PERTUSSIS VACCINE TESTING FOR FREEDOM-FROM-TOXICITY

Safety assessments of recombinant DTaP vaccines developed in South Korea

Purpose

Pertussis bacteria have many pathogenic and virulent antigens and severe adverse reactions have occurred when using inactivated whole-cell pertussis vaccines. Therefore, inactivated acellular pertussis (aP) vaccines and genetically detoxified recombinant pertussis (rP) vaccines are being developed. The aim of this study was to assess the safety profile of a novel rP vaccine under development in comparison to commercial diphtheria-tetanus-acellular pertussis (DTaP) vaccines.

Materials and Methods

The two positive control DTaP vaccines (two- and tri-components aP vaccines) and two experimental recombinant DTaP (rDTaP) vaccine (two- and tri-components aP vaccines adsorbed to either aluminum hydroxide or purified oat beta-glucan) were used. Temperature histamine sensitization test (HIST), indirect Chinese hamster ovary (CHO) cell cluster assay, mouse-weight-gain (MWG) test, leukocytosis promoting (LP) test, and intramuscular inflammatory cytokine assay of the injection site performed for safety assessments.

Results

HIST results showed absence of residual pertussis toxin (PTx) in both control and experimental DTaP vaccine groups, whereas in groups immunized with tri-components vaccines, the experimental tri-components rDTaP absorbed to alum showed an ultra-small amount of 0.0066 IU/mL. CHO cell clustering was observed from 4 IU/mL in all groups. LP tests showed that neutrophils and lymphocytes were in the normal range in all groups immunized with the two components vaccine. However, in the tri-components control DTaP vaccine group, as well as two- and tri-components rDTaP with beta-glucan group, a higher monocyte count was observed 3 days after vaccination, although less than 2 times the normal range. In the MWG test, both groups showed changes less than 20% in body temperature and body weight before the after the final immunizations. Inflammatory cytokines within the muscle at the injection site on day 3 after intramuscular injection revealed no significant response in all groups.

Conclusion

There were no findings associated with residual PTx, and no significant differences in both local and systemic adverse reactions in the novel rDTaP vaccine compared to existing available DTaP vaccines. The results suggest that the novel rDTaP vaccine is safe.

Inflammation and Autophagy: A Convergent Point between Autism Spectrum Disorder (ASD)-Related Genetic and Environmental Factors: Focus on Aluminum Adjuvants

Autism spectrum disorder (ASD), schizophrenia, and bipolar disorder are genetically complex and heterogeneous neurodevelopmental disorders (NDDs) resulting from genetic factors and gene-environment (GxE) interactions for which onset occurs in early brain development. Recent progress highlights the link between ASD and (i) immunogenetics, neurodevelopment, and inflammation, and (ii) impairments of autophagy, a crucial neurodevelopmental process involved in synaptic pruning. Among various environmental factors causing risk for ASD, aluminum (Al)-containing vaccines injected during critical periods have received special attention and triggered relevant scientific questions. The aim of this review is to discuss the current knowledge on the role of early inflammation, immune and autophagy dysfunction in ASD as well as preclinical studies which question Al adjuvant impacts on brain and immune maturation. We highlight the most recent breakthroughs and the lack of epidemiological, pharmacokinetic and pharmacodynamic data constituting a "scientific gap". We propose additional research, such as genetic studies that could contribute to identify populations at genetic risk, improving diagnosis, and potentially the development of new therapeutic tools.

In Vivo Models and In Vitro Assays for the Assessment of Pertussis Toxin Activity

One of the main virulence factors produced by Bordetella pertussis is pertussis toxin (PTx) which, in its inactivated form, is the major component of all marketed acellular pertussis vaccines. PTx ADP ribosylates Gα_i proteins, thereby affecting the inhibition of adenylate cyclases and resulting in the accumulation of cAMP. Apart from this classical model, PTx also activates some receptors and can affect various ADP ribosylation- and adenylate cyclase-independent signalling pathways. Due to its potent ADP-ribosylation properties, PTx has been used in many research areas. Initially the research primarily focussed on the in vivo effects of the toxin, including histamine sensitization, insulin secretion and leukocytosis. Nowadays, PTx is also used in toxicology research, cell signalling, research involving the blood–brain barrier, and testing of neutralizing antibodies. However, the most important area of use is testing of acellular pertussis vaccines for the presence of residual PTx. In vivo models and in vitro assays for PTx often reflect one of the toxin’s properties or details of its mechanism. Here, the established and novel in vivo and in vitro methods used to evaluate PTx are reviewed, their mechanisms, characteristics and limitations are described, and their application for regulatory and research purposes are considered.

Toxicity and potency evaluation of pertussis vaccines

Current methods for determining the potency and toxicity of pertussis vaccines are outdated and require improvement. The intracerebral challenge test is effective for determining the potency of whole-cell vaccines but is objectionable on animal welfare and technical grounds. The same applies to its modification for assaying acellular pertussis vaccines. Respiratory challenge methods offer an interim solution pending establishment of validated in vitro correlates of protection, for example nitric oxide induction. Their evaluation is being promoted by the World Health Organization through the Pertussis Vaccines Working Group. Current toxicity assays based on weight gain and histamine sensitization of mice are imprecise and need replacement. Limits need to be established for specific toxin content of both acellular and whole-cell vaccines and should be supported by specific assays. More precise methods based on determination of ribosyltransferase activity in tandem with receptor-binding assays are under evaluation. Genome sequence data and the use of gene microarrays to screen responses triggered by vaccine components may also provide leads to improved methods for assessing both toxicity and immunogenicity.

Reactions after pertussis vaccine: a manufacturer's experiences and difficulties since 1964

Pertussis vaccines vary in quality, safety, and efficacy according to the production strains of Bordetella pertussis, the method of manufacture, and quality control procedures. It is therefore not justifiable to combine information on the incidence, nature, and severity of reactions after all manufacturers' pertussis vaccines as if they were a single product. Attempts were made to collect information on all suspected cases of severe reactions that occurred after administration of about 15 million doses of Wellcome pertussis vaccines in the United Kingdom and Northern Ireland from 1964 to mid-1977. Altogether six deaths, six neurological reactions with sequelae, and 17 convulsions without sequelae were reported, but some were clearly not attributable to the vaccine, while, in other cases, the available information was inadequate for assessing the role of vaccination. Neurological disorders, similar to those reported in a few children after pertussis vaccination, occur unexpectedly in apparently healthy infants at the recommended age for immunisation, so chance association between vaccination and these events can be expected in some children. The Joint Committee on Vaccination and Immunisation has made several recommendations aimed at reducing severe reactions after pertussis vaccination. These include replacing plain vaccine with aluminium-adsorbed vaccine, but there is no clear evidence that the aluminium-adsorbed vaccine produces fewer reactions than the plain.There are difficulties enough in deciding the cause of events that occur after vaccination, since these reactions often occur naturally in children of vaccination age. The task is made even harder by the assumption that various manufacturers' vaccines are the same and the lack of information available to manufacturers about cases in which their vaccine has been implicated. Information on vaccines administered is entered on immunisation records cards; it should be used and referred to if reactions occur.

Determination of endotoxicity in bacterial vaccines

Endotoxicity of bacterial vaccines was quantitated in mice by using actinomycin D as potentiating agent. The results were compared with those obtained by the mouse weight gain test. The lethality of Escherichia coli lipopolysaccharide was increased 2,140 times when 12.5 mug of actinomycin D was used. The mean lethal dose values of heated and unheated pertussis vaccines were similar in the actinomycin D enhancement assay, but the unheated vaccine was significantly more toxic in the mouse weight gain test. Acetone-inactivated typhoid vaccine was slightly less toxic than the heat-phenol-inactivated vaccine in both the actinomycin D enhancement assay and mouse weight gain test. Endotoxicity of experimental vaccines prepared by extraction of Pseudomonas aeruginosa strains was high as compared with E. coli lipopolysaccharide. The BALB/c mice were about four times more susceptible than the random bred NIH strain mice. The results indicate that the actinomycin D enhancement assay had the advantages of being more sensitive and probably more specific.

Human immunity to the meningococcus. IV. Immunogenicity of group A and group C meningococcal polysaccharides in human volunteers

High molecular weight group A and group C meningococcal polysaccharides had no significant toxicity for mice or guinea pigs. Furthermore, these polysaccharide preparations contained negligible amounts of biologically active endotoxin. The high molecular weight group A and group C meningococcal polysaccharides were excellent immunogens in six human volunteers. Antibodies belonging to the immunoglobulin classes IgG, IgM, and IgA were produced. These antibodies were highly meningococcocidal in the presence of complement.

Advantages of aluminium hydroxide adsorbed combined diphtheria, tetanus, and pertussis vaccines for the immunization of infants

Three combined triple antigen vaccines were used to inoculate infants receiving primary immunization at 3 to 6 months of age. Laboratory potency and toxicity tests and clinical evaluation again showed that the mouse weight gain test is able to predict which vaccines will give reactions in children. The addition of aluminium hydroxide to the vaccine both increased potency and reduced the tendency to cause reactions. Assays on sera showed that almost all children produced agglutinins to Bordetella pertussis types 1, 2, and 3 when the vaccine contained aluminium hydroxide.

Appearance of mouse-lethal toxin in liquid cultures of Bordetella pertussis

The mouse-lethal toxin present in liquid cultures of most smooth strains of Bordetella pertussis is known to originate in the cytoplasm of the organism but to be most lethal for mice when released into the supernatant fluid. It is also recognized that cell degeneration and lysis occur in liquid cultures during the stationary and decline phases of growth. For these reasons, it is generally believed that most of the toxicity demonstrable in liquid cultures at the time of harvest is released during the later stages of cultivation, when high alkalinity and aging of cells favor lysis. However, the results reported here have indicated that high levels of mouse-lethal toxicity arise during very early log phase and that the peak of toxicity is reached before the end of the log phase. No further increase in toxicity was observed during stationary and decline phases. The very early appearance of toxicity could not be explained by the presence in the inoculum of a proportion of dead and degenerating cells, and it is concluded that the toxin is produced mainly by actively growing cells. This was confirmed by tests on organisms growing in continuous culture. Electron-microscopic examination of cells from a very early log-phase culture revealed the presence of large numbers of small vesicles on the cell walls of about 5% of the population. It is suggested that these vesicles may be associated with the releases of toxin from living cells. It is concluded that no useful reduction in the toxicity of cultures would result from harvesting before the end of the log phase of growth.

Detoxification of liquid cultures of Bordetella pertussis by forced aeration at high pH

Cultures of Bordetella pertussis cultivated in shake flasks were invariably highly toxic for mice, but cultures of the same strain grown in vortex-aerated vessels were nontoxic at the time of harvest. Results reported here indicate that toxin is present during the early log phase in vortex-aerated cultures, but is lost as the cultivation proceeds. The loss of toxicity is apparently due to denaturation of the toxin by the combined influence of vigorous aeration and elevated pH.