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Deruelle F. The pharmaceutical industry is dangerous to health. Further proof with COVID-19. Surg Neurol Int 2022; 13:475. [PMID: 36324959 PMCID: PMC9610448 DOI: 10.25259/sni_377_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The COVID-19 period highlights a huge problem that has been developing for decades, the control of science by industry. In the 1950s, the tobacco industry set the example, which the pharmaceutical industry followed. Since then, the latter has been regularly condemned for illegal marketing, misrepresentation of experimental results, dissimulation of information about the dangers of drugs, and considered as criminal. Therefore, this study was conducted to show that knowledge is powerfully manipulated by harmful corporations, whose goals are: 1/financial; 2/to suppress our ability to make choices to acquire global control of public health. Methods: Pharmaceutical industry techniques for manipulating science and COVID-19 reporting were reviewed. Several sources of official documents were used: PubMed; National Institutes of Health resources; pharmaceutical companies; policy documents; national newspapers and news agencies; and books by prominent professionals (scientific and legal). A few studies have not been published in peer-reviewed journals; however, they have been conducted by reputable scientists in their respective fields. Results: Since the beginning of COVID-19, we can list the following methods of information manipulation which have been used: falsified clinical trials and inaccessible data; fake or conflict-of-interest studies; concealment of vaccines’ short-term side effects and total lack of knowledge of the long-term effects of COVID-19 vaccination; doubtful composition of vaccines; inadequate testing methods; governments and international organizations under conflicts of interest; bribed physicians; the denigration of renowned scientists; the banning of all alternative effective treatments; unscientific and liberticidal social methods; government use of behavior modification and social engineering techniques to impose confinements, masks, and vaccine acceptance; scientific censorship by the media. Conclusion: By supporting and selecting only the one side of science information while suppressing alternative viewpoints, and with obvious conflicts of interest revealed by this study, governments and the media constantly disinform the public. Consequently, the unscientifically validated vaccination laws, originating from industry-controlled medical science, led to the adoption of social measures for the supposed protection of the public but which became serious threats to the health and freedoms of the population.
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Topham DJ, DeDiego ML, Nogales A, Sangster MY, Sant A. Immunity to Influenza Infection in Humans. Cold Spring Harb Perspect Med 2021; 11:a038729. [PMID: 31871226 PMCID: PMC7919402 DOI: 10.1101/cshperspect.a038729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review discusses the human immune responses to influenza infection with some insights from studies using animal models, such as experimental infection of mice. Recent technological advances in the study of human immune responses have greatly added to our knowledge of the infection and immune responses, and therefore much of the focus is on recent studies that have moved the field forward. We consider the complexity of the adaptive response generated by many sequential encounters through infection and vaccination.
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Affiliation(s)
- David J Topham
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Marta L DeDiego
- Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Cientificas, 28049 Madrid, Spain
| | - Aitor Nogales
- Instituto Nacional de Investigación y Tecnologia Agraria y Ailmentaria, 28040 Madrid, Spain
| | - Mark Y Sangster
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York 14642, USA
| | - Andrea Sant
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York 14642, USA
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3
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Endo M, Tanishima M, Ibaragi K, Hayashida K, Fukuda T, Tanabe T, Naruse T, Kino Y, Ueda K. Clinical phase II and III studies of an AS03-adjuvanted H5N1 influenza vaccine produced in an EB66 ® cell culture platform. Influenza Other Respir Viruses 2020; 14:551-563. [PMID: 32579785 PMCID: PMC7431644 DOI: 10.1111/irv.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/09/2019] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background We have developed an AS03‐adjuvanted H5N1 influenza vaccine produced in an EB66® cell culture platform (KD‐295). Objectives In accordance with Japanese guidelines for development of pandemic prototype vaccines, the phase II study was conducted in a double‐blind, randomized, parallel‐group comparison study and the phase III study was conducted in an open‐label, non‐randomized, uncontrolled study. Methods Healthy adult volunteers aged 20 ‐ 64 years enrolled in the phase II and III studies (N = 248 and N = 369) received KD‐295 intramuscularly twice with a 21‐day interval. After administration, immune response and adverse events were evaluated. In the phase II study, four different vaccine formulations were compared: MA (3.75 μg hemagglutinin [HA] antigen + AS03 adjuvant system), MB (3.75 μg HA + 1/2AS03), HA (7.5 μg HA + AS03), and HB (7.5 μg HA + 1/2AS03). In the phase III study, the MA formulation was further evaluated. Results In the phase II study, all four vaccine formulations were well‐tolerated and no SAE related to vaccination were observed. The MA formulation was slightly more immunogenic and less reactogenic among the vaccine formulations. Therefore, the MA formulation was selected for the phase III study, and it was well‐tolerated and no serious adverse drug reactions were observed. The vaccine fulfilled the three immunogenicity criteria described in the Japanese guidelines. Conclusions These data indicate that the MA formulation of KD‐295 was well‐tolerated and highly immunogenic and it can be considered a useful pandemic and pre‐pandemic influenza vaccine.
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Affiliation(s)
- Masafumi Endo
- KM Biologics Co., Ltd. (KM Biologics), Kumamoto, Japan
| | | | - Kayo Ibaragi
- KM Biologics Co., Ltd. (KM Biologics), Kumamoto, Japan
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4
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Huang QS, Bandaranayake D, Wood T, Newbern EC, Seeds R, Ralston J, Waite B, Bissielo A, Prasad N, Todd A, Jelley L, Gunn W, McNicholas A, Metz T, Lawrence S, Collis E, Retter A, Wong SS, Webby R, Bocacao J, Haubrock J, Mackereth G, Turner N, McArdle B, Cameron J, Reynolds EG, Baker MG, Grant CC, McArthur C, Roberts S, Trenholme A, Wong C, Taylor S, Thomas P, Duque J, Gross D, Thompson MG, Widdowson MA. Risk Factors and Attack Rates of Seasonal Influenza Infection: Results of the Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) Seroepidemiologic Cohort Study. J Infect Dis 2019; 219:347-357. [PMID: 30016464 DOI: 10.1093/infdis/jiy443] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Understanding the attack rate of influenza infection and the proportion who become ill by risk group is key to implementing prevention measures. While population-based studies of antihemagglutinin antibody responses have been described previously, studies examining both antihemagglutinin and antineuraminidase antibodies are lacking. Methods In 2015, we conducted a seroepidemiologic cohort study of individuals randomly selected from a population in New Zealand. We tested paired sera for hemagglutination inhibition (HAI) or neuraminidase inhibition (NAI) titers for seroconversion. We followed participants weekly and performed influenza polymerase chain reaction (PCR) for those reporting influenza-like illness (ILI). Results Influenza infection (either HAI or NAI seroconversion) was found in 321 (35% [95% confidence interval, 32%-38%]) of 911 unvaccinated participants, of whom 100 (31%) seroconverted to NAI alone. Young children and Pacific peoples experienced the highest influenza infection attack rates, but overall only a quarter of all infected reported influenza PCR-confirmed ILI, and one-quarter of these sought medical attention. Seroconversion to NAI alone was higher among children aged <5 years vs those aged ≥5 years (14% vs 4%; P < .001) and among those with influenza B vs A(H3N2) virus infections (7% vs 0.3%; P < .001). Conclusions Measurement of antineuraminidase antibodies in addition to antihemagglutinin antibodies may be important in capturing the true influenza infection rates.
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Affiliation(s)
- Q Sue Huang
- Institute of Environmental Science and Research, Wellington
| | | | - Tim Wood
- Institute of Environmental Science and Research, Wellington
| | | | - Ruth Seeds
- Institute of Environmental Science and Research, Wellington
| | - Jacqui Ralston
- Institute of Environmental Science and Research, Wellington
| | - Ben Waite
- Institute of Environmental Science and Research, Wellington
| | - Ange Bissielo
- Institute of Environmental Science and Research, Wellington
| | - Namrata Prasad
- Institute of Environmental Science and Research, Wellington
| | - Angela Todd
- Institute of Environmental Science and Research, Wellington
| | - Lauren Jelley
- Institute of Environmental Science and Research, Wellington
| | - Wendy Gunn
- Institute of Environmental Science and Research, Wellington
| | | | - Thomas Metz
- Institute of Environmental Science and Research, Wellington
| | | | - Emma Collis
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Amanda Retter
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Sook-San Wong
- World Health Organization Collaborating Centre, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Webby
- World Health Organization Collaborating Centre, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Judy Bocacao
- Institute of Environmental Science and Research, Wellington
| | | | | | | | | | | | | | | | | | | | | | | | - Conroy Wong
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Susan Taylor
- Counties Manukau District Health Board, Auckland, New Zealand
| | - Paul Thomas
- World Health Organization Collaborating Centre, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jazmin Duque
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diane Gross
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia
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5
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Knowlden ZAG, Richards KA, Moritzky SA, Sant AJ. Peptide Epitope Hot Spots of CD4 T Cell Recognition Within Influenza Hemagglutinin During the Primary Response to Infection. Pathogens 2019; 8:pathogens8040220. [PMID: 31694141 PMCID: PMC6963931 DOI: 10.3390/pathogens8040220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 01/15/2023] Open
Abstract
Antibodies specific for the hemagglutinin (HA) protein of influenza virus are critical for protective immunity to infection. Our studies show that CD4 T cells specific for epitopes derived from HA are the most effective in providing help for the HA-specific B cell responses to infection and vaccination. In this study, we asked whether HA epitopes recognized by CD4 T cells in the primary response to infection are equally distributed across the HA protein or if certain segments are enriched in CD4 T cell epitopes. Mice that collectively expressed eight alternative MHC (Major Histocompatibility Complex) class II molecules, that would each have different peptide binding specificities, were infected with an H1N1 influenza virus. CD4 T cell peptide epitope specificities were identified by cytokine EliSpots. These studies revealed that the HA-specific CD4 T cell epitopes cluster in two distinct regions of HA and that some segments of HA are completely devoid of CD4 T cell epitopes. When located on the HA structure, it appears that the regions that most poorly recruit CD4 T cells are sequestered within the interior of the HA trimer, perhaps inaccessible to the proteolytic machinery inside the endosomal compartments of antigen presenting cells.
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6
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Qiu X, Duvvuri VR, Bahl J. Computational Approaches and Challenges to Developing Universal Influenza Vaccines. Vaccines (Basel) 2019; 7:E45. [PMID: 31141933 PMCID: PMC6631137 DOI: 10.3390/vaccines7020045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 12/25/2022] Open
Abstract
The traditional design of effective vaccines for rapidly-evolving pathogens, such as influenza A virus, has failed to provide broad spectrum and long-lasting protection. With low cost whole genome sequencing technology and powerful computing capabilities, novel computational approaches have demonstrated the potential to facilitate the design of a universal influenza vaccine. However, few studies have integrated computational optimization in the design and discovery of new vaccines. Understanding the potential of computational vaccine design is necessary before these approaches can be implemented on a broad scale. This review summarizes some promising computational approaches under current development, including computationally optimized broadly reactive antigens with consensus sequences, phylogenetic model-based ancestral sequence reconstruction, and immunomics to compute conserved cross-reactive T-cell epitopes. Interactions between virus-host-environment determine the evolvability of the influenza population. We propose that with the development of novel technologies that allow the integration of data sources such as protein structural modeling, host antibody repertoire analysis and advanced phylodynamic modeling, computational approaches will be crucial for the development of a long-lasting universal influenza vaccine. Taken together, computational approaches are powerful and promising tools for the development of a universal influenza vaccine with durable and broad protection.
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Affiliation(s)
- Xueting Qiu
- Center for Ecology of Infectious Diseases, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
| | - Venkata R Duvvuri
- Center for Ecology of Infectious Diseases, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
| | - Justin Bahl
- Center for Ecology of Infectious Diseases, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA.
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA 30606, USA.
- Duke-NUS Graduate Medical School, Singapore 169857, Singapore.
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Trucchi C, Paganino C, Amicizia D, Orsi A, Tisa V, Piazza MF, Icardi G, Ansaldi F. Universal influenza virus vaccines: what needs to happen next? Expert Opin Biol Ther 2019; 19:671-683. [PMID: 30957589 DOI: 10.1080/14712598.2019.1604671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Influenza occurs worldwide and causes significant disease burden in terms of morbidity, associated complications, hospitalizations, and deaths. Vaccination constitutes the primary approach for controlling influenza. Current influenza vaccines elicit a strain-specific response yet occasionally exhibit suboptimal effectiveness. This review describes the limits of available immunization tools and the future prospects and potentiality of universal influenza vaccines. AREAS COVERED New 'universal' vaccines, which are presently under development, are expected to overcome the problems related to the high variability of influenza viruses, such as the need for seasonal vaccine updates and re-vaccination. Here, we explore vaccines based on the highly conserved epitopes of the HA, NA, or extracellular domain of the influenza M2 protein, along with those based on the internal proteins such as NP and M1. EXPERT OPINION The development of a universal influenza vaccine that confers protection against homologous, drifted, and shifted influenza virus strains could obviate the need for annual reformulation and mitigate disease burden. The scientific community has long been awaiting the advent of universal influenza vaccines; these are currently under development in laboratories worldwide. If such vaccines are immunogenic, efficacious, and able to confer long-lasting immunity, they might be integrated with or supplant traditional influenza vaccines.
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Affiliation(s)
- Cecilia Trucchi
- a Health Planning Unit , Liguria Health Authority (A.Li.Sa) , Genoa , Italy.,b Hygiene Unit , Ospedale Policlinico San Martino IRCCS teaching hospital , Genoa , Italy
| | - Chiara Paganino
- a Health Planning Unit , Liguria Health Authority (A.Li.Sa) , Genoa , Italy
| | - Daniela Amicizia
- a Health Planning Unit , Liguria Health Authority (A.Li.Sa) , Genoa , Italy.,b Hygiene Unit , Ospedale Policlinico San Martino IRCCS teaching hospital , Genoa , Italy.,c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Andrea Orsi
- b Hygiene Unit , Ospedale Policlinico San Martino IRCCS teaching hospital , Genoa , Italy.,c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Valentino Tisa
- c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Maria Francesca Piazza
- a Health Planning Unit , Liguria Health Authority (A.Li.Sa) , Genoa , Italy.,c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Giancarlo Icardi
- b Hygiene Unit , Ospedale Policlinico San Martino IRCCS teaching hospital , Genoa , Italy.,c Department of Health Sciences , University of Genoa , Genoa , Italy
| | - Filippo Ansaldi
- a Health Planning Unit , Liguria Health Authority (A.Li.Sa) , Genoa , Italy.,b Hygiene Unit , Ospedale Policlinico San Martino IRCCS teaching hospital , Genoa , Italy.,c Department of Health Sciences , University of Genoa , Genoa , Italy
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8
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Palya V, Tatár-Kis T, Walkóné Kovács E, Kiss I, Homonnay Z, Gardin Y, Kertész K, Dán Á. Efficacy of a Recombinant Turkey Herpesvirus AI (H5) Vaccine in Preventing Transmission of Heterologous Highly Pathogenic H5N8 Clade 2.3.4.4b Challenge Virus in Commercial Broilers and Layer Pullets. J Immunol Res 2018; 2018:3143189. [PMID: 30584541 PMCID: PMC6280313 DOI: 10.1155/2018/3143189] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
Outbreaks caused by the highly pathogenic avian influenza virus (HPAIV) H5N8 subtype clade 2.3.4.4 were first reported in 2014 in South Korea then spread very rapidly in Asia, to Europe, and for the first time, to North America. Efficacy of a recombinant HVT-AI (H5) vaccine (rHVT-H5) to provide clinical protection as well as to significantly reduce the shedding of an H5N8 challenge virus has already been demonstrated in SPF chickens. The aim of our studies was to test the efficacy of the same rHVT-H5 vaccine in controlling the transmission of a recent Hungarian HPAIV H5N8 challenge virus in commercial chickens. Broilers and layers were vaccinated at day old according to the manufacturer's recommendation and then challenged with a 2017 Hungarian HPAIV H5N8 (2.3.4.4b) isolate at 5 or 7 weeks of age, respectively. Evaluation of clinical protection, reduction of challenge virus shedding, and transmission to vaccinated contact birds was done on the basis of clinical signs/mortality, detection, and quantitation of challenge virus in oronasal and cloacal swabs (regularly between 1 and 14 days postchallenge). Measurement of seroconversion to AIV nucleoprotein was used as an indicator of infection and replication of challenge virus. Our results demonstrated that rHVT-H5 vaccination could prevent the development of clinical disease and suppress shedding very efficiently, resulting in the lack of challenge virus transmission to vaccinated contact chickens, regardless the type of birds. Single immunization with the tested rHVT-H5 vaccine proved to be effective to stop HPAIV H5N8 (2.3.4.4b) transmission within vaccinated poultry population under experimental conditions.
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Affiliation(s)
- Vilmos Palya
- Scientific Support and Investigation Unit, Ceva-Phylaxia, Ceva Animal Health, Budapest 1107, Hungary
| | - Tímea Tatár-Kis
- Scientific Support and Investigation Unit, Ceva-Phylaxia, Ceva Animal Health, Budapest 1107, Hungary
| | - Edit Walkóné Kovács
- Scientific Support and Investigation Unit, Ceva-Phylaxia, Ceva Animal Health, Budapest 1107, Hungary
| | - István Kiss
- Scientific Support and Investigation Unit, Ceva-Phylaxia, Ceva Animal Health, Budapest 1107, Hungary
| | - Zalán Homonnay
- Scientific Support and Investigation Unit, Ceva-Phylaxia, Ceva Animal Health, Budapest 1107, Hungary
| | | | | | - Ádám Dán
- Veterinary Diagnostic Directorate, National Food Chain Safety Office (NEBIH), Budapest 1149, Hungary
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Sant AJ, Richards KA, Nayak J. Distinct and complementary roles of CD4 T cells in protective immunity to influenza virus. Curr Opin Immunol 2018; 53:13-21. [PMID: 29621639 PMCID: PMC6141328 DOI: 10.1016/j.coi.2018.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 02/01/2023]
Abstract
CD4 T cells play a multiplicity of roles in protective immunity to influenza. Included in these functions are help for high affinity antibody production, enhancement of CD8 T cell expansion, function and memory, acceleration of the early innate response to infection and direct cytotoxicity. The influenza-specific CD4 T cell repertoire in humans established through exposures to infection and vaccination has been found to be highly variable in abundance, specificity and functionality. Deficits in particular subsets of CD4 T cells recruited into the response result in diminished antibody responses and protection from infection. Therefore, improved strategies for vaccination should include better methods to identify deficiencies in the circulating CD4 T cell repertoire, and vaccine constructs that increase the representation of CD4 T cells of the correct specificity and functionality.
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Affiliation(s)
- Andrea J Sant
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester Medical Center, USA; Department of Microbiology and Immunology, University of Rochester Medical Center, USA.
| | - Katherine A Richards
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester Medical Center, USA
| | - Jennifer Nayak
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester Medical Center, USA; Department of Microbiology and Immunology, University of Rochester Medical Center, USA; Department of Pediatrics, Division of Infectious Diseases, University of Rochester Medical Center, USA
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10
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Kumar A, Meldgaard TS, Bertholet S. Novel Platforms for the Development of a Universal Influenza Vaccine. Front Immunol 2018; 9:600. [PMID: 29628926 PMCID: PMC5877485 DOI: 10.3389/fimmu.2018.00600] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
Despite advancements in immunotherapeutic approaches, influenza continues to cause severe illness, particularly among immunocompromised individuals, young children, and elderly adults. Vaccination is the most effective way to reduce rates of morbidity and mortality caused by influenza viruses. Frequent genetic shift and drift among influenza-virus strains with the resultant disparity between circulating and vaccine virus strains limits the effectiveness of the available conventional influenza vaccines. One approach to overcome this limitation is to develop a universal influenza vaccine that could provide protection against all subtypes of influenza viruses. Moreover, the development of a novel or improved universal influenza vaccines may be greatly facilitated by new technologies including virus-like particles, T-cell-inducing peptides and recombinant proteins, synthetic viruses, broadly neutralizing antibodies, and nucleic acid-based vaccines. This review discusses recent scientific advances in the development of next-generation universal influenza vaccines.
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Affiliation(s)
- Arun Kumar
- GSK, Research and Development Center, Siena, Italy.,Linköping University, Linköping, Sweden
| | - Trine Sundebo Meldgaard
- GSK, Research and Development Center, Siena, Italy.,DTU Nanotech, Technical University of Denmark, Copenhagen, Denmark
| | - Sylvie Bertholet
- GSK, Research and Development Center, Siena, Italy.,GSK, Research and Development Center, Rockville, MD, United States
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Pillet S, Aubin É, Trépanier S, Poulin JF, Yassine-Diab B, Ter Meulen J, Ward BJ, Landry N. Humoral and cell-mediated immune responses to H5N1 plant-made virus-like particle vaccine are differentially impacted by alum and GLA-SE adjuvants in a Phase 2 clinical trial. NPJ Vaccines 2018; 3:3. [PMID: 29387473 PMCID: PMC5780465 DOI: 10.1038/s41541-017-0043-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
The hemagglutinination inhibition (HI) response remains the gold standard used for the licensure of influenza vaccines. However, cell-mediated immunity (CMI) deserves more attention, especially when evaluating H5N1 influenza vaccines that tend to induce poor HI response. In this study, we measured the humoral response (HI) and CMI (flow cytometry) during a Phase II dose-ranging clinical trial (NCT01991561). Subjects received two intramuscular doses, 21 days apart, of plant-derived virus-like particles (VLP) presenting the A/Indonesia/05/2005 H5N1 influenza hemagglutinin protein (H5) at the surface of the VLP (H5VLP). The vaccine was co-administrated with Alhydrogel® or with a glucopyranosyl lipid adjuvant-stable emulsion (GLA-SE). We demonstrated that low doses (3.75 or 7.5 μg H5VLP) of GLA-SE-adjuvanted vaccines induced HI responses that met criteria for licensure at both antigen doses tested. Alhydrogel adjuvanted vaccines induced readily detectable HI response that however failed to meet licensure criteria at any of three doses (10, 15 and 20 μg) tested. The H5VLP also induced a sustained (up to 6 months) polyfunctional and cross-reactive HA-specific CD4+ T cell response in all vaccinated groups. Interestingly, the frequency of central memory Th1-primed precursor cells before the boost significantly correlated with HI titers 21 days after the boost. The ability of the low dose GLA-SE-adjuvanted H5VLP to elicit both humoral response and a sustained cross-reactive CMI in healthy adults is very attractive and could result in significant dose-sparing in a pandemic situation.
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Affiliation(s)
- Stéphane Pillet
- 1Medicago Inc., Québec, G1V 3V9 QC Canada.,2Research Institute of the McGill University Health Centre, Montreal, H4A 3J1 QC Canada
| | - Éric Aubin
- 1Medicago Inc., Québec, G1V 3V9 QC Canada
| | | | | | | | - Jan Ter Meulen
- Immune Design, Seattle, WA 98102 USA.,Immune Design, San Francisco, CA 94080-7006 USA
| | - Brian J Ward
- 2Research Institute of the McGill University Health Centre, Montreal, H4A 3J1 QC Canada
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12
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Ward BJ, Pillet S, Charland N, Trepanier S, Couillard J, Landry N. The establishment of surrogates and correlates of protection: Useful tools for the licensure of effective influenza vaccines? Hum Vaccin Immunother 2018; 14:647-656. [PMID: 29252098 PMCID: PMC5861778 DOI: 10.1080/21645515.2017.1413518] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The search for a test that can predict vaccine efficacy is an important part of any vaccine development program. Although regulators hesitate to acknowledge any test as a true ‘correlate of protection’, there are many precedents for defining ‘surrogate’ assays. Surrogates can be powerful tools for vaccine optimization, licensure, comparisons between products and development of improved products. When such tests achieve ‘reference’ status however, they can inadvertently become barriers to new technologies that do not work the same way as existing vaccines. This is particularly true when these tests are based upon circularly-defined ‘reference’ or, even worse, proprietary reagents. The situation with inactivated influenza vaccines is a good example of this phenomenon. The most frequently used tests to define vaccine-induced immunity are all serologic assays: hemagglutination inhibition (HI), single radial hemolysis (SRH) and microneutralization (MN). The first two, and particularly the HI assay, have achieved reference status and criteria have been established in many jurisdictions for their use in licensing new vaccines and to compare the performance of different vaccines. However, all of these assays are based on biological reagents that are notoriously difficult to standardize and can vary substantially by geography, by chance (i.e. developing reagents in eggs that may not antigenitically match wild-type viruses) and by intention (ie: choosing reagents that yield the most favorable results). This review describes attempts to standardize these assays to improve their performance as surrogates, the dangers of over-reliance on ‘reference’ serologic assays, the ways that manufacturers can exploit the existing regulatory framework to make their products ‘look good’ and the implications of this long-established system for the introduction of novel influenza vaccines.
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Affiliation(s)
- Brian J Ward
- a Research Institute of the McGill University Health Centre, Infectious Diseases Division , Montreal , QC , Canada.,b Medicago Inc , Québec , QC , Canada
| | - Stephane Pillet
- a Research Institute of the McGill University Health Centre, Infectious Diseases Division , Montreal , QC , Canada.,b Medicago Inc , Québec , QC , Canada
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DiPiazza A, Richards K, Poulton N, Sant AJ. Avian and Human Seasonal Influenza Hemagglutinin Proteins Elicit CD4 T Cell Responses That Are Comparable in Epitope Abundance and Diversity. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:e00548-16. [PMID: 28100497 PMCID: PMC5339641 DOI: 10.1128/cvi.00548-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
Abstract
Avian influenza viruses remain a significant concern due to their pandemic potential. Vaccine trials have suggested that humans respond poorly to avian influenza vaccines relative to seasonal vaccines. It is important to understand, first, if there is a general deficiency in the ability of avian hemagglutinin (HA) proteins to generate immune responses and, if so, what underlies this defect. This question is of particular interest because it has been suggested that in humans, the poor immunogenicity of H7 vaccines may be due to a paucity of CD4 T cell epitopes. Because of the generally high levels of cross-reactive CD4 T cells in humans, it is not possible to compare the inherent immunogenicities of avian and seasonal HA proteins in an unbiased manner. Here, we empirically examine the epitope diversity and abundance of CD4 T cells elicited by seasonal and avian HA proteins. HLA-DR1 and HLA-DR4 transgenic mice were vaccinated with purified HA proteins, and CD4 T cells to specific epitopes were identified and quantified. These studies revealed that the diversity and abundance of CD4 T cells specific for HA do not segregate on the basis of whether the HA was derived from human seasonal or avian influenza viruses. Therefore, we conclude that failure in responses to avian vaccines in humans is likely due to a lack of cross-reactive CD4 T cell memory perhaps coupled with competition with or suppression of naive, HA-specific CD4 T cells by memory CD4 T cells specific for more highly conserved proteins.
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Affiliation(s)
- Anthony DiPiazza
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Richards
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Nicholas Poulton
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
| | - Andrea J Sant
- David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, New York, USA
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14
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Pillet S, Aubin É, Trépanier S, Bussière D, Dargis M, Poulin JF, Yassine-Diab B, Ward BJ, Landry N. A plant-derived quadrivalent virus like particle influenza vaccine induces cross-reactive antibody and T cell response in healthy adults. Clin Immunol 2016; 168:72-87. [PMID: 26987887 DOI: 10.1016/j.clim.2016.03.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/22/2016] [Accepted: 03/07/2016] [Indexed: 01/09/2023]
Abstract
Recent issues regarding efficacy of influenza vaccines have re-emphasized the need of new approaches to face this major public health issue. In a phase 1-2 clinical trial, healthy adults received one intramuscular dose of a seasonal influenza plant-based quadrivalent virus-like particle (QVLP) vaccine or placebo. The hemagglutination inhibition (HI) titers met all the European licensure criteria for the type A influenza strains at the 3μg/strain dose and for all four strains at the higher dosages 21days after immunization. High HI titers were maintained for most of the strains 6months after vaccination. QVLP vaccine induced a substantial and sustained increase of hemagglutinin-specific polyfunctional CD4 T cells, mainly transitional memory and TEMRA effector IFN-γ(+) CD4 T cells. A T cells cross-reactive response was also observed against A/Hong-Kong/1/1968 H3N2 and B/Massachusetts/2/2012. Plant-based QVLP offers an attractive alternative manufacturing method for producing effective and HA-strain matching seasonal influenza vaccines.
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Affiliation(s)
- Stéphane Pillet
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9; Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, QC, Canada, H3H 2R9
| | - Éric Aubin
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9
| | - Sonia Trépanier
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9
| | - Diane Bussière
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9
| | - Michèle Dargis
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9
| | | | - Bader Yassine-Diab
- ImmuneCarta, 201 Avenue du Président-Kennedy, Montreal, QC, Canada, H2X 3Y7
| | - Brian J Ward
- Research Institute of the McGill University Health Centre, 2155 Guy Street, 5th Floor, Montreal, QC, Canada, H3H 2R9
| | - Nathalie Landry
- Medicago Inc., 1020 route de l'Église office 600, Québec, QC, Canada, G1V 3V9.
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15
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Laskowski M, Xiao Y, Charland N, Moghadas SM. Strategies for Early Vaccination During Novel Influenza Outbreaks. Sci Rep 2015; 5:18062. [PMID: 26658016 PMCID: PMC4677284 DOI: 10.1038/srep18062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/03/2015] [Indexed: 01/22/2023] Open
Abstract
Ongoing research and technology developments hold the promise of rapid production and large-scale deployment of strain-specific or cross-protective vaccines for novel influenza viruses. We sought to investigate the impact of early vaccination on age-specific attack rates and evaluate the outcomes of different vaccination strategies that are influenced by the level of single or two-dose vaccine-induced protections. We developed and parameterized an agent-based model for two population demographics of urban and remote areas in Canada. Our results demonstrate that there is a time period before and after the onset of epidemic, during which the outcomes of vaccination strategies may differ significantly and are highly influenced by demographic characteristics. For the urban population, attack rates were lowest for children younger than 5 years of age in all vaccination strategies. However, for the remote population, the lowest attack rates were obtained for adults older than 50 years of age in most strategies. We found that the reduction of attack rates following the start of vaccination campaigns during the epidemic depends critically on the disease transmissibility, suggesting that for a sufficiently high transmissibility, vaccine delivery after the onset of epidemic has little or no effect, regardless of the population demographics.
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Affiliation(s)
- M. Laskowski
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada M3J 1P3
| | - Y. Xiao
- Department of Mathematical Sciences, University of Cincinnati, Cincinnati OH, 45221 USA
| | - N. Charland
- Medicago Inc., 1020 Route de l’Église, Bureau 600, Quebec, Quebec, Canada GIV 3V9
| | - S. M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada M3J 1P3
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16
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Using epidemics to map H3 equine influenza virus determinants of antigenicity. Virology 2015; 481:187-98. [DOI: 10.1016/j.virol.2015.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/08/2014] [Accepted: 02/14/2015] [Indexed: 01/25/2023]
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17
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Landry N, Pillet S, Favre D, Poulin JF, Trépanier S, Yassine-Diab B, Ward BJ. Influenza virus-like particle vaccines made in Nicotiana benthamiana elicit durable, poly-functional and cross-reactive T cell responses to influenza HA antigens. Clin Immunol 2014; 154:164-77. [PMID: 25128897 DOI: 10.1016/j.clim.2014.08.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 12/14/2022]
Abstract
Cell-mediated immunity plays a major role in long-lived, cross-reactive protection against influenza virus. We measured long-term poly-functional and cross-reactive T cell responses to influenza hemagglutinin (HA) elicited by a new plant-made Virus-Like Particle (VLP) vaccine targeting either H1N1 A/California/7/09 (H1) or H5N1 A/Indonesia/5/05 (H5). In two independent clinical trials, we characterized the CD4(+) and CD8(+) T cell homotypic and heterotypic responses 6 months after different vaccination regimens. Responses of VLP-vaccinated subjects were compared with placebo and/or a commercial trivalent inactivated vaccine (TIV:Fluzone™) recipients. Both H1 and H5 VLP vaccines elicited significantly greater poly-functional CD4(+) T cell responses than placebo and TIV. Poly-functional CD8(+) T cell responses were also observed after H1 VLP vaccination. Our results show that plant-made HA VLP vaccines elicit both strong antibody responses and poly-functional, cross-reactive memory T cells that persist for at least 6 months after vaccination.
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Affiliation(s)
- Nathalie Landry
- Medicago inc., 1020 Route de l'Église, Bureau 600, Québec, Qc G1V 3V9, Canada.
| | - Stéphane Pillet
- Medicago inc., 1020 Route de l'Église, Bureau 600, Québec, Qc G1V 3V9, Canada; Research Institute of the McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Qc H3G 1A4, Canada.
| | - David Favre
- ImmuneCarta, 201 President-Kennedy, Suite PK-3900, Montreal, Qc H2X 3Y7, Canada.
| | - Jean-François Poulin
- ImmuneCarta, 201 President-Kennedy, Suite PK-3900, Montreal, Qc H2X 3Y7, Canada.
| | - Sonia Trépanier
- Medicago inc., 1020 Route de l'Église, Bureau 600, Québec, Qc G1V 3V9, Canada.
| | - Bader Yassine-Diab
- ImmuneCarta, 201 President-Kennedy, Suite PK-3900, Montreal, Qc H2X 3Y7, Canada.
| | - Brian J Ward
- Research Institute of the McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Qc H3G 1A4, Canada.
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18
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Dignani MC, Costantini P, Salgueira C, Jordán R, Guerrini G, Valledor A, Herrera F, Nenna A, Mora C, Roccia-Rossi I, Stecher D, Carbone E, Laborde A, Efron E, Altclas J, Calmaggi A, Cozzi J. Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study. F1000Res 2014; 3:221. [PMID: 25469231 DOI: 10.12688/f1000research.5251.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season. METHODS Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed. RESULTS From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation <96% at presentation was a predictor of mortality (OR 19.5; 95%CI: 2.28 to 165.9). CONCLUSIONS In our cancer patient population, the pandemic 2009 Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation <96% was significantly associated with death. No deaths were observed among vaccinated patients.
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Affiliation(s)
- Maria Cecilia Dignani
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Patricia Costantini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Instituto de Oncología Angel H. Roffo, University of Buenos Aires, Buenos Aires, 1417, Argentina
| | - Claudia Salgueira
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina
| | - Rosana Jordán
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina
| | - Graciela Guerrini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - Alejandra Valledor
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Italiano, Buenos Aires, 1181, Argentina
| | - Fabián Herrera
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, CEMIC, Buenos Aires, 1425, Argentina
| | - Andrea Nenna
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Municipal de Oncología "Marie Curie", Buenos Aires, 1405, Argentina
| | - Claudia Mora
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, FLENI, Buenos Aires, 1428, Argentina
| | - Inés Roccia-Rossi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Hospital San Martín, Buenos Aires, 1900, Argentina
| | - Daniel Stecher
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, 1120, Argentina
| | - Edith Carbone
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Aeronáutico Central, Buenos Aires, 1437, Argentina
| | - Ana Laborde
- Infectious Diseases, FUNDALEU, Buenos Aires, 1114, Argentina
| | - Ernesto Efron
- Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Javier Altclas
- Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Aníbal Calmaggi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - José Cozzi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Bone Marrow Transplant, CETRAMOR, Rosario, Pcia. Sta Fé, 2000, Argentina
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19
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Dignani MC, Costantini P, Salgueira C, Jordán R, Guerrini G, Valledor A, Herrera F, Nenna A, Mora C, Roccia-Rossi I, Stecher D, Carbone E, Laborde A, Efron E, Altclas J, Calmaggi A, Cozzi J. Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study. F1000Res 2014; 3:221. [PMID: 25469231 PMCID: PMC4240245 DOI: 10.12688/f1000research.5251.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND During March 2009 a novel Influenza A virus emerged in Mexico. We describe the clinical picture of the pandemic Influenza A (H1N1) Influenza in cancer patients during the 2009 influenza season. METHODS Twelve centers participated in a multicenter retrospective observational study of cancer patients with confirmed infection with the 2009 H1N1 Influenza A virus (influenza-like illness or pneumonia plus positive PCR for the 2009 H1N1 Influenza A virus in respiratory secretions). Clinical data were obtained by retrospective chart review and analyzed. RESULTS From May to August 2009, data of 65 patients were collected. Median age was 51 years, 57 % of the patients were female. Most patients (47) had onco-hematological cancers and 18 had solid tumors. Cancer treatment mainly consisted of chemotherapy (46), or stem cell transplantation (SCT) (16). Only 19 of 64 patients had received the 2009 seasonal Influenza vaccine. Clinical presentation included pneumonia (43) and upper respiratory tract infection (22). Forty five of 58 ambulatory patients were admitted. Mechanical ventilation was required in 12 patients (18%). Treatment included oseltamivir monotherapy or in combination with amantadine for a median of 7 days. The global 30-day mortality rate was 18%. All 12 deaths were among the non-vaccinated patients. No deaths were observed among the 19 vaccinated patients. Oxygen saturation <96% at presentation was a predictor of mortality (OR 19.5; 95%CI: 2.28 to 165.9). CONCLUSIONS In our cancer patient population, the pandemic 2009 Influenza A (H1N1) virus was associated with high incidence of pneumonia (66%), and 30-day mortality (18.5%). Saturation <96% was significantly associated with death. No deaths were observed among vaccinated patients.
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Affiliation(s)
- Maria Cecilia Dignani
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Patricia Costantini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Instituto de Oncología Angel H. Roffo, University of Buenos Aires, Buenos Aires, 1417, Argentina
| | - Claudia Salgueira
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina
| | - Rosana Jordán
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina
| | - Graciela Guerrini
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - Alejandra Valledor
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Italiano, Buenos Aires, 1181, Argentina
| | - Fabián Herrera
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, CEMIC, Buenos Aires, 1425, Argentina
| | - Andrea Nenna
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Municipal de Oncología "Marie Curie", Buenos Aires, 1405, Argentina
| | - Claudia Mora
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, FLENI, Buenos Aires, 1428, Argentina
| | - Inés Roccia-Rossi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Hospital San Martín, Buenos Aires, 1900, Argentina
| | - Daniel Stecher
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, 1120, Argentina
| | - Edith Carbone
- Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Aeronáutico Central, Buenos Aires, 1437, Argentina
| | - Ana Laborde
- Infectious Diseases, FUNDALEU, Buenos Aires, 1114, Argentina
| | - Ernesto Efron
- Infectious Diseases, Hospital Británico, Buenos Aires, 1280, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Javier Altclas
- Infectious Diseases, Sanatorio Anchorena 1425 and Sanatorio Trinidad Mitre, Buenos Aires, 1430, Argentina ; Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina
| | - Aníbal Calmaggi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Infectious Diseases, Hospital Rossi, Buenos Aires, 1900, Argentina
| | - José Cozzi
- Commission of Infections in Immunocompromised Patients, Argentinean Society of Infectious Diseases (SADI), Buenos Aires, 1085, Argentina ; Bone Marrow Transplant, CETRAMOR, Rosario, Pcia. Sta Fé, 2000, Argentina
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Chen L, Duvvuri B, Grigull J, Jamnik R, Wither JE, Wu GE. Experimental evidence that mutated-self peptides derived from mitochondrial DNA somatic mutations have the potential to trigger autoimmunity. Hum Immunol 2014; 75:873-9. [PMID: 24979674 DOI: 10.1016/j.humimm.2014.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 12/20/2022]
Abstract
Autoimmune disease is a critical health concern, whose etiology remains enigmatic. We hypothesized that immune responses to somatically mutated self proteins could have a role in the development of autoimmune disease. IFN-γ secretion by T cells stimulated with mitochondrial peptides encoded by published mitochondrial DNA was monitored to test the hypothesis. Human peripheral blood mononuclear cells (PBMCs) of healthy controls and autoimmune patients were assessed for their responses to the self peptides and mutated-self peptides differing from self by one amino acid. None of the self peptides but some of the mutated-self peptides elicited an immune response in healthy controls. In some autoimmune patients, PBMCs responded not only to some of the mutated-self peptides, but also to some of the self peptides, suggesting that there is a breach of self-tolerance in these patients. Although PBMCs from healthy controls failed to respond to self peptides when stimulated with self, the mutated-self peptide could elicit a response to the self peptide upon re-stimulation in vitro, suggesting that priming with mutated-self peptides elicits a cross-reactive response with self. The data raise the possibility that DNA somatic mutations are one of the events that trigger and/or sustain T cell responses in autoimmune diseases.
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Affiliation(s)
- Lina Chen
- Department of Kinesiology and Health Science, York University, Canada.
| | - Bhargavi Duvvuri
- Department of Kinesiology and Health Science, York University, Canada
| | - Jörg Grigull
- Department of Mathematics and Statistics, York University, Canada
| | - Roni Jamnik
- Department of Kinesiology and Health Science, York University, Canada
| | - Joan E Wither
- University Health Network and University of Toronto, Canada
| | - Gillian E Wu
- Department of Kinesiology and Health Science, York University, Canada
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21
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Duvvuri VR, Duvvuri B, Alice C, Wu GE, Gubbay JB, Wu J. Preexisting CD4+ T-cell immunity in human population to avian influenza H7N9 virus: whole proteome-wide immunoinformatics analyses. PLoS One 2014; 9:e91273. [PMID: 24609014 PMCID: PMC3946744 DOI: 10.1371/journal.pone.0091273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/09/2014] [Indexed: 01/05/2023] Open
Abstract
In 2013, a novel avian influenza H7N9 virus was identified in human in China. The antigenically distinct H7N9 surface glycoproteins raised concerns about lack of cross-protective neutralizing antibodies. Epitope-specific preexisting T-cell immunity was one of the protective mechanisms in pandemic 2009 H1N1 even in the absence of cross-protective antibodies. Hence, the assessment of preexisting CD4+ T-cell immunity to conserved epitopes shared between H7N9 and human influenza A viruses (IAV) is critical. A comparative whole proteome-wide immunoinformatics analysis was performed to predict the CD4+ T-cell epitopes that are commonly conserved within the proteome of H7N9 in reference to IAV subtypes (H1N1, H2N2, and H3N2). The CD4+ T-cell epitopes that are commonly conserved (∼556) were further screened against the Immune Epitope Database (IEDB) to validate their immunogenic potential. This analysis revealed that 45.5% (253 of 556) epitopes are experimentally proven to induce CD4+ T-cell memory responses. In addition, we also found that 23.3% of CD4+ T-cell epitopes have ≥90% of sequence homology with experimentally defined CD8+ T-cell epitopes. We also conducted the population coverage analysis across different ethnicities using commonly conserved CD4+ T-cell epitopes and corresponding HLA-DRB1 alleles. Interestingly, the indigenous populations from Canada, United States, Mexico and Australia exhibited low coverage (28.65% to 45.62%) when compared with other ethnicities (57.77% to 94.84%). In summary, the present analysis demonstrate an evidence on the likely presence of preexisting T-cell immunity in human population and also shed light to understand the potential risk of H7N9 virus among indigenous populations, given their high susceptibility during previous pandemic influenza events. This information is crucial for public health policy, in targeting priority groups for immunization programs.
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Affiliation(s)
- Venkata R. Duvvuri
- Centre for Disease Modelling, York Institute of Health Research, Toronto, Canada
- * E-mail:
| | - Bhargavi Duvvuri
- Centre for Disease Modelling, York Institute of Health Research, Toronto, Canada
| | - Christilda Alice
- Centre for Disease Modelling, York Institute of Health Research, Toronto, Canada
| | | | - Jonathan B. Gubbay
- The Hospital for Sick Children, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- University of Toronto, Toronto, Canada
- Mount Sinai Hospital, Toronto, Canada
| | - Jianhong Wu
- Centre for Disease Modelling, York Institute of Health Research, Toronto, Canada
- York University, Toronto, Canada
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22
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Driedger SM, Cooper EJ, Moghadas SM. Developing model-based public health policy through knowledge translation: the need for a 'Communities of Practice'. Public Health 2014; 128:561-7. [PMID: 24461909 DOI: 10.1016/j.puhe.2013.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The 2009 influenza A (H1N1) pandemic prompted public health agencies worldwide to respond in a context of substantial uncertainty. While many lessons around successful management strategies were learned during the influenza A (H1N1) pandemic, the usefulness and impact of mathematical models to optimize policy decisions in protecting public health were poorly realized. The authors explored the experiences of modellers and public health practitioners in trying to develop model-based public health policies in the management of the 2009 influenza A (H1N1) pandemic in Canada. STUDY DESIGN A qualitative case study design based on interviews and other textual data was used. METHODS Individual interviews were conducted with mathematical modellers and public health professionals from academia and government health departments during the second wave of the 2009 influenza A (H1N1) pandemic (both prior to and following the vaccine roll-out), using a convergent interviewing process. Interviews were supplemented with discussions held during three separate workshops involving representatives from these groups on the role of modelling in pandemic preparedness and responses. NVivo9™ was used to analyse interview data and associated notes. RESULTS Mathematical models were underutilized during the response phase of the 2009 influenza A (H1N1) pandemic, largely because many public health professionals were unaware of modelling infrastructure in Canada. Challenges were reflected in three ways: 1) the relevance of models to public health priorities; 2) the need for clear communication and plain language around modelling and its contributions and limitations; and 3) the need for increased trust and collaboration to develop strong working relationships. CONCLUSIONS Developing a 'Communities of Practice' between public health professionals and mathematical modellers during inter-pandemic periods based on common targeted goals, using plain language, and where relationships between individuals and organizations are developed early, could be an effective strategy to assist the process of public health policy decision-making, particularly when characterized by high levels of uncertainty.
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Affiliation(s)
- S M Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba R3E 0W3, Canada.
| | - E J Cooper
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba R3E 0W3, Canada.
| | - S M Moghadas
- Centre for Disease Modelling, York Institute for Health Research, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
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Rambal V, Müller K, Dang-Heine C, Sattler A, Dziubianau M, Weist B, Luu SH, Stoyanova A, Nickel P, Thiel A, Neumann A, Schweiger B, Reinke P, Babel N. Differential influenza H1N1-specific humoral and cellular response kinetics in kidney transplant patients. Med Microbiol Immunol 2013; 203:35-45. [PMID: 24057515 DOI: 10.1007/s00430-013-0312-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/03/2013] [Indexed: 12/17/2022]
Abstract
Renal transplant recipients (RTR) are considered at high risk for influenza-associated complications due to immunosuppression. The efficacy of standard influenza vaccination in RTRs is unclear. Hence, we evaluated activation of the adaptive immunity by the pandemic influenza A(H1N1) 2009 (A(H1N1)pdm09) vaccine in RTRs as compared to healthy controls. To determine cross-reactivity and/or bystander activation, seasonal trivalent influenza vaccine and tetanus/diphteria toxoid (TT/DT) vaccine-specific T cells along with allospecific T cells were quantified before and after A(H1N1)pdm09 vaccination. Vaccination-induced alloimmunity was additionally determined by quantifying serum creatinine and proinflammatory protein IP-10. Contrary to healthy controls, RTRs required a booster vaccination to achieve seroconversion (13.3 % day 21; 90 % day 90). In contrast to humoral immunity, sufficient A(H1N1)pdm09-specific T-cell responses were mounted in RTRs already after the first immunization with a magnitude comparable with healthy controls. Interestingly, vaccination simultaneously boosted T cells reacting to seasonal flu but not to TT/DT, suggesting cross-activation. No alloimmune effects were recorded. In conclusion, protective antibody responses required booster vaccination. However, sufficient cellular immunity is established already after the first vaccination, demonstrating differential kinetics of humoral and cellular immunity.
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Affiliation(s)
- Vinay Rambal
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
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Clearance of influenza virus infections by T cells: risk of collateral damage? Curr Opin Virol 2013; 3:430-7. [PMID: 23721864 DOI: 10.1016/j.coviro.2013.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 04/24/2013] [Accepted: 05/01/2013] [Indexed: 02/02/2023]
Abstract
Influenza A viruses are a major cause of respiratory infections in humans. To protect against influenza, vaccines mainly aim at the induction of antibodies against the two surface proteins and do not protect against influenza A viruses from other subtypes. There is an increasing interest in heterosubtypic immunity that does protect against different subtypes. CD8 and CD4 T cells have a beneficial effect on the course of influenza A virus infection and can recognize conserved IAV epitopes. The T cell responses are tightly regulated to avoid collateral damage due to overreaction. Different studies have shown that an aberrant T cell response to an influenza virus infection could be harmful and could contribute to immunopathology. Here we discuss the recent findings on the balance between the beneficial and detrimental effects of T cell responses in influenza virus infections.
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Duvvuri VR, Duvvuri B, Jamnik V, Gubbay JB, Wu J, Wu GE. T cell memory to evolutionarily conserved and shared hemagglutinin epitopes of H1N1 viruses: a pilot scale study. BMC Infect Dis 2013; 13:204. [PMID: 23641949 PMCID: PMC3649888 DOI: 10.1186/1471-2334-13-204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 05/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2009 pandemic influenza was milder than expected. Based on the apparent lack of pre-existing cross-protective antibodies to the A (H1N1)pdm09 strain, it was hypothesized that pre-existing CD4+ T cellular immunity provided the crucial immunity that led to an attenuation of disease severity. We carried out a pilot scale study by conducting in silico and in vitro T cellular assays in healthy population, to evaluate the pre-existing immunity to A (H1N1)pdm09 strain. METHODS Large-scale epitope prediction analysis was done by examining the NCBI available (H1N1) HA proteins. NetMHCIIpan, an eptiope prediction tool was used to identify the putative and shared CD4+ T cell epitopes between seasonal H1N1 and A (H1N1)pdm09 strains. To identify the immunogenicity of these putative epitopes, human IFN-γ-ELISPOT assays were conducted using the peripheral blood mononuclear cells from fourteen healthy human donors. All donors were screened for the HLA-DRB1 alleles. RESULTS Epitope-specific CD4+ T cellular memory responses (IFN-γ) were generated to highly conserved HA epitopes from majority of the donors (93%). Higher magnitude of the CD4+ T cell responses was observed in the older adults. The study identified two HA2 immunodominant CD4+ T cell epitopes, of which one was found to be novel. CONCLUSIONS The current study provides a compelling evidence of HA epitope specific CD4+ T cellular memory towards A (H1N1)pdm09 strain. These well-characterized epitopes could recruit alternative immunological pathways to overcome the challenge of annual seasonal flu vaccine escape.
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Huang P, Yu S, Wu C, Liang L. Highly conserved antigenic epitope regions of hemagglutinin and neuraminidase genes between 2009 H1N1 and seasonal H1N1 influenza: vaccine considerations. J Transl Med 2013; 11:47. [PMID: 23433453 PMCID: PMC3606485 DOI: 10.1186/1479-5876-11-47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/20/2013] [Indexed: 01/14/2023] Open
Abstract
An immunoinformatics study was conducted to determine the highly conserved antigenic epitope regions of hemagglutinin (HA) and neuraminidase (NA) genes in the humoral immunity and CD4+ and CD8+ T cellular immunity between 2009 pandemic H1N1 (pH1N1) and seasonal H1N1 (sH1N1) viruses. It was found that in sH1N1 viruses, 29 epitope regions of HA genes and 8 epitope regions of NA genes which had been experimentally identified, were highly conserved (97.1-100.0%) in the corresponding genes and predictive epitopes of the pH1N1 viruses. The results suggested that highly conserved antigenic epitope regions might act as the basis of common antigenic vaccines against pH1N1 and sH1N1 viruses.
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Affiliation(s)
- Ping Huang
- Key Laboratory for Emergency Pathogen Detection, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, 511430, China.
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27
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Agrati C, Gioia C, Castilletti C, Lapa D, Berno G, Puro V, Carletti F, Cimini E, Nisii C, Castellino F, Martini F, Capobianchi MR. Cellular and humoral immune responses to pandemic influenza vaccine in healthy and in highly active antiretroviral therapy-treated HIV patients. AIDS Res Hum Retroviruses 2012; 28:1606-16. [PMID: 22439734 PMCID: PMC3505053 DOI: 10.1089/aid.2011.0371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Influenza vaccination is recommended for HAART-treated HIV patients to prevent influenza illness and complications. Due to the known ability of T cells to mediate a broadly cross-reactive response, vaccination effectiveness in cell-mediated immune (CMI) response induction is a main objective in new influenza vaccination strategies. Nevertheless, data on CMI responses after pandemic vaccination in HIV subjects are still missing. In the present study, the ability of a single dose of adjuvanted pandemic influenza vaccine to induce humoral and CMI responses was compared in HAART-treated HIV patients and in healthcare workers. Healthcare workers (HCW, n=65) and HAART-treated HIV patients (HIV, n=67) receiving pandemic vaccination were enrolled and analyzed before (t0) and after (t1) vaccination. The analysis of strain-specific humoral response was performed by HAI assay; CMI against pandemic (A/H1N1/Cal/09) and seasonal (A/H1N1/Brisb/07 and A/H3N2/Brisb/07) strains was analyzed by ELISpot and intracellular staining followed by flow cytometry. Pandemic vaccination was effective in inducing both humoral and cell-mediated responses in HAART-treated HIV patients as well as in HCWs. A large fraction of both HCWs and HIV-infected patients showed a T cell response to the pandemic strain before vaccination, suggesting possible previous exposure to A/H1N1/pdm/09 and/or cross-reactive T cells. Notably, pandemic vaccine was also able to boost cross-reactive immune responses to seasonal strains. Finally, a weaker boost of both strain-specific and cross-reactive T cell immunity was found in individuals showing a higher baseline response. These data show the effectiveness of adjuvanted pandemic vaccine to induce both humoral and cellular (strain-specific and cross-reactive) immune responses in HIV patients similar to HCWs.
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Affiliation(s)
- Chiara Agrati
- National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani, Rome, Italy.
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Duvvuri VR, Heffernan JM, Moghadas SM, Duvvuri B, Guo H, Fisman DN, Wu J, Wu GE. The role of cellular immunity in influenza H1N1 population dynamics. BMC Infect Dis 2012. [PMID: 23192104 PMCID: PMC3552667 DOI: 10.1186/1471-2334-12-329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Pre-existing cellular immunity has been recognized as one of the key factors in determining the outcome of influenza infection by reducing the likelihood of clinical disease and mitigates illness. Whether, and to what extent, the effect of this self-protective mechanism can be captured in the population dynamics of an influenza epidemic has not been addressed. Methods We applied previous findings regarding T-cell cross-reactivity between the 2009 pandemic H1N1 strain and seasonal H1N1 strains to investigate the possible changes in the magnitude and peak time of the epidemic. Continuous Monte-Carlo Markov Chain (MCMC) model was employed to simulate the role of pre-existing immunity on the dynamical behavior of epidemic peak. Results From the MCMC model simulations, we observed that, as the size of subpopulation with partially effective pre-existing immunity increases, the mean magnitude of the epidemic peak decreases, while the mean time to reach the peak increases. However, the corresponding ranges of these variations are relatively small. Conclusions Our study concludes that the effective role of pre-existing immunity in alleviating disease outcomes (e.g., hospitalization) of novel influenza virus remains largely undetectable in population dynamics of an epidemic. The model outcome suggests that rapid clinical investigations on T-cell assays remain crucial for determining the protection level conferred by pre-existing cellular responses in the face of an emerging influenza virus.
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Potential T cell epitopes within swine-origin triple reassortant influenza A (H3N2) variant virus which emerged in 2011: an immunoinformatics study. Vaccine 2012; 30:6054-63. [PMID: 22877860 DOI: 10.1016/j.vaccine.2012.07.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/14/2012] [Accepted: 07/23/2012] [Indexed: 11/24/2022]
Abstract
An immuno-informatics study was conducted to determine possible pre-existing T cellular immunity to the recently emerged swine-origin triple reassortant H3N2 variant (S-OtrH3N2v-2011) which acquired the matrix gene of influenza A (H1N1)pdm09. Given the genetic origin of S-OtrH3N2v-2011, our study focused on the hemagglutinin (HA) and matrix1 (M1) proteins to identify common and conserved T cell epitopes. We compared HA CD4+ T cell epitopes of S-OtrH3N2v-2011 with seasonal H3N2 (1968-2011)-HA proteins. M1 CD4+ and CD8+ T cell epitopes of S-OtrH3N2v-2011 were compared with the M1 proteins of seasonal H1N1 (1977-2009) and A (H1N1)pdm09 (2009-2011) subtypes. The results revealed a high conservancy of epitopes localized particularly on HA2 and the entire M1 protein. The overall cross reactivity of predicted CD4+ T cell epitopes with previously experimentally defined (Immuno Epitope Database) CD4+ T epitopes of HA and M1 proteins was ∼51%. CD8+ T cell cross-reactivity of ∼74% was documented for M1 protein. Analysis suggests possible pre-existing CD4+ T cell immunity to S-OtrH3N2v-2011 in the human population.
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A human CD4+ T cell epitope in the influenza hemagglutinin is cross-reactive to influenza A virus subtypes and to influenza B virus. J Virol 2012; 86:9233-43. [PMID: 22718815 DOI: 10.1128/jvi.06325-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The hemagglutinin protein (HA) of the influenza virus family is a major antigen for protective immunity. Thus, it is a relevant target for developing vaccines. Here, we describe a human CD4(+) T cell epitope in the influenza virus HA that lies in the fusion peptide of the HA. This epitope is well conserved in all 16 subtypes of the HA protein of influenza A virus and the HA protein of influenza B virus. By stimulating peripheral blood mononuclear cells (PBMCs) from a healthy adult donor with peptides covering the entire HA protein based on the sequence of A/Japan/305/1957 (H2N2), we generated a T cell line specific to this epitope. This CD4(+) T cell line recognizes target cells infected with influenza A virus seasonal H1N1 and H3N2 strains, a reassortant H2N1 strain, the 2009 pandemic H1N1 strain, and influenza B virus in cytotoxicity assays and intracellular-cytokine-staining assays. It also lysed target cells infected with avian H5N1 virus. We screened healthy adult PBMCs for T cell responses specific to this epitope and found individuals who had ex vivo gamma interferon (IFN-γ) responses to the peptide epitope in enzyme-linked immunospot (ELISPOT) assays. Almost all donors who responded to the epitope had the HLA-DRB1*09 allele, a relatively common HLA allele. Although natural infection or standard vaccination may not induce strong T and B cell responses to this highly conserved epitope in the fusion peptide, it may be possible to develop a vaccination strategy to induce these CD4(+) T cells, which are cross-reactive to both influenza A and B viruses.
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Horby P, Mai LQ, Fox A, Thai PQ, Thi Thu Yen N, Thanh LT, Le Khanh Hang N, Duong TN, Thoang DD, Farrar J, Wolbers M, Hien NT. The epidemiology of interpandemic and pandemic influenza in Vietnam, 2007-2010: the Ha Nam household cohort study I. Am J Epidemiol 2012; 175:1062-74. [PMID: 22411862 PMCID: PMC3353138 DOI: 10.1093/aje/kws121] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective community-based studies have provided fundamental insights into the epidemiology of influenza in temperate regions, but few comparable studies have been undertaken in the tropics. The authors conducted prospective influenza surveillance and intermittent seroprevalence surveys in a household-based cohort in Vietnam between December 2007 and April 2010, resulting in 1,793 person-seasons of influenza surveillance. Age- and sex-standardized estimates of the risk of acquiring any influenza infection per season in persons 5 years of age or older were 21.1% (95% confidence interval: 17.4, 24.7) in season 1, 26.4% (95% confidence interval: 22.6, 30.2) in season 2, and 17.0% (95% confidence interval: 13.6, 20.4) in season 3. Some individuals experienced multiple episodes of infection with different influenza types/subtypes in the same season (n = 27) or reinfection with the same subtype in different seasons (n = 22). The highest risk of influenza infection was in persons 5-9 years old, in whom the risk of influenza infection per season was 41.8%. Although the highest infection risk was in school-aged children, there were important heterogeneities in the age of infection by subtype and season. These heterogeneities could influence the impact of school closure and childhood vaccination on influenza transmission in tropical areas, such as Vietnam.
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Affiliation(s)
- Peter Horby
- Oxford University Clinical Research Unit, National Hospital of Tropical Diseases, 78 Giai Phong Street, Dong Da District, Hanoi, Vietnam.
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Cheng VCC, To KKW, Tse H, Hung IFN, Yuen KY. Two years after pandemic influenza A/2009/H1N1: what have we learned? Clin Microbiol Rev 2012; 25:223-63. [PMID: 22491771 PMCID: PMC3346300 DOI: 10.1128/cmr.05012-11] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The world had been anticipating another influenza pandemic since the last one in 1968. The pandemic influenza A H1N1 2009 virus (A/2009/H1N1) finally arrived, causing the first pandemic influenza of the new millennium, which has affected over 214 countries and caused over 18,449 deaths. Because of the persistent threat from the A/H5N1 virus since 1997 and the outbreak of the severe acute respiratory syndrome (SARS) coronavirus in 2003, medical and scientific communities have been more prepared in mindset and infrastructure. This preparedness has allowed for rapid and effective research on the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the disease, with impacts on its control. A PubMed search using the keywords "pandemic influenza virus H1N1 2009" yielded over 2,500 publications, which markedly exceeded the number published on previous pandemics. Only representative works with relevance to clinical microbiology and infectious diseases are reviewed in this article. A significant increase in the understanding of this virus and the disease within such a short amount of time has allowed for the timely development of diagnostic tests, treatments, and preventive measures. These findings could prove useful for future randomized controlled clinical trials and the epidemiological control of future pandemics.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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Squires RB, Noronha J, Hunt V, García-Sastre A, Macken C, Baumgarth N, Suarez D, Pickett BE, Zhang Y, Larsen CN, Ramsey A, Zhou L, Zaremba S, Kumar S, Deitrich J, Klem E, Scheuermann RH. Influenza research database: an integrated bioinformatics resource for influenza research and surveillance. Influenza Other Respir Viruses 2012; 6:404-16. [PMID: 22260278 PMCID: PMC3345175 DOI: 10.1111/j.1750-2659.2011.00331.x] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Please cite this paper as: Squires et al. (2012) Influenza research database: an integrated bioinformatics resource for influenza research and surveillance. Influenza and Other Respiratory Viruses 6(6), 404–416. Background The recent emergence of the 2009 pandemic influenza A/H1N1 virus has highlighted the value of free and open access to influenza virus genome sequence data integrated with information about other important virus characteristics. Design The Influenza Research Database (IRD, http://www.fludb.org) is a free, open, publicly‐accessible resource funded by the U.S. National Institute of Allergy and Infectious Diseases through the Bioinformatics Resource Centers program. IRD provides a comprehensive, integrated database and analysis resource for influenza sequence, surveillance, and research data, including user‐friendly interfaces for data retrieval, visualization and comparative genomics analysis, together with personal log in‐protected ‘workbench’ spaces for saving data sets and analysis results. IRD integrates genomic, proteomic, immune epitope, and surveillance data from a variety of sources, including public databases, computational algorithms, external research groups, and the scientific literature. Results To demonstrate the utility of the data and analysis tools available in IRD, two scientific use cases are presented. A comparison of hemagglutinin sequence conservation and epitope coverage information revealed highly conserved protein regions that can be recognized by the human adaptive immune system as possible targets for inducing cross‐protective immunity. Phylogenetic and geospatial analysis of sequences from wild bird surveillance samples revealed a possible evolutionary connection between influenza virus from Delaware Bay shorebirds and Alberta ducks. Conclusions The IRD provides a wealth of integrated data and information about influenza virus to support research of the genetic determinants dictating virus pathogenicity, host range restriction and transmission, and to facilitate development of vaccines, diagnostics, and therapeutics.
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Affiliation(s)
- R Burke Squires
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Mostaço-Guidolin LC, Greer A, Sander B, Wu J, Moghadas SM. Variability in transmissibility of the 2009 H1N1 pandemic in Canadian communities. BMC Res Notes 2011; 4:537. [PMID: 22166307 PMCID: PMC3278401 DOI: 10.1186/1756-0500-4-537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 12/13/2011] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence and severity of the 2009 H1N1 pandemic appeared to vary significantly across populations and geographic regions. We sought to investigate the variability in transmissibility of H1N1 pandemic in different health regions (including urban centres and remote, isolated communities) in the province of Manitoba, Canada. Methods The Richards model was used to fit to the daily number of laboratory-confirmed cases and estimate transmissibility (referred to as the basic reproduction number, R0), doubling times, and turning points of outbreaks in both spring and fall waves of the H1N1 pandemic in several health regions. Results We observed considerable variation in R0 estimates ranging from 1.55 to 2.24, with confidence intervals ranging from 1.45 to 2.88, for an average generation time of 2.9 days, and shorter doubling times in some remote and isolated communities compared to urban centres, suggesting a more rapid spread of disease in these communities during the first wave. For the second wave, Re, the effective reproduction number, is estimated to be lower for remote and isolated communities; however, outbreaks appear to have been driven by somewhat higher transmissibility in urban centres. Conclusions There was considerable geographic variation in transmissibility of the 2009 pandemic outbreaks. While highlighting the importance of estimating R0 for informing health responses, the findings indicate that projecting the transmissibility for large-scale epidemics may not faithfully characterize the early spread of disease in remote and isolated communities.
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Affiliation(s)
- Luiz C Mostaço-Guidolin
- Centre for Disease Modelling, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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Seroprevalence to influenza A(H1N1) 2009 virus--where are we? CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:1205-12. [PMID: 21653743 DOI: 10.1128/cvi.05072-11] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Age-specific seroprevalences for influenza virus make important contributions to estimating the burden of infection and determining the vulnerable populations. It is especially difficult to know the true clinical attack rates of the 2009 influenza A(H1N1) pandemic; however, we can estimate infection rates through analyses of seroprevalences based on national studies from different continents and countries with different demographics. After the 2009 influenza A(H1N1) pandemic, seroprevalence studies found 5 to 60% of populations across different continents and age groups having antibodies against the A(H1N1) 2009 virus. The seropositivity was highest in children and teenagers (20 to 60%) as well as in the elderly older than 80 years (20 to 40%). Preexisting cross-reactive antibodies against the virus were present mostly in sera of older people (born before 1950) who could have encountered viruses descended from the 1918 pandemic viruses. Experience with the 2009 pandemic indicates how essential early and timely serology data against the emerging virus can be for informing decisions on use of antivirals and vaccination campaigns, especially in regard to risk groups. The objectives of this review were to summarize the current data available on seroprevalence before and after the 2009 influenza A(H1N1) pandemic and the lessons learned for future pandemic preparedness.
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Ghosh S, Heffernan J. Influenza pandemic waves under various mitigation strategies with 2009 H1N1 as a case study. PLoS One 2010; 5:e14307. [PMID: 21187938 PMCID: PMC3004963 DOI: 10.1371/journal.pone.0014307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 10/29/2010] [Indexed: 11/18/2022] Open
Abstract
A significant feature of influenza pandemics is multiple waves of morbidity and mortality over a few months or years. The size of these successive waves depends on intervention strategies including antivirals and vaccination, as well as the effects of immunity gained from previous infection. However, the global vaccine manufacturing capacity is limited. Also, antiviral stockpiles are costly and thus, are limited to very few countries. The combined effect of antivirals and vaccination in successive waves of a pandemic has not been quantified. The effect of acquired immunity from vaccination and previous infection has also not been characterized. In times of a pandemic threat countries must consider the effects of a limited vaccine, limited antiviral use and the effects of prior immunity so as to adopt a pandemic strategy that will best aid the population. We developed a mathematical model describing the first and second waves of an influenza pandemic including drug therapy, vaccination and acquired immunity. The first wave model includes the use of antiviral drugs under different treatment profiles. In the second wave model the effects of antivirals, vaccination and immunity gained from the first wave are considered. The models are used to characterize the severity of infection in a population under different drug therapy and vaccination strategies, as well as school closure, so that public health policies regarding future influenza pandemics are better informed.
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Affiliation(s)
- Suma Ghosh
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Center for Disease Modelling, York University, Toronto, Ontario, Canada
- * E-mail: (SG); (JH)
| | - Jane Heffernan
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
- Center for Disease Modelling, York University, Toronto, Ontario, Canada
- * E-mail: (SG); (JH)
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