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Hickey BW, Lumsden JM, Reyes S, Sedegah M, Hollingdale MR, Freilich DA, Luke TC, Charoenvit Y, Goh LM, Berzins MP, Bebris L, Sacci JB, De La Vega P, Wang R, Ganeshan H, Abot EN, Carucci DJ, Doolan DL, Brice GT, Kumar A, Aguiar J, Nutman TB, Leitman SF, Hoffman SL, Epstein JE, Richie TL. Mosquito bite immunization with radiation-attenuated Plasmodium falciparum sporozoites: safety, tolerability, protective efficacy and humoral immunogenicity. Malar J 2016; 15:377. [PMID: 27448805 PMCID: PMC4957371 DOI: 10.1186/s12936-016-1435-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this phase 1 clinical trial, healthy adult, malaria-naïve subjects were immunized with radiation-attenuated Plasmodium falciparum sporozoites (PfRAS) by mosquito bite and then underwent controlled human malaria infection (CHMI). The PfRAS model for immunization against malaria had previously induced >90 % sterile protection against homologous CHMI. This study was to further explore the safety, tolerability and protective efficacy of the PfRAS model and to provide biological specimens to characterize protective immune responses and identify protective antigens in support of malaria vaccine development. METHODS Fifty-seven subjects were screened, 41 enrolled and 30 received at least one immunization. The true-immunized subjects received PfRAS via mosquito bite and the mock-immunized subjects received mosquito bites from irradiated uninfected mosquitoes. Sera and peripheral blood mononuclear cells (PBMCs) were collected before and after PfRAS immunizations. RESULTS Immunization with PfRAS was generally safe and well tolerated, and repeated immunization via mosquito bite did not appear to increase the risk or severity of AEs. Local adverse events (AEs) of true-immunized and mock-immunized groups consisted of erythaema, papules, swelling, and induration and were consistent with reactions from mosquito bites seen in nature. Two subjects, one true- and one mock-immunized, developed large local reactions that completely resolved, were likely a result of mosquito salivary antigens, and were withdrawn from further participation as a safety precaution. Systemic AEs were generally rare and mild, consisting of headache, myalgia, nausea, and low-grade fevers. Two true-immunized subjects experienced fever, malaise, myalgia, nausea, and rigours approximately 16 h after immunization. These symptoms likely resulted from pre-formed antibodies interacting with mosquito salivary antigens. Ten subjects immunized with PfRAS underwent CHMI and five subjects (50 %) were sterilely protected and there was a significant delay to parasitaemia in the other five subjects. All ten subjects developed humoral immune responses to whole sporozoites and to the circumsporozoite protein prior to CHMI, although the differences between protected and non-protected subjects were not statistically significant for this small sample size. CONCLUSIONS The protective efficacy of this clinical trial (50 %) was notably less than previously reported (>90 %). This may be related to differences in host genetics or the inherent variability in mosquito biting behavior and numbers of sporozoites injected. Differences in trial procedures, such as the use of leukapheresis prior to CHMI and of a longer interval between the final immunization and CHMI in these subjects compared to earlier trials, may also have reduced protective efficacy. This trial has been retrospectively registered at ISRCTN ID 17372582, May 31, 2016.
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Affiliation(s)
- Bradley W. Hickey
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Joanne M. Lumsden
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Sharina Reyes
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Martha Sedegah
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Michael R. Hollingdale
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Daniel A. Freilich
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Thomas C. Luke
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Yupin Charoenvit
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Lucy M. Goh
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Mara P. Berzins
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Lolita Bebris
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - John B. Sacci
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Patricia De La Vega
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Ruobing Wang
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Harini Ganeshan
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Esteban N. Abot
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD USA
| | - Daniel J. Carucci
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Denise L. Doolan
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Gary T. Brice
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Anita Kumar
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Joao Aguiar
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Thomas B. Nutman
- />Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Susan F. Leitman
- />Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD USA
| | - Stephen L. Hoffman
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Sanaria Inc., Rockville, MD USA
| | - Judith E. Epstein
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
| | - Thomas L. Richie
- />US Military Malaria Vaccine Program, Naval Medical Research Center, Silver Spring, MD USA
- />Sanaria Inc., Rockville, MD USA
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Budde H, Kolb S, Salinas Tejedor L, Wulf G, Reichardt HM, Riggert J, Legler TJ. Modified extracorporeal photopheresis with cells from a healthy donor for acute graft-versus-host disease in a mouse model. PLoS One 2014; 9:e105896. [PMID: 25148404 PMCID: PMC4141828 DOI: 10.1371/journal.pone.0105896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/25/2014] [Indexed: 01/08/2023] Open
Abstract
Background Graft-versus-host disease (GvHD) is a major challenge after hematopoietic stem cell transplantation but treatment options for patients are still limited. In many cases first-line treatment with glucocorticoids is not successful. Among second-line therapies the extracorporeal photopheresis (ECP) is frequently performed, due to induction of selective tolerance instead of general immunosuppression. However, for some patients with severe acute GvHD the leukapheresis step of the ECP procedure is physically exhausting and limits the number of ECP cycles. Methods We hypothesized that leukocytes from healthy cell donors could be used as a replacement for ECP leukocytes gained from the GvHD patient. For this purpose we used a well established mouse model of acute GvHD. The ECP therapy was based on cells with the genetic background of the initial donor of the stem cell transplantation. As a precondition we developed a protocol representing conventional ECP in mice equivalent to clinical used ECP setup. Results We could demonstrate that conventional, clinically derived ECP setup is able to alleviate acute GvHD. By using leukocytes obtained from healthy mice with the bone marrow donor’s genetic background we could not observe a statistically significant therapeutic effect. Conclusions Conventional human ECP setup is effective in the mouse model of severe acute GvHD. In addition we could not prove that ECP cells from healthy mice with bone marrow donor’s genetic background are as effective as ECP cells derived from GvHD mice. Based on our findings, new questions arise for further studies, in which the cellular characteristics for ECP mediated immune tolerance are a matter of investigation.
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Affiliation(s)
- Holger Budde
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
| | - Susanne Kolb
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Salinas Tejedor
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Gerald Wulf
- Department of Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Holger M. Reichardt
- Institute for Cellular and Molecular Immunology, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias J. Legler
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
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Cintolo JA, Datta J, Mathew SJ, Czerniecki BJ. Dendritic cell-based vaccines: barriers and opportunities. Future Oncol 2013; 8:1273-99. [PMID: 23130928 DOI: 10.2217/fon.12.125] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dendritic cells (DCs) have several characteristics that make them an ideal vehicle for tumor vaccines, and with the first US FDA-approved DC-based vaccine in use for the treatment of prostate cancer, this technology has become a promising new therapeutic option. However, DC-based vaccines face several barriers that have limited their effectiveness in clinical trials. A major barrier includes the activation state of the DC. Both DC lineage and maturation signals must be selected to optimize the antitumor response and overcome immunosuppressive effects of the tumor microenvironment. Another barrier to successful vaccination is the selection of target antigens that will activate both CD8(+) and CD4(+) T cells in a potent, immune-specific manner. Finally, tumor progression and immune dysfunction limit vaccine efficacy in advanced stages, which may make DC-based vaccines more efficacious in treating early-stage disease. This review underscores the scientific basis and advances in the development of DC-based vaccines, focuses on current barriers to success and highlights new research opportunities to address these obstacles.
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Affiliation(s)
- Jessica A Cintolo
- Department of Surgery & Harrison Department of Surgical Research, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
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Buhl T, Legler TJ, Rosenberger A, Schardt A, Schön MP, Haenssle HA. Controlled-rate freezer cryopreservation of highly concentrated peripheral blood mononuclear cells results in higher cell yields and superior autologous T-cell stimulation for dendritic cell-based immunotherapy. Cancer Immunol Immunother 2012; 61:2021-31. [PMID: 22527251 PMCID: PMC3493671 DOI: 10.1007/s00262-012-1262-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 04/04/2012] [Indexed: 11/28/2022]
Abstract
Availability of large quantities of functionally effective dendritic cells (DC) represents one of the major challenges for immunotherapeutic trials against infectious or malignant diseases. Low numbers or insufficient T-cell activation of DC may result in premature termination of treatment and unsatisfying immune responses in clinical trials. Based on the notion that cryopreservation of monocytes is superior to cryopreservation of immature or mature DC in terms of resulting DC quantity and immuno-stimulatory capacity, we aimed to establish an optimized protocol for the cryopreservation of highly concentrated peripheral blood mononuclear cells (PBMC) for DC-based immunotherapy. Cryopreserved cell preparations were analyzed regarding quantitative recovery, viability, phenotype, and functional properties. In contrast to standard isopropyl alcohol (IPA) freezing, PBMC cryopreservation in an automated controlled-rate freezer (CRF) with subsequent thawing and differentiation resulted in significantly higher cell yields of immature and mature DC. Immature DC yields and total protein content after using CRF were comparable with results obtained with freshly prepared PBMC and exceeded results of standard IPA freezing by approximately 50 %. While differentiation markers, allogeneic T-cell stimulation, viability, and cytokine profiles were similar to DC from standard freezing procedures, DC generated from CRF-cryopreserved PBMC induced a significantly higher antigen-specific IFN-γ release from autologous effector T cells. In summary, automated controlled-rate freezing of highly concentrated PBMC represents an improved method for increasing DC yields and autologous T-cell stimulation.
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Affiliation(s)
- Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
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Probst-Kepper M, Kröger A, Garritsen HSP, Buer J. Perspectives on Regulatory T Cell Therapies. Transfus Med Hemother 2009; 36:302-308. [PMID: 21076548 PMCID: PMC2969127 DOI: 10.1159/000235929] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 08/25/2009] [Indexed: 12/14/2022] Open
Abstract
Adoptive transfer in animal models clearly indicate an essential role of CD4+ CD25+ FOXP3+ regulatory T (T(reg)) cells in prevention and treatment of autoimmune and graft-versus-host disease. Thus, T(reg) cell therapies and development of drugs that specifically enhance T(reg) cell function and development represent promising tools to establish dominant tolerance. So far, lack of specific markers to differentiate human T(reg) cells from activated CD4+ CD25+ effector T cells, which also express FOXP3 at different levels, hampered such an approach. Recent identification of the orphan receptor glycoprotein-A repetitions predominant (GARP or LRRC32) as T(reg) cell-specific key molecule that dominantly controls FOXP3 via a positive feedback loop opens up new perspectives for molecular and cellular therapies. This brief review focuses on the role of GARP as a safeguard of a complex regulatory network of human T(reg) cells and its implications for regulatory T cell therapies in autoimmunity and graft-versus-host disease.
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Affiliation(s)
- Michael Probst-Kepper
- Institut für Mikrobiologie, Immunologie und Krankenhaushygiene, Braunschweig, Germany
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Meyer-Monard S, Passweg J, Siegler U, Kalberer C, Koehl U, Rovó A, Halter J, Stern M, Heim D, Alois Gratwohl JR, Tichelli A. Clinical-grade purification of natural killer cells in haploidentical hematopoietic stem cell transplantation. Transfusion 2009; 49:362-71. [PMID: 19389215 DOI: 10.1111/j.1537-2995.2008.01969.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of a high risk of graft-versus-host disease (GVHD), donor lymphocyte infusions with unmodified lymphapheresis products are not used after haploidentical hematopoietic stem cell transplantation. Natural killer (NK) cells have antitumor activity and may consolidate engraftment without inducing GVHD. Production of NK cells under good manufacturing practice (GMP) conditions in a sufficient number is difficult. STUDY DESIGN AND METHODS Twenty-four apheresis procedures and subsequent NK-cell enrichment from 14 haploidentical donors were performed. NK-cell enrichment was performed using a GMP suitable immunomagnetic procedure. Factors influencing the NK-cell recovery, purity, and NK-cell dose were analyzed. RESULTS A median number of 4.9 x 10(8) NK cells were obtained and median NK-cell recovery was 58 percent. Median T-cell depletion was 4.32 log. The absolute NK-cell number in the final product after processing significantly correlated with the preharvest NK-cell content of the peripheral blood (p = 0.002, r = 0.867). The NK-cell recovery was inversely correlated to the absolute NK-cell number in the apheresis product (p = 0.01, r = -0.51). The NK-cell dose per kg of body weight of the patient was inversely correlated to the weight of the patient (p = 0.007, r = -0.533). CONCLUSION Donors with a high NK-cell count in peripheral blood are likely to provide NK-cell products with the highest cell number. However, maximal NK-cell dose is limited and high NK-cell doses may only be obtained for patients with a low body weight, making children and young adults the best candidates for NK-cell therapy.
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11
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Passweg JR, Koehl U, Uharek L, Meyer-Monard S, Tichelli A. Natural-killer-cell-based treatment in haematopoietic stem-cell transplantation. Best Pract Res Clin Haematol 2006; 19:811-24. [PMID: 16997185 DOI: 10.1016/j.beha.2006.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adoptive immunotherapy using natural killer (NK) cells is currently under investigation, especially in situations where anti-neoplastic effect is needed but infusion of T cells is considered hazardous, such as in recipients of haematopoietic stem-cell transplantation (HSCT) from haploidentical donors. NK-cell therapy is mainly but not exclusively investigated in the setting of allogeneic stem-cell transplantation. NK cells may induce potent anti-leukaemic and possibly anti-rejection activity, and may even mitigate graft-versus-host disease (GvHD). It remains to be determined whether such effects are clinically important and whether or not they are mediated mainly or exclusively by KIR-HLA class I interactions. Recent advances in graft engineering has provided methods for isolating large numbers of purified NK cells. Several groups have shown that clinical-grade NK cells at doses up to 10(7)/kg may be collected and purified for the purpose of infusion to patients. Early results in a limited number of patients show that these cell doses may be administered without adverse events and possibly without inducing GvHD. Further study is required to determine whether such infusions will be useful in preventing graft rejection, exerting graft-versus-leukaemia effects, and/or hastening immune recovery.
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Affiliation(s)
- Jakob R Passweg
- Service d'Hématologie, Departement Medecine Interne, Hôpitaux Universitaires de Genève, Genève, Switzerland.
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