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Sharma H, Parekh S, Pujari P, Shewale S, Desai S, Kawade A, Lalwani S, Ravi MD, Kamath V, Mahopatra J, Kulkarni G, Tayade D, Ramanan PV, Uttam KG, Rawal L, Gawande A, Kumar NR, Tiple N, Vagha J, Thakkar P, Khandgave P, Deshmukh BJ, Agarwal A, Dogar V, Gautam M, Jaganathan KS, Kumar R, Sharma I, Gairola S. A phase III randomized-controlled study of safety and immunogenicity of DTwP-HepB-IPV-Hib vaccine (HEXASIIL ®) in infants. NPJ Vaccines 2024; 9:41. [PMID: 38383584 PMCID: PMC10881502 DOI: 10.1038/s41541-024-00828-w] [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: 03/24/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
A fully liquid hexavalent containing Diphtheria (D), Tetanus (T) toxoids, whole cell Pertussis (wP), Hepatitis B (Hep B), type 1, 2, 3 of inactivated poliovirus (IPV) and Haemophilus influenzae type b (Hib) conjugate vaccine (DTwP-HepB-IPV-Hib vaccine, HEXASIIL®) was tested for lot-to-lot consistency and non-inferiority against licensed DTwP-HepB-Hib + IPV in an open label, randomized Phase II/III study. In Phase III part, healthy infants received DTwP-HepB-IPV-Hib or DTwP-HepB-Hib + IPV vaccines at 6, 10 and 14 weeks of age. Blood samples were collected prior to the first dose and 28 days, post dose 3. Non inferiority versus DTwP-HepB-Hib + IPV was demonstrated with 95% CIs for the treatment difference for seroprotection/seroconversion rates. For DTwP-HepB-IPV-Hib lots, limits of 95% CI for post-vaccination geometric mean concentration ratios were within equivalence limits (0.5 and 2). Vaccine was well-tolerated and no safety concerns observed.Clinical Trial Registration - CTRI/2019/11/022052.
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Affiliation(s)
- Hitt Sharma
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India.
| | - Sameer Parekh
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Pramod Pujari
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Sunil Shewale
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Shivani Desai
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd., Pune, India
| | - Anand Kawade
- Department of Pediatrics, KEM Hospital Research Centre, Vadu, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College & Hospital, Pune, India
| | - M D Ravi
- Department of Pediatrics, JSS Hospital, Mysuru, India
| | - Veena Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Jagannath Mahopatra
- Department of Pediatrics, Hamdard Institute of Medical Science and Research, New Delhi, India
| | - Ganesh Kulkarni
- Department of Pediatrics, Sanjeevani Children's Hospital, Aurangabad, India
| | - Deepak Tayade
- Department of Pediatrics, Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | | | - Lalit Rawal
- Department of Pediatrics, Grant Medical Foundation Ruby Hall Clinic, Pune, India
| | - Avinash Gawande
- Department of Pediatrics, Government Medical College and Hospital, Nagpur, India
| | - N Ravi Kumar
- Department of Pediatrics, Niloufer Hospital, Hyderabad, India
| | - Nishikant Tiple
- Department of Pediatrics, Government Medical College, Chandrapur, India
| | - Jayant Vagha
- Department of Pediatrics, Acharya Vinoba Bhave Rural Hospital, Wardha, India
| | | | | | | | - Anurag Agarwal
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vikas Dogar
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
| | - Manish Gautam
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
| | - K S Jaganathan
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Rakesh Kumar
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Inderjit Sharma
- Production Department, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sunil Gairola
- Department of Quality Control, Serum Institute of India Pvt. Ltd, Pune, India
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Kaufmann SHE. Vaccine development against tuberculosis before and after Covid-19. Front Immunol 2023; 14:1273938. [PMID: 38035095 PMCID: PMC10684952 DOI: 10.3389/fimmu.2023.1273938] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease (Covid-19) has not only shaped awareness of the impact of infectious diseases on global health. It has also provided instructive lessons for better prevention strategies against new and current infectious diseases of major importance. Tuberculosis (TB) is a major current health threat caused by Mycobacterium tuberculosis (Mtb) which has claimed more lives than any other pathogen over the last few centuries. Hence, better intervention measures, notably novel vaccines, are urgently needed to accomplish the goal of the World Health Organization to end TB by 2030. This article describes how the research and development of TB vaccines can benefit from recent developments in the Covid-19 vaccine pipeline from research to clinical development and outlines how the field of TB research can pursue its own approaches. It begins with a brief discussion of major vaccine platforms in general terms followed by a short description of the most widely applied Covid-19 vaccines. Next, different vaccination regimes and particular hurdles for TB vaccine research and development are described. This specifically considers the complex immune mechanisms underlying protection and pathology in TB which involve innate as well as acquired immune mechanisms and strongly depend on fine tuning the response. A brief description of the TB vaccine candidates that have entered clinical trials follows. Finally, it discusses how experiences from Covid-19 vaccine research, development, and rollout can and have been applied to the TB vaccine pipeline, emphasizing similarities and dissimilarities.
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Affiliation(s)
- Stefan H. E. Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany
- Systems Immunology, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, United States
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Indian Biosimilars and Vaccines at Crossroads-Replicating the Success of Pharmagenerics. Vaccines (Basel) 2023; 11:vaccines11010110. [PMID: 36679955 PMCID: PMC9865573 DOI: 10.3390/vaccines11010110] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The global pharma sector is fast shifting from generics to biologics and biosimilars with the first approval in Europe in 2006 followed by US approval in 2015. In the form of Hepatitis B vaccine, India saw its first recombinant biologics approval in 2000. Around 20% of generic medications and 62% of vaccines are now supplied by the Indian pharmaceutical industry. It is this good position in biologics and biosimilars production that could potentially improve healthcare via decreased treatment cost. India has witnessed large investments in biosimilars over the years. Numerous India-bred new players, e.g., Enzene Biosciences Ltd., are keen on biosimilars and have joined the race alongside the emerging giants, e.g., Biocon and Dr. Reddy's. A very positive sign was the remarkable disposition during the COVID-19 pandemic by Bharat Biotech and the Serum Institute of India. India's biopharmaceutical industry has been instrumental in producing and supplying preventives and therapeutics to fight COVID-19. Despite a weak supply chain and workforce pressure, the production was augmented to provide reasonably priced high-quality medications to more than 133 nations. Biosimilars could cost-effectively treat chronic diseases involving expensive conventional therapies, including diabetes, respiratory ailments, cancer, and connective tissue diseases. Biologics and biosimilars have been and are being tested to treat and manage COVID-19 symptoms characterized by inflammation and respiratory distress. PURPOSE OF REVIEW Although India boasts many universities, research centers, and a relatively skilled workforce, its global University-Industry collaboration ranking is 24, IPR ranking remains 47 and innovation ranking 39. This reveals a wide industry-academia gap to bridge. There are gaps in effective translational research in India that must be promptly and appropriately addressed. Innovation demands strong and effective collaborations among universities, techno-incubators, and industries. METHODOLOGY Many successful research findings in academia do not get translation opportunities supposedly due to low industrial collaboration, low IP knowledge, and publication pressure with stringent timelines. In light of this, a detailed review of literature, including policy papers, government initiatives, and corporate reviews, was carried out, and the compilation and synthesis of the secondary data were meticulously summarized for the easy comprehension of the facts and roadmap ahead. For easy comprehension, charts, figures, and compiled tables are presented. RESULTS This review assesses India's situation in the biosimilar space, the gaps and areas to improve for Indian investment strategies, development, and innovation, addressing need for a more skilled workforce, industrial collaboration, and business models. CONCLUSIONS This review also proposes forward an approach to empowering technopreneurs to develop MSMEs for large-scale operations to support India in taking innovative thoughts to the global level to ultimately realize a self-reliant India. The limitations of the compilation are also highlighted towards the end.
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Sharma H, Lalwani S, Parekh S, Pujari P, Shewale S, Palkar S, Hanumante N, Gokhale S, Ks J, Kumar R, Sharma I, Gairola S. A phase I, open label, clinical study to assess the safety and immunogenicity of indigenously developed liquid (DTwP-HepB-IPV-Hib) hexavalent combination vaccine in healthy toddlers aged 16-24 months. Hum Vaccin Immunother 2022; 18:2146435. [PMID: 36412272 DOI: 10.1080/21645515.2022.2146435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This first in human study was designed as an open label clinical trial to assess the safety and immunogenicity of SIIPL DTwP-HepB-IPV-Hib (Hexavalent) combination vaccine in healthy toddlers, aged 16-24 months. A total of 24 healthy toddlers were administered a 0.5 ml single dose of SIIPL DTwP-HepB-IPV-Hib vaccine intramuscularly, and followed for 28 days for safety outcomes viz. immediate, solicited, unsolicited and serious adverse events. Blood samples were collected immediately prior to and 28 days after vaccination to assess the immunogenicity. Twenty four completed the study in compliance with the study protocol. None of the participants experienced any immediate or any serious adverse event. In terms of the frequency and intensity, the adverse events were comparable to DTwP-based combination vaccines. The vaccine elicited a strong booster response as demonstrated by a large increase in antibodies against all vaccine antigens. One month post booster vaccination seroprotection for diphtheria, tetanus, Hepatitis B, Haemophilus influenzae type b and polio virus type 1 and 3 was 100%. The percentage sero-response for pertussis was 75%. Four-fold increase in antibody concentration for pertussis was achieved in 87.5% subjects. Indigenously developed DTwP-HepB-IPV-Hib vaccine by Serum Institute of India Pvt. Ltd. was found to be safe, well tolerated and showed a robust immune response in toddlers. It was concluded that this vaccine should be assessed in the next phases of clinical development in the target population.Clinical Trial Registration - CTRI/2018/10/015875.
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Affiliation(s)
- Hitt Sharma
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Sameer Parekh
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Pramod Pujari
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sunil Shewale
- Department of Clinical Research and Pharmacovigilance, Serum Institute of India Pvt. Ltd, Pune, India
| | - Sonali Palkar
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Neeta Hanumante
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Shilpa Gokhale
- Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical college & Hospital, Pune, India
| | - Jaganathan Ks
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Rakesh Kumar
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Inderjit Sharma
- Department of Production, Serum Institute of India Pvt. Ltd., Pune, India
| | - Sunil Gairola
- Department of Quality Control, Serum Institute of India Pvt. Ltd., Pune, India
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Kaufmann SHE. Vaccine Development Against Tuberculosis Over the Last 140 Years: Failure as Part of Success. Front Microbiol 2021; 12:750124. [PMID: 34691001 PMCID: PMC8526900 DOI: 10.3389/fmicb.2021.750124] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/31/2021] [Indexed: 01/16/2023] Open
Abstract
The year 2020 was shaped by the COVID-19 pandemic which killed more people than any other infectious disease in this particular year. At the same time, the development of highly efficacious COVID-19 vaccines within less than a year raises hope that this threat can be tamed in the near future. For the last 200 years, the agent of tuberculosis (TB) has been the worst killer amongst all pathogens. Although a vaccine has been available for 100 years, TB remains a substantial threat. The TB vaccine, Bacille Calmette-Guérin (BCG), has saved tens of millions of lives since its deployment. It was the best and only choice available amongst many attempts to develop efficacious vaccines and all competitors, be they subunit vaccines, viable vaccines or killed whole cell vaccines have failed. Yet, BCG is insufficient. The last decades have witnessed a reawakening of novel vaccine approaches based on deeper insights into immunity underlying TB and BCG immunization. In addition, technical advances in molecular genetics and the design of viral vectors and adjuvants have facilitated TB vaccine development. This treatise discusses firstly early TB vaccine developments leading to BCG as the sole preventive measure which stood the test of time, but failed to significantly contribute to TB control and secondly more recent attempts to develop novel vaccines are described that focus on the genetically modified BCG-based vaccine VPM1002, which has become the frontrunner amongst viable TB vaccine candidates. It is hoped that highly efficacious vaccines against TB will become available even though it remains unclear whether and when this ambition can be accomplished. None the less it is clear that the goal of reducing TB morbidity and mortality by 90% or 95%, respectively, by 2030 as proposed by the World Health Organization depends significantly on better vaccines.
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Affiliation(s)
- Stefan H E Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany.,Max Planck Institute for Biophysical Chemistry, Göttingen, Germany.,Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, United States
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Kaufmann SHE. Vaccination Against Tuberculosis: Revamping BCG by Molecular Genetics Guided by Immunology. Front Immunol 2020; 11:316. [PMID: 32174919 PMCID: PMC7056705 DOI: 10.3389/fimmu.2020.00316] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Tuberculosis (TB) remains a major health threat. Although a vaccine has been available for almost 100 years termed Bacille Calmette-Guérin (BCG), it is insufficient and better vaccines are urgently needed. This treatise describes first the basic immunology and pathology of TB with an emphasis on the role of T lymphocytes. Better understanding of the immune response to Mycobacterium tuberculosis (Mtb) serves as blueprint for rational design of TB vaccines. Then, disease epidemiology and the benefits and failures of BCG vaccination will be presented. Next, types of novel vaccine candidates are being discussed. These include: (i) antigen/adjuvant subunit vaccines; (ii) viral vectored vaccines; and (III) whole cell mycobacterial vaccines which come as live recombinant vaccines or as dead whole cell or multi-component vaccines. Subsequently, the major endpoints of clinical trials as well as administration schemes are being described. Major endpoints for clinical trials are prevention of infection (PoI), prevention of disease (PoD), and prevention of recurrence (PoR). Vaccines can be administered either pre-exposure or post-exposure with Mtb. A central part of this treatise is the description of the viable BCG-based vaccine, VPM1002, currently undergoing phase III clinical trial assessment. Finally, new approaches which could facilitate design of refined next generation TB vaccines will be discussed.
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Affiliation(s)
- Stefan H. E. Kaufmann
- Max Planck Institute for Infection Biology, Berlin, Germany
- Hagler Institute for Advanced Study, Texas A&M University, College Station, TX, United States
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