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Chen S, Ying Z, Liu Y, Li Y, Yu Y, Huang M, Huang Z, Ou Z, Liao Y, Zhang Y, Liu G, Zhao W, Fu R, Shou Q, Zheng M, Liao X, Tu Y, Stek J, Hartzel J, Li C, Zhang J. A phase 3 randomized, open-label study evaluating the immunogenicity and safety of concomitant and staggered administration of a live, pentavalent rotavirus vaccine and an inactivated poliomyelitis vaccine in healthy infants in China. Hum Vaccin Immunother 2024; 20:2324538. [PMID: 38509699 PMCID: PMC10962606 DOI: 10.1080/21645515.2024.2324538] [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: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/22/2024] Open
Abstract
This open-label, randomized, phase 3 study in China (V260-074; NCT04481191) evaluated the immunogenicity and safety of concomitant and staggered administration of three doses of an oral, live, pentavalent rotavirus vaccine (RV5) and three doses of an intramuscular, inactivated poliomyelitis vaccine (IPV) in 400 healthy infants. The primary objective was the non-inferiority of neutralizing antibody (nAb) responses in the concomitant- versus the staggered-use groups. Antibody responses were measured at baseline and 1-month post-dose 3 (PD3). Parents/legal guardians recorded adverse events for 30 or 15 d after study vaccinations in the concomitant-use or staggered-use groups, respectively. At PD3, >98% of participants seroconverted to all three poliovirus types, and the primary objective was met as lower bounds of the two-sided 95% CI for between-group difference in nAb seroconversion percentages ranged from - 4.3% to - 1.6%, for all poliovirus types, p < .001. At PD3, geometric mean titers (GMTs) of nAb responses to poliovirus types 1, 2, and 3 in the concomitant-use group and the staggered-use group were comparable; 100% of participants had nAb titers ≥1:8 and ≥1:64 for all poliovirus types. Anti-rotavirus serotype-specific IgA GMTs and participants with ≥3-fold rise in postvaccination titers from baseline were comparable between groups. Administration of RV5 and IPV was well tolerated with comparable safety profiles in both groups. The immunogenicity of IPV in the concomitant-use group was non-inferior to the staggered-use group and RV5 was immunogenic in both groups. No safety concerns were identified. These data support the concomitant use of RV5 and IPV in healthy Chinese infants.
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Affiliation(s)
- Shaomin Chen
- Biological Products Surveillance and Evaluation, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
| | - Zhifang Ying
- Respiratory Virus Vaccine, National Institutes for Food and Drug Control, Beijing, China
| | - Yan Liu
- Division of Hepatitis Virus and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Yuan Li
- Biological Products Surveillance and Evaluation, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
| | - Yebin Yu
- Vaccine Clinical Research Office, Yangchun Center for Disease Control and Prevention, Yangchun, Guangdong, China
| | - Meilian Huang
- Vaccine Clinical Research Office, Yangchun Center for Disease Control and Prevention, Yangchun, Guangdong, China
| | - Zhuhang Huang
- Biological Products Surveillance and Evaluation, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
| | - Zhiqiang Ou
- Biological Products Surveillance and Evaluation, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
| | - Yuyi Liao
- Biological Products Surveillance and Evaluation, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
| | - Yong Zhang
- Division of Hepatitis Virus and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, China
| | - Guixiu Liu
- Clinical Research, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Weiwei Zhao
- Biostatistics and Research Decision Sciences, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Rong Fu
- Biostatistics and Research Decision Sciences, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Qiong Shou
- Biostatistics and Research Decision Sciences, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Minghuan Zheng
- Clinical Research, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Xueyan Liao
- Clinical Research, MSD Research and Development (China) Co. Ltd., Beijing, China
| | - Yingmei Tu
- Infectious Diseases/Vaccines Clinical Research, Merck & Co. Inc., Rahway, NJ, USA
| | - Jon Stek
- Infectious Diseases/Vaccines Clinical Research, Merck & Co. Inc., Rahway, NJ, USA
| | - Jonathan Hartzel
- Biostatistics and Research Decision Sciences, Merck & Co. Inc., Rahway, NJ, USA
| | - Changgui Li
- Institute for Control of Biological Products, National Institutes for Food and Drug Control, Beijing, China
| | - Jikai Zhang
- Directors Office, Guangdong Provincial Institute of Biological Products and Materia Medica, Guangzhou, Guangdong, China
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Hyöty H, Kääriäinen S, Laiho JE, Comer GM, Tian W, Härkönen T, Lehtonen JP, Oikarinen S, Puustinen L, Snyder M, León F, Scheinin M, Knip M, Sanjuan M. Safety, tolerability and immunogenicity of PRV-101, a multivalent vaccine targeting coxsackie B viruses (CVBs) associated with type 1 diabetes: a double-blind randomised placebo-controlled Phase I trial. Diabetologia 2024; 67:811-821. [PMID: 38369573 PMCID: PMC10954874 DOI: 10.1007/s00125-024-06092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/21/2023] [Indexed: 02/20/2024]
Abstract
AIMS/HYPOTHESIS Infection with coxsackie B viruses (CVBs) can cause diseases ranging from mild common cold-type symptoms to severe life-threatening conditions. CVB infections are considered to be prime candidates for environmental triggers of type 1 diabetes. This, together with the significant disease burden of acute CVB infections and their association with chronic diseases other than diabetes, has prompted the development of human CVB vaccines. The current study evaluated the safety and immunogenicity of the first human vaccine designed against CVBs associated with type 1 diabetes in a double-blind randomised placebo-controlled Phase I trial. METHODS The main eligibility criteria for participants were good general health, age between 18 and 45 years, provision of written informed consent and willingness to comply with all trial procedures. Treatment allocation (PRV-101 or placebo) was based on a computer-generated randomisation schedule and people assessing the outcomes were masked to group assignment. In total, 32 participants (17 men, 15 women) aged 18-44 years were randomised to receive a low (n=12) or high (n=12) dose of a multivalent, formalin-inactivated vaccine including CVB serotypes 1-5 (PRV-101), or placebo (n=8), given by intramuscular injections at weeks 0, 4 and 8 at a single study site in Finland. The participants were followed for another 24 weeks. Safety and tolerability were the primary endpoints. Anti-CVB IgG and virus-neutralising titres were analysed using an ELISA and neutralising plaque reduction assays, respectively. RESULTS Among the 32 participants (low dose, n=12; high dose, n=12; placebo, n=8) no serious adverse events or adverse events leading to study treatment discontinuation were observed. Treatment-emergent adverse events considered to be related to the study drug occurred in 37.5% of the participants in the placebo group and 62.5% in the PRV-101 group (injection site pain, headache, injection site discomfort and injection site pruritus being most common). PRV-101 induced dose-dependent neutralising antibody responses against all five CVB serotypes included in the vaccine in both the high- and low-dose groups. Protective titres ≥8 against all five serotypes were seen in >90% of participants over the entire follow-up period. CONCLUSIONS/INTERPRETATION The results indicate that the tested multivalent CVB vaccine is well tolerated and immunogenic, supporting its further clinical development. TRIAL REGISTRATION ClinicalTrials.gov NCT04690426. FUNDING This trial was funded by Provention Bio, a Sanofi company.
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Affiliation(s)
- Heikki Hyöty
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Fimlab Laboratories, Tampere, Finland.
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
| | | | - Jutta E Laiho
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Gail M Comer
- Provention Bio, Inc., a Sanofi Company, Bridgewater, NJ, USA
| | - Wei Tian
- Provention Bio, Inc., a Sanofi Company, Bridgewater, NJ, USA
| | - Taina Härkönen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi P Lehtonen
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sami Oikarinen
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena Puustinen
- Department of Virology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Michele Snyder
- Provention Bio, Inc., a Sanofi Company, Bridgewater, NJ, USA
| | - Francisco León
- Provention Bio, Inc., a Sanofi Company, Bridgewater, NJ, USA
| | - Mika Scheinin
- Clinical Research Services Turku - CRST Oy, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mikael Knip
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Miguel Sanjuan
- Provention Bio, Inc., a Sanofi Company, Bridgewater, NJ, USA
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3
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Liu S, Lu W, Ma S, Guo H, Zhang Z, Li X. Comparison of the neutralizing activities of antibodies in clinical sera against both Sabin and wild-type polio pseudoviruses. J Virol Methods 2021; 300:114376. [PMID: 34826519 DOI: 10.1016/j.jviromet.2021.114376] [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: 07/14/2020] [Revised: 09/18/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
The cost-effectiveness of the Sabin inactivated poliovirus vaccine derived from the Sabin strains (S-IPV) and its reduced biosecurity risks during its manufacture make it the vaccine of choice over the IPVs derived from wild-type polioviruses. However, it is difficult to evaluate whether S-IPVs can achieve wild-type poliovirus containment in China, making its development there less attractive. To facilitate the development and adoption of S-IPVs in China, the aim of this study was to develop an alternative neutralizing assay using either a polio pseudovirus derived from a Sabin strain (S-pNA) or one derived from a wild-type strain (w-pNA) to replace the conventional neutralizing assay which uses live polioviruses. A total of 100 sera were collected from children immunized with an oral poliovirus vaccine and their antibody titers were assessed by both the S-pNA and w-pNA. The results showed that this method was feasible for the quantification of neutralizing antibody activities in the sera of the vaccinated individuals. The Wilcoxon signed-rank sum test indicated that the neutralizing antibody titers obtained against the Sabin strains were higher than those obtained with the wild-type strains for types 1 and 3, while for type 2, the titers against the wild-type strains were higher than those against the Sabin strains (p < 0.001 for all three types). It is hoped that this assay could be used to assess whether immune sera by the S-IPV possess adequate neutralizing capacity against both attenuated and wild-type poliovirus strains.
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Affiliation(s)
- Shaohua Liu
- National Vaccine & Serum Institute, Beijing, China
| | - Weiwei Lu
- National Vaccine & Serum Institute, Beijing, China
| | - Shuhua Ma
- National Vaccine & Serum Institute, Beijing, China
| | - Huijie Guo
- National Vaccine & Serum Institute, Beijing, China
| | | | - Xiuling Li
- National Vaccine & Serum Institute, Beijing, China; Shanghai Institute of Biological Products Co. LTD, China.
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Sealy RE, Dayton B, Finkelstein D, Hurwitz JL. Harnessing Natural Mosaics: Antibody-Instructed, Multi-Envelope HIV-1 Vaccine Design. Viruses 2021; 13:v13050884. [PMID: 34064894 PMCID: PMC8151930 DOI: 10.3390/v13050884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
The year 2021 marks the 40th anniversary since physicians recognized symptoms of the acquired immunodeficiency syndrome (AIDS), a disease that has since caused more than 30 million deaths worldwide. Despite the passing of four decades, there remains no licensed vaccine for the human immunodeficiency virus type 1 (HIV-1), the etiologic agent of AIDS. Despite the development of outstanding anti-retroviral drugs, there are currently more than one-half million deaths each year due to AIDS. Here, we revisit a conventional vaccine strategy used for protection against variable pathogens like HIV-1, which combines an array of diverse surface antigens. The strategy uses antibody recognition patterns to categorize viruses and their surface antigens into groups. Then a leader is assigned for each group and group leaders are formulated into vaccine cocktails. The group leaders are ‘natural mosaics’, because they share one or more epitope(s) with each of the other group members. We encourage the application of this conventional approach to HIV-1 vaccine design. We suggest that the partnering of an antibody-instructed envelope cocktail with new vaccine vectors will yield a successful vaccine in the HIV-1 field.
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Affiliation(s)
- Robert E. Sealy
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA;
| | - Barry Dayton
- Department of Mathematics, Northeastern Illinois University, 5500 N. St Louis Ave, Chicago, IL 60625, USA;
| | - David Finkelstein
- Hartwell Center for Bioinformatics and Biotechnology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA;
| | - Julia L. Hurwitz
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA;
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, 858 Madison Avenue, Memphis, TN 38163, USA
- Correspondence: ; Tel.: +1-901-595-2464
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5
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Slobod KS, Hurwitz JL. How Basic Immunological Principles May Instruct the Design of a Successful HIV-Type 1 Vaccine. Viral Immunol 2021; 33:233-236. [PMID: 32286171 PMCID: PMC7185311 DOI: 10.1089/vim.2019.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article is dedicated to Dr. Peter Doherty. While Peter continues to make groundbreaking discoveries in the field of immunology, he also provides outstanding scientific mentorship to his trainees. Here we contemplate our past training with Peter, Peter's teachings of basic immunological principles, and how basic principles may instruct the design of a successful human immunodeficiency virus-type 1 vaccine.
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Affiliation(s)
| | - Julia L Hurwitz
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
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Penkert RR, Hankins JS, Young NS, Hurwitz JL. Vaccine Design Informed by Virus-Induced Immunity. Viral Immunol 2020; 33:342-350. [PMID: 32366204 PMCID: PMC7247049 DOI: 10.1089/vim.2019.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
When an individual is exposed to a viral pathogen for the first time, the adaptive immune system is naive and cannot prevent virus replication. The consequence may be severe disease. At the same time, the host may rapidly generate a pathogen-specific immune response that will prevent disease if the virus is encountered again. Parvovirus B19 provides one such example. Children with sickle cell disease can experience life-threatening transient aplastic crisis when first exposed to parvovirus B19, but an effective immune response confers lifelong protection. We briefly examine the induction and benefits of virus-induced immunity. We focus on three human viruses for which there are no licensed vaccines (respiratory syncytial virus, human immunodeficiency virus type 1, and parvovirus B19) and consider how virus-induced immunity may inform successful vaccine design.
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Affiliation(s)
- Rhiannon R. Penkert
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jane S. Hankins
- Pathology Department, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Neal S. Young
- Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Julia L. Hurwitz
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Multiplex PCR-Based Neutralization (MPBN) Assay for Titers Determination of the Three Types of Anti-Poliovirus Neutralizing-Antibodies. Vaccines (Basel) 2020; 8:vaccines8010120. [PMID: 32150852 PMCID: PMC7157629 DOI: 10.3390/vaccines8010120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
Determination of poliovirus-neutralizing antibodies is an important part of clinical studies of poliovirus vaccines, epidemiological surveillance and seroprevalence studies that are crucial for global polio eradication campaigns. The conventional neutralization test is based on inhibition of cytopathic effect caused by poliovirus by serial dilutions of test serum. It is laborious, time-consuming and not suitable for large scale analysis. To overcome these limitations, a multiplex PCR-based neutralization (MPBN) assay was developed to measure the neutralizing antibody titers of anti-poliovirus sera against three serotypes of the virus in the same reaction and in shorter time. All three anti-poliovirus sera types were analyzed in a single assay. The MPBN assay was reproducible, robust and sensitive. Its lower limits of titration for the three anti-poliovirus sera types were within range of 0.76-1.64 per mL. Different anti-poliovirus sera were tested with conventional and MPBN assays; the results obtained by both methods correlated well and generated similar results. The MPBN is the first neutralization assay that specifically titrates anti-poliovirus antibodies against the three serotypes of the virus in the same reaction; it can be completed in two to three days instead of ten days for the conventional assay and can be automated for high-throughput implementation.
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Hurwitz JL, Bonsignori M. Multi-Envelope HIV-1 Vaccine Development: Two Targeted Immune Pathways, One Desired Protective Outcome. Viral Immunol 2018; 31:124-132. [PMID: 29315059 DOI: 10.1089/vim.2017.0144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In 2016, there were more than 30 million individuals living with HIV-1, ∼1.8 million new HIV-1 infections, and ∼1 million HIV-1-related deaths according to UNAIDS ( unaids.org ). Hence, a preventive HIV-1 vaccine remains a global priority. The variant envelopes of HIV-1 present a significant obstacle to vaccine development and the vaccine field has realized that immunization with a single HIV-1 envelope protein will not be sufficient to generate broadly neutralizing antibodies. Here we describe two nonmutually exclusive, targeted pathways with which a multi-envelope HIV-1 vaccine may generate protective immune responses against variant HIV-1. Pathways include (i) the induction of a polyclonal immune response, comprising a plethora of antibodies with subset-reactive and cross-reactive specificities, together able to neutralize diverse HIV-1 (termed Poly-nAb in this report) and (ii) the induction of one or a few monoclonal antibodies, each with a broadly neutralizing specificity (bnAb). With each pathway in mind, we describe challenges and strategies that may ultimately support HIV-1 vaccine success.
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Affiliation(s)
- Julia L Hurwitz
- 1 Department of Infectious Diseases, St. Jude Children's Research Hospital , Memphis, Tennessee.,2 Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center , Memphis, Tennessee
| | - Mattia Bonsignori
- 3 Duke Human Vaccine Institute , Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina.,4 Department of Medicine, Duke University School of Medicine, Duke University Medical Center , Durham, North Carolina
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Liu S, Song D, Bai H, Lu W, Dai X, Hao C, Zhang Z, Guo H, Zhang Y, Li X. A safe and reliable neutralization assay based on pseudovirus to measure neutralizing antibody titer against poliovirus. J Med Virol 2017; 89:2075-2083. [PMID: 28786502 DOI: 10.1002/jmv.24909] [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: 03/24/2017] [Accepted: 07/01/2017] [Indexed: 12/11/2022]
Abstract
With the promotion of inactivated poliomyelitis vaccine (IPV) and live attenuated oral poliomyelitis vaccine (OPV), the global reported cases of poliomyelitis have reduced sharply from 0.35 million in 1988 to 74 in 2015. The Polio Eradication & Endgame Strategic Plan published by WHO in 2013 included the strategy of implementation of poliovirus safe handling and containment measures to minimize the risks of facility-associated reintroduction of virus into the polio-free community to prevent the re-import of poliovirus. Toward this strategy, we produced replication-incompetent pseudovirus of poliovirus type 1, 2, 3 attenuated strains by constructing poliovirus capsid expression vectors and poliovirus replicon then transfecting HEK293T cells and developed a pseudovirus-based neutralization assay (pNA) to determine neutralizing antibody titer which is more secure, time-saving and reliable than conventional neutralization assay (cNA). By using anti-poliovirus rat serum, we demonstrated excellent correlation between neutralizing antibody titers measured by cNA and pNA. It was concluded that pNA can be a potential alternative to replace cNA as a safe and time-saving system for titer determination after live poliovirus's safekeeping.
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Affiliation(s)
- Shaohua Liu
- National Vaccine and Serum Institute, Beijing, China
| | - Dongmei Song
- National Vaccine and Serum Institute, Beijing, China
| | - Han Bai
- National Vaccine and Serum Institute, Beijing, China
| | - Weiwei Lu
- National Vaccine and Serum Institute, Beijing, China
| | - Xinxian Dai
- National Vaccine and Serum Institute, Beijing, China
| | - Chunsheng Hao
- National Vaccine and Serum Institute, Beijing, China
| | | | - Huijie Guo
- National Vaccine and Serum Institute, Beijing, China
| | - Yue Zhang
- National Vaccine and Serum Institute, Beijing, China
| | - Xiuling Li
- National Vaccine and Serum Institute, Beijing, China
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Foiadelli T, Savasta S, Battistone A, Kota M, Passera C, Fiore S, Bino S, Amato C, Lozza A, Marseglia GL, Fiore L. Nucleotide variation in Sabin type 3 poliovirus from an Albanian infant with agammaglobulinemia and vaccine associated poliomyelitis. BMC Infect Dis 2016; 16:277. [PMID: 27287521 PMCID: PMC4903009 DOI: 10.1186/s12879-016-1587-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/14/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vaccine-associated paralytic poliomyelitis (VAPP) and immunodeficient long-term polio excretors constitute a significant public health burden and are a major concern for the WHO global polio eradication endgame. CASE PRESENTATION Poliovirus type 3 characterized as Sabin-like was isolated from a 5-month-old Albanian child with X-linked agammaglobulinemia and VAPP after oral polio vaccine administration. Diagnostic workup and treatment were performed in Italy. Poliovirus replicated in the gut for 7 months. The 5' non coding region (NCR), VP1, VP3 capsid proteins and the 3D polymerase genomic regions of sequential isolates were sequenced. Increasing accumulation of nucleotide mutations in the VP1 region was detected over time, reaching 1.0 % of genome variation with respect to the Sabin reference strain, which is the threshold that defines a vaccine-derived poliovirus (VDPV). We identified mutations in the 5'NCR and VP3 regions that are associated with reversion to neurovirulence. Despite this, all isolates were characterized as Sabin-like. Several amino acid mutations were identified in the VP1 region, probably involved in growth adaptation and viral persistence in the human gut. Intertypic recombination with Sabin type 2 polio in the 3D polymerase region, possibly associated with increased virus transmissibility, was found in all isolates. Gamma-globulin replacement therapy led to viral clearance and neurological improvement, preventing the occurrence of persistent immunodeficiency-related VDPV. CONCLUSIONS This is the first case of VAPP in an immunodeficient child detected in Albania through the Acute Flaccid Paralysis surveillance system and the first investigated case of vaccine associated poliomyelitis in Italy since the introduction of an all-Salk schedule in 2002. We discuss over the biological and clinical implications in the context of the Global Polio Eradication Program and emphasize on the importance of the Acute Flaccid Paralysis surveillance.
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Affiliation(s)
- Thomas Foiadelli
- Department of Pediatrics, University of Pavia, Policlinico San Matteo IRCCS Foundation, Pavia, Italy.
| | - Salvatore Savasta
- Department of Pediatrics, University of Pavia, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Andrea Battistone
- National Center for Immunobiologicals Control and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Majlinda Kota
- Control of Communicable Disease Department, Institute of Public Health, Tirana, Albania
| | - Carolina Passera
- Department of Pediatrics, University of Pavia, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Stefano Fiore
- National Center for Immunobiologicals Control and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Bino
- Control of Communicable Disease Department, Institute of Public Health, Tirana, Albania
| | - Concetta Amato
- National Center for Immunobiologicals Control and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Lozza
- National Neurological Institute IRCCS Foundation C. Mondino, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, University of Pavia, Policlinico San Matteo IRCCS Foundation, Pavia, Italy
| | - Lucia Fiore
- National Center for Immunobiologicals Control and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Mehndiratta MM, Mehndiratta P, Pande R. Poliomyelitis: historical facts, epidemiology, and current challenges in eradication. Neurohospitalist 2014; 4:223-9. [PMID: 25360208 DOI: 10.1177/1941874414533352] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Poliomyelitis is a highly infectious disease caused by a virus belonging to the Picornaviridae family. It finds a mention even in ancient Egyptian paintings and carvings. The clinical features are varied ranging from mild cases of respiratory illness, gastroenteritis, and malaise to severe forms of paralysis. These have been categorized into inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic poliomyelitis), and paralytic poliomyelitis. This disease has been associated with crippling deformities affecting thousands of lives throughout the world. Only due to the perseverance and determination of great scientists in 1900s, the genomic structure of the virus and its pathogenesis could be elucidated. Contribution of Salk and Sabin in the form of vaccines-oral polio vaccine (OPV) and the inactivated polio vaccine-heralded a scientific revolution. In 1994, the World Health Organization (WHO) Region of The Americas was certified polio free followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002 of the 3 types of wild poliovirus (types 1, 2, and 3). In 2013, only 3 countries remained polio endemic-Nigeria, Pakistan, and Afghanistan. Global eradication of polio is imperative else the threat of an outbreak will hover forever. Today, all the governments of the world in collaboration with WHO stand unified in their fight against poliomyelitis and the task when achieved will pave the way for eliminating other infections in future.
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Affiliation(s)
- Man Mohan Mehndiratta
- Department of Neurology, Janakpuri Superspeciality Hospital, Janakpuri, New Delhi, India
| | - Prachi Mehndiratta
- Department of Neurology, subspecialty division Vascular neurology-StrokeDepartment of Neurology, subspecialty division Vascular neurology-Stroke, University of Virginia, Charlottesville, VA, USA
| | - Renuka Pande
- Department of Microbiology, Janakpuri Superspeciality Hospital, New Delhi, India
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Abstract
Two vaccine trials that were conducted 50 years apart are reviewed and compared: the 1954 field trial of the Salk inactivated polio vaccine and the RV144 HIV vaccine trial conducted in Thailand between 2003 and 2009. Despite the obvious differences in science and historical periods, several lessons were identified that could inform the future HIV vaccine effort. Those lessons are related to paradigm changes that occur when science progresses, the need to test scientific hypothesis in efficacy trials, the controversies surrounding those trials, the need for strong community and political support, the participation of government and nongovernment institutions, the balance between implementation of other preventive and therapeutic interventions, and the priority given by society to develop a vaccine. If we have the humility and courage to apply some of those lessons, we may be able accelerate the development of an urgently needed HIV vaccine.
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Reply to “Poliovirus-Neutralization Test with Poliovirus Pseudovirus To Measure Neutralizing Antibody in Humans”. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2012. [DOI: 10.1128/cvi.05698-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Development of a poliovirus neutralization test with poliovirus pseudovirus for measurement of neutralizing antibody titer in human serum. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1889-94. [PMID: 21880850 DOI: 10.1128/cvi.05225-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the Global Polio Eradication Initiative, laboratory diagnosis plays a critical role by isolating and identifying poliovirus (PV) from the stool samples from acute flaccid paralysis (AFP) cases. In recent years, reestablishment of PV circulation in countries where PV was previously eliminated has occurred because of decreased herd immunity, possibly due to poor vaccination coverage. To monitor the vulnerability of countries to PV circulation, surveillance of neutralizing-antibody titers against PV in susceptible populations is essential in the end game of the polio eradication program. In this study, we have developed a PV neutralization test with type 1, 2, and 3 PV pseudoviruses to determine the neutralizing-antibody titer against PV in human serum samples. With this test, the neutralizing-antibody titer against PV could be determined within 2 days by automated interpretation of luciferase signals without using infectious PV strains. We validated the pseudovirus PV neutralization test with 131 human serum samples collected from a wide range of age groups (ages 1 to >60 years) by comparison with a conventional neutralization test. We found good correlation in the neutralizing-antibody titers determined by these tests. These results suggest that a pseudovirus PV neutralization test would serve as a safe and simple procedure for the measurement of the neutralizing-antibody titer against PV.
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