviruses that may crossreact with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Results: Both IVIGs showed consistent reactivity to components of the tested viruses. Positive crossreactivity was seen in SARS-CoV, middle east respiratory syndrome-CoV and SARS-CoV-2. For SARS-CoV-2, positive reactivity was observed at IVIG concentrations ranging from 100 μg/ml with Gamunex-C to 1 mg/ml with Flebogamma 5% DIF. Conclusion: Gamunex-C and Flebogamma DIF contain antibodies reacting against SARS-CoV-2 antigens. Studies to confirm the utility of IVIG preparations for COVID-19 management may be warranted.
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Affiliation(s)
- José-María Díez
- Research & Development – Bioscience Industrial Group, Grifols, Barcelona, Spain
| | - Carolina Romero
- Research & Development – Bioscience Industrial Group, Grifols, Barcelona, Spain
| | - Rodrigo Gajardo
- Research & Development – Bioscience Industrial Group, Grifols, Barcelona, Spain
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17
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Wong HK, Lee CK. Pivotal role of convalescent plasma in managing emerging infectious diseases. Vox Sang 2020; 115:545-547. [PMID: 32240549 PMCID: PMC7228342 DOI: 10.1111/vox.12927] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Hoi-Kei Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China
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18
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Wang CH, Lee GB. Screening of multiple hemoprotein-specific aptamers and their applications for the binding, quantification, and extraction of hemoproteins in a microfluidic system. BIOMICROFLUIDICS 2020; 14:024110. [PMID: 32549920 PMCID: PMC7156270 DOI: 10.1063/1.5141871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/01/2020] [Indexed: 05/07/2023]
Abstract
The blood hemoproteins, albumin, γ-globulin, and fibrinogen, serve as biomarkers for a variety of human diseases, including kidney and hepatorenal syndromes. Therefore, there is a need to quickly and accurately measure their concentrations in blood. Herein, nucleic acid aptamers demonstrating high affinity and specificity toward these hemoproteins were selected via systematic evolution of ligands by exponential enrichment, and their ability to capture their protein targets was assessed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by a tetramethyl benzidine assay. The limits of detection for the hemoproteins were all around 10-3 μM, and dissociation constant values of 131, 639, and 29nM were obtained; capture rates were measured to be 66%, 71%, and 61%, which is likely to be suitable for clinical diagnostics. Furthermore, a multi-layer microfluidic disk system featuring hemoprotein-specific aptamers for depleting hemoproteins was demonstrated. It could be a promising approach to use aptamers to replace conventional antibodies.
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Affiliation(s)
- Chih-Hung Wang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Gwo-Bin Lee
- Author to whom correspondence should be addressed:
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Alonso W, Vandeberg P, Lang J, Yuziuk J, Silverstein R, Stokes K, McBride D, Cruz M, Burns D, Merritt WK, Willis T, Jorquera JI. Immune globulin subcutaneous, human 20% solution (Xembify®), a new high concentration immunoglobulin product for subcutaneous administration. Biologicals 2020; 64:34-40. [PMID: 32085977 DOI: 10.1016/j.biologicals.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022] Open
Abstract
Immune globulin subcutaneous, human 20% solution (IGSC-C 20%, Xembify®)-a new 20% immunoglobulin (IgG) liquid product for subcutaneous (SC) administration-has been developed by Grifols. The IGSC-C 20% formulation is based on knowledge acquired from the formulation of Immune Globulin Injection (Human),10% Caprylate/Chromatography Purified (IGIV-C 10%, Gamunex®-C). The protein concentration was increased from 10% to 20% to provide a smaller volume for SC administration. The IGSC-C 20% manufacturing process employs the same caprylate/chromatography purification steps as IGIV-C 10%, with the addition of an ultrafiltration step so that the product can be formulated at a higher protein concentration. IGSC-C 20% has been produced at full industrial scale to support clinical studies and licensure. These batches were characterized using a comprehensive panel of analytical testing. The new IGSC-C 20% product maintains the same composition, neutralizing activity, purity, and quality characteristics found in IGIV-C 10%.
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Affiliation(s)
- William Alonso
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Pete Vandeberg
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - John Lang
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Jeffrey Yuziuk
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Rebecca Silverstein
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Kenya Stokes
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Dennis McBride
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Maria Cruz
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Doug Burns
- Grifols Therapeutics LLC, 8368 US 70 Business Hwy West, Clayton, NC, 27520, USA
| | - W Keither Merritt
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Todd Willis
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Juan I Jorquera
- Grifols Bioscience Research Group, 85 TW Alexander Drive, Research Triangle Park, NC, 27709, USA
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Duplantier AJ, Shurtleff AC, Miller C, Chiang CY, Panchal RG, Sunay M. Combating biothreat pathogens: ongoing efforts for countermeasure development and unique challenges. DRUG DISCOVERY TARGETING DRUG-RESISTANT BACTERIA 2020. [PMCID: PMC7258707 DOI: 10.1016/b978-0-12-818480-6.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research to discover and develop antibacterial and antiviral drugs with potent activity against pathogens of biothreat concern presents unique methodological and process-driven challenges. Herein, we review laboratory approaches for finding new antibodies, antibiotics, and antiviral molecules for pathogens of biothreat concern. Using high-throughput screening techniques, molecules that directly inhibit a pathogen’s entry, replication, or growth can be identified. Alternatively, molecules that target host proteins can be interesting targets for development when countering biothreat pathogens, due to the modulation of the host immune response or targeting proteins that interfere with the pathways required by the pathogen for replication. Monoclonal and cocktail antibody therapies approved by the Food and Drug Administration for countering anthrax and under development for treatment of Ebola virus infection are discussed. A comprehensive tabular review of current in vitro, in vivo, pharmacokinetic and efficacy datasets has been presented for biothreat pathogens of greatest concern. Finally, clinical trials and animal rule or traditional drug approval pathways are also reviewed. Opinions; interpretations; conclusions; and recommendations are those of the authors and are not necessarily endorsed by the US Army.
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21
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Mangioni D, Grasselli G, Abbruzzese C, Muscatello A, Gori A, Bandera A. Adjuvant treatment of severe varicella pneumonia with intravenous varicella zoster virus-specific immunoglobulins. Int J Infect Dis 2019; 85:70-73. [PMID: 31132473 DOI: 10.1016/j.ijid.2019.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 12/11/2022] Open
Abstract
Varicella zoster virus (VZV) pneumonia is associated with significant mortality, especially in the immunocompromised host. VZV-specific immunoglobulins (VZIG) are currently used as post-exposure prophylaxis for at-risk patients, but not as adjunctive therapy. A novel case of VZV pneumonia in an immunocompromised patient, treated successfully with intravenous VZIG in combination with acyclovir, is reported here.
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Affiliation(s)
- Davide Mangioni
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy.
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Abbruzzese
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, School of Medicine and Surgery, University of Milan, Milan, Italy
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22
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Zika virus: An emerging infectious disease with serious perinatal and neurologic complications. J Allergy Clin Immunol 2017; 141:482-490. [PMID: 29273403 DOI: 10.1016/j.jaci.2017.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/24/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022]
Abstract
Zika virus (ZIKV) is a flavivirus that is primarily transmitted by Aedes aegypti, the mosquito vector also important in transmission of the flaviviruses responsible for dengue fever, yellow fever, and chikungunya. Because of occurrence in the same geographic regions, serologic cross-reactivity, and similar but often less severe clinical manifestations, such as dengue and chikungunya infections, ZIKV infection likely has gone undetected, misdiagnosed, or both for many years. ZIKV is somewhat unique among flaviviruses in its ability to also be transmitted through sexual contact, nonsexual body fluids, and perinatally. The relatively recent detection of the link between ZIKV infection and Guillain-Barré syndrome and fetal neurological defects, including microcephaly, has prompted intense efforts aimed at the development of new and specific diagnostic tests. Infection with ZIKV has been postulated to lead to a more severe clinical course from other structurally related viruses, especially dengue, and vice versa because of a phenomenon termed antibody-dependent enhancement. Inactivated whole virus, DNA, RNA, and vectored vaccine approaches to prevent ZIKV infection are in development, as are treatments for active disease that are safe in pregnant women. Here we summarize the important epidemiologic and clinical features of ZIKV infection, as well as the progress and challenges in developing rapid point-of-care diagnostic tests and vaccines to prevent disease. We used electronic databases to identify relevant published data regarding ZIKV MeSH searches.
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