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Soriolo N, Benoni R, Dalla Valle D, Zunino F, Olivieri A, Campagna I, Tardivo S, Augusta Gonella L, Russo F, Tonon M, Da Re F, Moretti U, Zanoni G, Moretti F. Adverse events following Measles-Mumps-Rubella and varicella immunization: A safety profile analysis and comparison of different vaccination schedules based on the Italian Pharmacovigilance Network in the Veneto Region. Prev Med Rep 2024; 41:102711. [PMID: 38606113 PMCID: PMC11007536 DOI: 10.1016/j.pmedr.2024.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
Objective The vaccines for measles, mumps, rubella and varicella (MMR and V) have been mandatory in Italy since 2017. Two different vaccination strategies are suggested for the first dose: trivalent MMR and a separate V vaccine or the tetravalent MMRV vaccine. Our aim is to compare the safety profile of MMRV and MMR-V vaccines through the passive adverse event reporting system in the Veneto region and to perform a case-by-case review of a few conditions of interest (febrile and afebrile seizures, ataxia, encephalitis, Guillain-Barré Syndrome, thrombocytopenia, neutropenia and Henoch-Schönlein Purpura). Age and sex differences were also explored. Methods We identified all reports following MMRV or MMR-V vaccination in the Veneto Region and received into the National Pharmacovigilance Network between 2007 and April 30, 2022. Results 9,510 reports were retrieved, of which 5,662 (59.5 %) were related to MMRV and 3,848 (40.5 %) to MMR-V. No safety signals were detected supporting the evidence that MMRV and MMR-V vaccinations have a good safety profile. The reporting rate (RR) for serious events between 2007 and 2022 resulted in 13.67 per 10,000 administered doses for MMRV and 10.90 for MMR-V. Conclusion Passive surveillance data show a significantly higher rate of serious events for males 0-2 years old, both overall and stratified per vaccination strategy. Further studies are needed to confirm this observation. The analyses suggest that retrieved differences do not have a significant impact on the overall safety of both formulations.
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Affiliation(s)
- Nicola Soriolo
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Roberto Benoni
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Diana Dalla Valle
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Francesco Zunino
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Adele Olivieri
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Irene Campagna
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Stefano Tardivo
- University of Verona, Diagnostics and Public Health Department, Section of Hygiene and Preventive Medicine, Verona, Italy
| | - Laura Augusta Gonella
- University of Verona, Diagnostics and Public Health Department, Section of Pharmacology, Verona, Italy
| | - Francesca Russo
- Directorate for Prevention, Food Safety, Veterinary - Public Health Veneto Region, Italy
| | - Michele Tonon
- Directorate for Prevention, Food Safety, Veterinary - Public Health Veneto Region, Italy
| | - Filippo Da Re
- Directorate for Prevention, Food Safety, Veterinary - Public Health Veneto Region, Italy
| | - Ugo Moretti
- University of Verona, Diagnostics and Public Health Department, Section of Pharmacology, Verona, Italy
| | - Giovanna Zanoni
- University Hospital of Verona, Pathology and Diagnostics Department, Immunology Unit, Verona, Italy
| | - Francesca Moretti
- University of Verona, Neurosciences, Biomedicine and Movement Sciences Department, Verona, Italy
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Motta E, Camacho LAB, Filippis AMBD, Costa M, Pedro L, Cardoso SW, Souza MCDO, Mendes YDS, Grinsztejn B, Coelho LE. Safety of the yellow fever vaccine in people living with HIV: a longitudinal study exploring post-vaccination viremia and hematological and liver kinetics. Braz J Infect Dis 2024; 28:103719. [PMID: 38341187 PMCID: PMC10904163 DOI: 10.1016/j.bjid.2024.103719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Safety data on the yellow fever vaccine 17DD in People Living with HIV (PLWH) are limited. This study explored the occurrence of post-vaccination 17DD viremia and the kinetics of hematological and liver laboratorial parameters in PLWH and HIV-uninfected participants [HIV(-) controls]. METHODS We conducted a secondary analysis of a longitudinal interventional trial (NCT03132311) study that enrolled PLWH and HIV(-) controls to receive a single 17DD dose and were followed at 5, 30 and 365 days after vaccination in Rio de Janeiro, Brazil. 17DD viremia (obtained throughreal-time PCR and plaque forming units' assays), hematological (neutrophils, lymphocytes and platelets counts) and liver enzymes (ALT and AST) results were assessed at baseline and Days 5 and 30 post-vaccination. Logistic regression models explored factors associated with the odds of having positive 17DD viremia. Linear regression models explored variables associated with hematological and liver enzymes results at Day 5. RESULTS A total of 202 PLWH with CD4 ≥ 200 cells/µL and 68 HIV(-) controls were included in the analyses. 17DD viremia was found in 20.0 % of the participants and was twice more frequent in PLWH than in HIV(-) controls (22.8% vs. 11.8 %, p-value < 0.001). Neutrophils, lymphocytes and platelets counts dropped at Day 5 and returned to baseline values at Day 30. 17DD viremia was associated with lower nadir of lymphocytes and platelets at Day 5. ALT levels did not increase post-vaccination and were not associated with 17DD viremia. CONCLUSIONS 17DD was safe and well-tolerated in PLWH with CD4 ≥ 200 cells/µL. Post-vaccination viremia was more frequent in PLWH than in controls. Transient and self-limited decreases in lymphocytes and neutrophils occurred early after vaccination. 17DD viremia was associated with lower lymphocytes and platelets nadir after vaccination. We did not observe elevations in ALT after 17DD vaccination.
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Affiliation(s)
- Edwiges Motta
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Luiz Antonio B Camacho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Rio de Janeiro, RJ, Brazil
| | - Ana M Bispo de Filippis
- Fundação Oswaldo Cruz, Laboratório de Arbovírus e Vírus Hemorrágicos, Instituto Oswaldo Cruz (IOC), Rio de Janeiro, RJ, Brazil
| | - Marcellus Costa
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Luciana Pedro
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | | | - Ygara da Silva Mendes
- Fundação Oswaldo Cruz, Laboratório de Tecnologia Virológica, Biomanguinhos, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil
| | - Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas (INI), Rio de Janeiro, RJ, Brazil.
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Dobrewa W, Bielska M, Bąbol-Pokora K, Janczar S, Młynarski W. Congenital neutropenia: From lab bench to clinic bedside and back. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2024; 793:108476. [PMID: 37989463 DOI: 10.1016/j.mrrev.2023.108476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
Neutropenia is a hematological condition characterized by a decrease in absolute neutrophil count (ANC) in peripheral blood, typically classified in adults as mild (1-1.5 × 109/L), moderate (0.5-1 × 109/L), or severe (< 0.5 × 109/L). It can be categorized into two types: congenital and acquired. Congenital severe chronic neutropenia (SCN) arises from mutations in various genes, with different inheritance patterns, including autosomal recessive, autosomal dominant, and X-linked forms, often linked to mitochondrial diseases. The most common genetic cause is alterations in the ELANE gene. Some cases exist as non-syndromic neutropenia within the SCN spectrum, where genetic origins remain unidentified. The clinical consequences of congenital neutropenia depend on granulocyte levels and dysfunction. Infants with this condition often experience recurrent bacterial infections, with approximately half facing severe infections within their first six months of life. These infections commonly affect the respiratory system, digestive tract, and skin, resulting in symptoms like fever, abscesses, and even sepsis. The severity of these symptoms varies, and the specific organs and systems affected depend on the genetic defect. Congenital neutropenia elevates the risk of developing acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS), particularly with certain genetic variants. SCN patients may acquire CSF3R and RUNX1 mutations, which can predict the development of leukemia. It is important to note that high-dose granulocyte colony-stimulating factor (G-CSF) treatment may have the potential to promote leukemogenesis. Treatment for neutropenia involves antibiotics, drugs that boost neutrophil production, or bone marrow transplants. Immediate treatment is essential due to the heightened risk of severe infections. In severe congenital or cyclic neutropenia (CyN), the primary therapy is G-CSF, often combined with antibiotics. The G-CSF dosage is gradually increased to normalize neutrophil counts. Hematopoietic stem cell transplants are considered for non-responders or those at risk of AML/MDS. In cases of WHIM syndrome, CXCR4 inhibitors can be effective. Future treatments may involve gene editing and the use of the diabetes drug empagliflozin to alleviate neutropenia symptoms.
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Affiliation(s)
- Weronika Dobrewa
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland.
| | - Marta Bielska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Katarzyna Bąbol-Pokora
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 36\50 Sporna Str, 91-738 Lodz, Poland.
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Motta E, Camacho LAB, Cunha M, de Filippis AMB, Lima SM, Costa M, Pedro L, Cardoso SW, Cortes FH, Giacoia-Gripp CB, Morata M, Nazer S, Moreira RI, de Oliveira Souza MC, Mendes YS, de Souza Azevedo A, dos Santos Alvez N, Grinsztejn B, Coelho LE. Immunogenicity and reactogenicity of yellow fever vaccine in people with HIV. AIDS 2023; 37:2319-2329. [PMID: 37650759 PMCID: PMC10653289 DOI: 10.1097/qad.0000000000003696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To evaluate immunogenicity and reactogenicity of yellow fever (YF) vaccine in people with HIV (PWH) compared to HIV-uninfected controls. DESIGN In this longitudinal interventional trial (NCT03132311), PWH with CD4 + cell count ≥200 cells/μl and controls, aged 18-59, without a previous history of YF vaccination received a single standard dose of YF vaccine (17DD) and were followed at Days 5, 30 and Year 1. METHODS YF-neutralization titers were measured at Days 0, 30 and Year 1 and geometric mean titers (GMT) were calculated. Adverse events (AE) and YF virus detection were measured at Days 5 and 30. Linear regression evaluated factors associated with YF-neutralization titers. RESULTS Two hundred and eighteen PWH and 82 controls were included. At baseline, all PWH were using antiretroviral therapy; 92.6% had undetectable HIV viral load (VL) and median CD4 + cell count was 630 cells/μl [interquartile range (IQR) 463-888]. YF vaccine was safe and there were no serious AEs. At Day 30, seroconversion was observed in 98.6% of PWH [95% confidence interval (CI): 95.6-99.6] and in 100% of controls (95% CI: 93.9-100); at Year 1, 94.0% of PWH (95% CI: 89.6-96.7) and 98.4% of controls (95% CI 90.3-99.9) were seropositive. PWH had lower GMTs than controls at Day 30 and Year 1. Baseline VL >1000 copies/ml, low CD4 + cell count and low CD4 + /CD8 + ratio were associated with lower YF-neutralization titers. CONCLUSIONS YF vaccine is safe in PWH with CD4 + cell count ≥200 cells/μl. YF vaccine immunogenicity is impaired in PWH, particularly among those with high VL, low CD4 + cell count and low CD4 + /CD8 + ratio at vaccination and YF-neutralization titers decays over time.
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Affiliation(s)
- Edwiges Motta
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | | | - Marcelo Cunha
- Escola Nacional de Saúde Pública Sérgio Arouca - Fundação Oswaldo Cruz
| | | | - Sheila M.B. Lima
- Departamento de Desenvolvimento Experimental e pré-Clínico (DEDEP), Bio-Manguinhos/Fiocruz
| | - Marcellus Costa
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Luciana Pedro
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Sandra W. Cardoso
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | | | | | - Michelle Morata
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Sandro Nazer
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Ronaldo Ismério Moreira
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
- Escola Nacional de Saúde Pública Sérgio Arouca - Fundação Oswaldo Cruz
| | | | - Ygara S. Mendes
- Laboratório de Tecnologia Virológica (LATEV), Bio-Manguinhos/Fiocruz
| | | | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
| | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas - Fundação Oswaldo Cruz
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Montella L, Dell'Aversana C, Pacella D, Troise S, Russo P, Cacciapuoti V, Ottaiano A, Di Marino L, Coppola P, Liguori C, Berretta M, Maddaluno S, Altucci L, Facchini G. Exploring hematic crasis variations in cancer patients following SARS-CoV-2 vaccination: a real-practice study. Infect Agent Cancer 2023; 18:62. [PMID: 37848958 PMCID: PMC10583381 DOI: 10.1186/s13027-023-00532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
SARS-CoV-2 vaccination is strongly recommended, particularly for fragile patients such as those undergoing active oncological treatments. It is crucial to conduct post-marketing surveillance in this patient population. In our study, we conducted a retrospective analysis of real-world data, including 136 patients who received SARS-CoV-2 vaccines and were undergoing anticancer treatments between March 1st and June 30th, 2021. All patients received mRNA vaccines, namely Pfizer-BioNTech's COMIRNATY (BNT162b2 mRNA) and Moderna's mRNA-1273 COVID-19 vaccines. We collected blood samples from the patients one week to 10 days before and after vaccine administration to assess full blood count with white cell differentials. Additionally, we monitored serology titers to detect any previous SARS-CoV-2 infection before hospital admission and tracked changes over time. Our findings revealed a significant occurrence of leukopenia following both the first and second vaccine doses among patients receiving chemotherapy and chemo-immunotherapy. Importantly, this effect was independent of demographic factors such as sex, age, and Body Mass Index. In the chemo-immunotherapy treated group, we observed that concomitant immune-mediated diseases were significantly associated with leukopenia following the second vaccine dose. Notably, in healthy subjects, transient neutropenia was recognized as an adverse event following vaccination. The observed lymphocytopenia during SARS-CoV-2 infection, combined with the impact on leukocyte counts observed in our study, underscores the need for larger post-marketing surveillance studies. Despite a treatment delay occurring in 6.6% of patients, the administration of mRNA vaccines did not have a significant impact on the treatment schedule in our series. These findings from a real-world setting provide valuable insights and suggest avenues for further prospective studies to explore potential complex interactions specific to this patient population.
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Affiliation(s)
- Liliana Montella
- Oncology Operative Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Napoli, ASL NA2 NORD 80078, Italy.
| | - Carmela Dell'Aversana
- Institute Experimental Endocrinology and Oncology "Gaetano Salvatore" (IEOS)- CNR IT, Naples, Italy
- Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80131, Italy
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Napoli, 80131, Italy
| | - Simona Troise
- Food and Nutrition Hygiene Service (Servizio Igiene degli Alimenti e della Nutrizione, SIAN), Monteruscello, Pozzuoli, Napoli, 80078, Italy
| | - Paola Russo
- UOSD cure palliative PO San Gennaro, ASL NA1 Centro, Napoli, 80136, Italy
| | - Valentina Cacciapuoti
- Department of Laboratory Medicine, Unit of Laboratory of Clinical Pathology, "S.Maria delle Grazie" Hospital, ASL Napoli 2 Nord, Pozzuoli, Napoli, 80078, Italy
| | - Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via M. Semmola, Napoli, 80131, Italy
| | - Luigi Di Marino
- Pineta Grande Hospital, Via Domiziana, km 30/00, Castel Volturno Caserta, 81030, Italy
| | - Paola Coppola
- Oncology Operative Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Napoli, ASL NA2 NORD 80078, Italy
| | - Carmela Liguori
- Oncology Operative Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Napoli, ASL NA2 NORD 80078, Italy
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, 98122, Italy
| | - Salvatore Maddaluno
- Department of Laboratory Medicine, Unit of Laboratory of Clinical Pathology, "S.Maria delle Grazie" Hospital, ASL Napoli 2 Nord, Pozzuoli, Napoli, 80078, Italy
| | - Lucia Altucci
- Institute Experimental Endocrinology and Oncology "Gaetano Salvatore" (IEOS)- CNR IT, Naples, Italy
- Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, 80131, Italy
- BIOGEM, 83031 Ariano Irpino, Avellino, Italy
| | - Gaetano Facchini
- Oncology Operative Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Napoli, ASL NA2 NORD 80078, Italy
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Meshref TS, Hamad DA, Aly MM, Kamal DT, Elkhayat MR, Elghazally SA. Impact of SARS-CoV-2 AstraZeneca Vaccine on Safety and Blood Elements of Egyptian Healthcare Workers. Indian J Occup Environ Med 2023; 27:241-248. [PMID: 38047168 PMCID: PMC10691519 DOI: 10.4103/ijoem.ijoem_275_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/05/2023] [Accepted: 04/15/2023] [Indexed: 12/05/2023] Open
Abstract
Background Many coronavirus disease 2019 (COVID-19) vaccines were approved worldwide. Their safety was the primary concern. In Egypt, Oxford-AstraZeneca (AZ) vaccine was the first approved vaccine initially for healthcare workers (HCWs). Objective We aim to determine adverse events and hematological abnormalities following the COVID-19 AZ vaccine and estimate the infection rate of the candidates by COVID-19 between the first and second doses of vaccination. Methods Within 8-10 days of receiving their initial dose of the AZ vaccine, 909 HCWs were assessed for adverse events as part of a prospective longitudinal study. Complete blood counts (CBCs) were evaluated before and one month after vaccination. Results 37.2% of the candidates experienced side effects following vaccination. Pain at the injection site was the most common (25.4%) and more frequent in participants between 20 and 40 years (27.9%). The mean total leukocyte count (TLC), absolute leukocyte count (ALC), absolute neutrophil count (ANC), and absolute monocyte count (AMC) increased one month following vaccination (P < 0. 001). Sixty-six vaccinated HCWs were infected with COVID-19 between the two vaccine doses. 82% were infected after 14 days of the first dose, while 18% were infected before 14 days (P < 0.0001). Conclusions Most of the vaccinated personnel did not experience any side effects after the first dose of the vaccine. Furthermore, the most common complaints were pain at the injection site, fatigue, fever, headache, arthralgia, myalgia, and chills. Infected people with COVID-19 after the first dose had significantly more severe disease if they were infected before 14 days than those who got infected later on.
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Affiliation(s)
- Taghreed S. Meshref
- Department of Internal Medicine, Critical Care Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dina A. Hamad
- Department of Internal Medicine, Critical Care Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mai M. Aly
- Department of Internal Medicine, Clinical Hematology Unit, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dalia T. Kamal
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mariam R. Elkhayat
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shimaa A. Elghazally
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
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7
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Szubert AJ, Pollock KM, Cheeseman HM, Alagaratnam J, Bern H, Bird O, Boffito M, Byrne R, Cole T, Cosgrove CA, Faust SN, Fidler S, Galiza E, Hassanin H, Kalyan M, Libri V, McFarlane LR, Milinkovic A, O'Hara J, Owen DR, Owens D, Pacurar M, Rampling T, Skene S, Winston A, Woolley J, Yim YTN, Dunn DT, McCormack S, Shattock RJ. COVAC1 phase 2a expanded safety and immunogenicity study of a self-amplifying RNA vaccine against SARS-CoV-2. EClinicalMedicine 2023; 56:101823. [PMID: 36684396 PMCID: PMC9837478 DOI: 10.1016/j.eclinm.2022.101823] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Lipid nanoparticle (LNP) encapsulated self-amplifying RNA (saRNA) is well tolerated and immunogenic in SARS-CoV-2 seronegative and seropositive individuals aged 18-75. Methods A phase 2a expanded safety and immunogenicity study of a saRNA SARS-CoV-2 vaccine candidate LNP-nCoVsaRNA, was conducted at participating centres in the UK between 10th August 2020 and 30th July 2021. Participants received 1 μg then 10 μg of LNP-nCoVsaRNA, ∼14 weeks apart. Solicited adverse events (AEs) were collected for one week post-each vaccine, and unsolicited AEs throughout. Binding and neutralisating anti-SARS-CoV-2 antibody raised in participant sera was measured by means of an anti-Spike (S) IgG ELISA, and SARS-CoV-2 pseudoneutralisation assay. (The trial is registered: ISRCTN17072692, EudraCT 2020-001646-20). Findings 216 healthy individuals (median age 51 years) received 1.0 μg followed by 10.0 μg of the vaccine. 28/216 participants were either known to have previous SARS-CoV2 infection and/or were positive for anti-Spike (S) IgG at baseline. Reactogenicity was as expected based on the reactions following licensed COVID-19 vaccines, and there were no serious AEs related to vaccination. 80% of baseline SARS-CoV-2 naïve individuals (147/183) seroconverted two weeks post second immunization, irrespective of age (18-75); 56% (102/183) had detectable neutralising antibodies. Almost all (28/31) SARS-CoV-2 positive individuals had increased S IgG binding antibodies following their first 1.0 μg dose with a ≥0.5log10 increase in 71% (22/31). Interpretation Encapsulated saRNA was well tolerated and immunogenic in adults aged 18-75 years. Seroconversion rates in antigen naïve were higher than those reported in our dose-ranging study. Further work is required to determine if this difference is related to a longer dosing interval (14 vs. 4 weeks) or dosing with 1.0 μg followed by 10.0 μg. Boosting of S IgG antibodies was observed with a single 1.0 μg injection in those with pre-existing immune responses. Funding Grants and gifts from the Medical Research Council UKRI (MC_PC_19076), the National Institute for Health Research/Vaccine Task Force, Partners of Citadel and Citadel Securities, Sir Joseph Hotung Charitable Settlement, Jon Moulton Charity Trust, Pierre Andurand, and Restore the Earth.
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Affiliation(s)
| | - Katrina M. Pollock
- Department of Infectious Disease, Imperial College London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | | | | | - Henry Bern
- cMRC Clinical Trials Unit at UCL, London, UK
| | - Olivia Bird
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | | | - Ruth Byrne
- Chelsea & Westminster Hospital, London, UK
| | - Tom Cole
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
| | - Catherine A. Cosgrove
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, UK
| | - Eva Galiza
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
| | - Hana Hassanin
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Mohini Kalyan
- Department of Infectious Disease, Imperial College London, UK
| | - Vincenzo Libri
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | - Jessica O'Hara
- Department of Infectious Disease, Imperial College London, UK
| | - David R. Owen
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Daniel Owens
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Mihaela Pacurar
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Tommy Rampling
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | - Simon Skene
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, UK
| | - James Woolley
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Yee Ting N. Yim
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
| | | | | | | | - COVAC 1 Study Teaml
- cMRC Clinical Trials Unit at UCL, London, UK
- Department of Infectious Disease, Imperial College London, UK
- St George's Vaccine Institute, Institute for Infection and Immunity, St George's University of London, UK
- Chelsea & Westminster Hospital, London, UK
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
- Surrey Clinical Research Facility, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- dNIHR UCLH Clinical Research Facility and NIHR UCLH Biomedical Research Centre, London, UK
- NIHR Imperial Clinical Research Facility and NIHR Imperial Biomedical Research Centre, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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8
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Artan AS, Demir E, Güller N, Türkmen A. A Rare Adverse Event after CoronaVac® Administration: Neutropenia in a Kidney Transplant Recipient. Balkan Med J 2022; 39:305-306. [PMID: 35873917 PMCID: PMC9326945 DOI: 10.4274/balkanmedj.galenos.2022.2022-4-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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9
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Fox-Fisher I, Piyanzin S, Briller M, Oiknine-Djian E, Alfi O, Ben-Ami R, Peretz A, Neiman D, Ochana BL, Fridlich O, Drawshy Z, Klochendler A, Magenheim J, Share D, Avrahami R, Ribak Y, Talmon A, Rubin L, Milman N, Segev M, Feldman E, Tal Y, Shen-Orr SS, Glaser B, Shemer R, Wolf D, Dor Y. B cell-derived cfDNA after primary BNT162b2 mRNA vaccination anticipates memory B cells and SARS-CoV-2 neutralizing antibodies. MED 2022; 3:468-480.e5. [PMID: 35716665 PMCID: PMC9117261 DOI: 10.1016/j.medj.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/17/2022] [Accepted: 05/12/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Much remains unknown regarding the response of the immune system to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination. METHODS We employed circulating cell-free DNA (cfDNA) to assess the turnover of specific immune cell types following administration of the Pfizer/BioNTech vaccine. FINDINGS The levels of B cell cfDNA after the primary dose correlated with development of neutralizing antibodies and memory B cells after the booster, revealing a link between early B cell turnover-potentially reflecting affinity maturation-and later development of effective humoral response. We also observed co-elevation of B cell, T cell, and monocyte cfDNA after the booster, underscoring the involvement of innate immune cell turnover in the development of humoral and cellular adaptive immunity. Actual cell counts remained largely stable following vaccination, other than a previously demonstrated temporary reduction in neutrophil and lymphocyte counts. CONCLUSIONS Immune cfDNA dynamics reveal the crucial role of the primary SARS-CoV-2 vaccine in shaping responses of the immune system following the booster vaccine. FUNDING This work was supported by a generous gift from Shlomo Kramer. Supported by grants from Human Islet Research Network (HIRN UC4DK116274 and UC4DK104216 to R.S. and Y.D.), Ernest and Bonnie Beutler Research Program of Excellence in Genomic Medicine, The Alex U Soyka Pancreatic Cancer Fund, The Israel Science Foundation, the Waldholtz/Pakula family, the Robert M. and Marilyn Sternberg Family Charitable Foundation, the Helmsley Charitable Trust, Grail, and the DON Foundation (to Y.D.). Y.D. holds the Walter and Greta Stiel Chair and Research Grant in Heart Studies. I.F.-F. received a fellowship from the Glassman Hebrew University Diabetes Center.
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Affiliation(s)
- Ilana Fox-Fisher
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Sheina Piyanzin
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Mayan Briller
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Or Alfi
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Roni Ben-Ami
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ayelet Peretz
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Daniel Neiman
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Bracha-Lea Ochana
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ori Fridlich
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Zeina Drawshy
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Agnes Klochendler
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Judith Magenheim
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Danielle Share
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ran Avrahami
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yaarit Ribak
- Allergy and Clinical Immunology Unit, Department of Medicine, Jerusalem, Israel
| | - Aviv Talmon
- Allergy and Clinical Immunology Unit, Department of Medicine, Jerusalem, Israel
| | - Limor Rubin
- Allergy and Clinical Immunology Unit, Department of Medicine, Jerusalem, Israel
| | - Neta Milman
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Meital Segev
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Erik Feldman
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Jerusalem, Israel
| | - Shai S Shen-Orr
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Benjamin Glaser
- Endocrinology and Metabolism Service, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Dana Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, The Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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Stebbings R, Jones C, Cotton P, Armour G, Maguire S, Skellett V, Tang CM, Goodman J, Brady T, Takahashi V, Daunt A, Lapointe JM, Cohen TS. SARS-CoV-2 Spike Protein Expression In Vitro and Hematologic Effects in Mice Vaccinated With AZD1222 (ChAdOx1 nCoV-19). Front Immunol 2022; 13:836492. [PMID: 35493482 PMCID: PMC9039667 DOI: 10.3389/fimmu.2022.836492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 01/17/2023] Open
Abstract
Severe COVID-19 can be associated with a prothrombotic state, increasing risk of morbidity and mortality. The SARS-CoV-2 spike glycoprotein is purported to directly promote platelet activation via the S1 subunit and is cleaved from host cells during infection. High plasma concentrations of S1 subunit are associated with disease progression and respiratory failure during severe COVID-19. There is limited evidence on whether COVID-19 vaccine-induced spike protein is similarly cleaved and on the immediate effects of vaccination on host immune responses or hematology parameters. We investigated vaccine-induced S1 subunit cleavage and effects on hematology parameters using AZD1222 (ChAdOx1 nCoV-19), a simian, replication-deficient adenovirus-vectored COVID-19 vaccine. We observed S1 subunit cleavage in vitro following AZD1222 transduction of HEK293x cells. S1 subunit cleavage also occurred in vivo and was detectable in sera 12 hours post intramuscular immunization (1x1010 viral particles) in CD-1 mice. Soluble S1 protein levels decreased within 3 days and were no longer detectable 7–14 days post immunization. Intravenous immunization (1x109 viral particles) produced higher soluble S1 protein levels with similar expression kinetics. Spike protein was undetectable by immunohistochemistry 14 days post intramuscular immunization. Intramuscular immunization resulted in transiently lower platelet (12 hours) and white blood cell (12–24 hours) counts relative to vehicle. Similarly, intravenous immunization resulted in lower platelet (24–72 hours) and white blood cell (12–24 hours) counts, and increased neutrophil (2 hours) counts. The responses observed with either route of immunization represent transient hematologic changes and correspond to expected innate immune responses to adenoviral infection.
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Affiliation(s)
- Richard Stebbings
- Oncology Safety, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Melbourn, United Kingdom
| | - Christopher Jones
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Peter Cotton
- Research and Development, BioPharmaceuticals R&D, AstraZeneca, Macclesfield, United Kingdom
| | - Gillian Armour
- Regulatory Toxicology and Safety Pharmacology, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Melbourn, United Kingdom
| | - Shaun Maguire
- Regulatory Toxicology and Safety Pharmacology, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Melbourn, United Kingdom
| | - Vicky Skellett
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Chi-Man Tang
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Joanne Goodman
- Integrated Bioanalysis, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Tyler Brady
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Virginia Takahashi
- Microbiome Discovery, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
| | - Andrew Daunt
- Labcorp Early Development Laboratories Limited, Harrogate, United Kingdom
| | - Jean-Martin Lapointe
- Oncology Safety Pathology, Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom
| | - Taylor S Cohen
- Microbiome Discovery, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States
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11
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Emi Aikawa N, Andrade Balbi V, Borba EF, Coracini Tonacio A, Maluf Elias Sallum A, Maria Arruda Campos L, Tomie Kozu K, Borges Vendramini M, Fontoura N, de Souza Azevedo A, Dias Schwarcz W, Marli Christovam Sartori A, Antonangelo L, Artur Silva C, Bonfá E. Yellow fever vaccination in Brazil: Short-term safety and immunogenicity in juvenile autoimmune rheumatic diseases. Vaccine X 2022; 10:100131. [PMID: 34977552 PMCID: PMC8686021 DOI: 10.1016/j.jvacx.2021.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/25/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
We examined 17DD yellow fever vaccine in juvenile autoimmune rheumatic disease patients under low immunosuppression during the recent epidemic in Sao Paulo-Brazil. No serious adverse events were reported and frequencies of mild adverse events were comparable between patients and healthy controls. Immunogenicity parameters against yellow fever vaccine were not hampered in juvenile autoimmune rheumatic disease patients. Peripheral white-blood-cells kinetics after yellow fever vaccination was demonstrated with transient decreases in lymphocytes at D5 and neutrophil levels at D10 with complete recovery at D30.
Yellow fever vaccine (YFV) is a live attenuated vaccine usually contraindicated for juvenile autoimmune rheumatic disease (JARD) patients. During the recent epidemic in Sao Paulo-Brazil, YFV was indicated for patients under low immunosuppression. Thirty JARD patients with inactive diseases undergoing low immunosuppression and 30 healthy controls (HC) were vaccinated with a fractional dose 17DD YFV (∼5495 IU) and evaluated 30 days later. JARD patients and controls had comparable median age (12.4 vs. 12 years, p = 0.250). Disease parameters remained stable 30 days after 17DD YFV (p > 0.05) and only mild adverse events were reported in both groups (p > 0.05). JARD and HC had similar seroprotection [93% vs. 100%;p = 0.49], seroconversion rates [96% vs. 100%;p = 0.489], and GMT [1249 vs.1293;p = 0.821]. Both groups had similar white-blood-cells kinetics with transient decreases in lymphocytes at D5 and neutrophils at D10, followed by full recovery at D30 (P < 0.05). In conclusion, 17DD YFV was safe and immunogenic in JARD. This study may contribute to recommendations for patients living/travelling to endemic areas.
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Affiliation(s)
- Nádia Emi Aikawa
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
- Corresponding authors at: 455, 3rd floor, room 3190 – Cerqueira Cesar, São Paulo, SP CEP 05403010, Brazil.
| | - Verena Andrade Balbi
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
- Corresponding authors at: 455, 3rd floor, room 3190 – Cerqueira Cesar, São Paulo, SP CEP 05403010, Brazil.
| | - Eduardo Ferreira Borba
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Adriana Coracini Tonacio
- Division of Infectology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Adriana Maluf Elias Sallum
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Kátia Tomie Kozu
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Margarete Borges Vendramini
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Nicole Fontoura
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Adriana de Souza Azevedo
- Institute of Technology in Immunobiologicals, Bio-Manguinhos, Fundação Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Waleska Dias Schwarcz
- Institute of Technology in Immunobiologicals, Bio-Manguinhos, Fundação Oswaldo Cruz Foundation, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Leila Antonangelo
- Central Laboratory, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Clovis Artur Silva
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
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12
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De Ryck I, Sarakinou E, Nakakana U, Cilio GL, Ndiaye A, Vella V, Auerbach J, Granada JP, Conti V, Podda A. GMMA Technology for the Development of Safe Vaccines: Meta-Analysis of Individual Patient Data to Assess the Safety Profile of Shigella sonnei 1790GAHB Vaccine in Healthy Adults, with Special Focus on Neutropenia. Infect Dis Ther 2022; 11:757-770. [PMID: 35118580 PMCID: PMC8960504 DOI: 10.1007/s40121-022-00596-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Shigellosis is a major health concern among children < 5 years of age from developing countries, and there are no widely available vaccines to prevent it. The GMMA-based 1790GAHB investigational vaccine against Shigella sonnei was well tolerated and immunogenic in phase 1 and 2 studies conducted in healthy adults from Shigella endemic and non-endemic populations. Based on pooled data of five individual trials, we assessed the association between vaccine administration and the risk of neutropenia as well as the overall safety profile of 1790GAHB. METHODS The risk ratio (RR) of neutropenia was evaluated between participants receiving 1790GAHB (vaccinees) and active comparator/placebo (controls) using different ethnicity-specific absolute neutrophil count (ANC) thresholds established to define neutropenia. Safety was assessed in terms of solicited, unsolicited, and serious adverse events (AEs). RESULTS Of the 279 participants, 11 (5.5%) vaccinees and 4 (5.0%) controls had ANC below the appropriate threshold within 7 days post-vaccination. RR was 0.96 [95% confidence interval (CI) 0.54-1.70]. When neutrophil counts of participants of African descent were measured against an ethnicity non-specific threshold, they resulted in neutropenia episodes in 30 (37.0%) vaccinees and 16 (30.2%) controls, while only 2 (2.5%) vaccinees and 1 (1.9%) control had neutropenia when the ethnicity-specific threshold was applied. RRs were 0.98 (95% CI 0.75-1.28) and 1.30 (95% CI 0.1-17.6), respectively. Solicited and unsolicited AEs were slightly more frequent among vaccinees than controls. No serious AEs, other than neutropenia cases, were recorded in the vaccine group. CONCLUSION By applying the appropriate threshold, no increased risk of neutropenia was identified in vaccinees compared with the controls. The frequency of neutropenia events varied drastically when ethnicity-appropriate thresholds were applied. This observation highlights the importance of selecting appropriate cut-off values according to the correct population reference. Overall, the 1790GAHB vaccine demonstrated an acceptable safety profile.
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Affiliation(s)
| | - Eleanna Sarakinou
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100, Siena, Italy
| | - Usman Nakakana
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100, Siena, Italy
| | | | | | | | - Joachim Auerbach
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100, Siena, Italy
- Coalition for Epidemic Preparedness Innovations, London, UK
| | | | - Valentino Conti
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100, Siena, Italy
| | - Audino Podda
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100, Siena, Italy
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Micoli F, Nakakana UN, Berlanda Scorza F. Towards a Four-Component GMMA-Based Vaccine against Shigella. Vaccines (Basel) 2022; 10:328. [PMID: 35214786 PMCID: PMC8880054 DOI: 10.3390/vaccines10020328] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/05/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023] Open
Abstract
Shigellosis remains a major public health problem around the world; it is one of the leading causes of diarrhoeal disease in low- and middle-income countries, particularly in young children. The increasing reports of Shigella cases associated with anti-microbial resistance are an additional element of concern. Currently, there are no licensed vaccines widely available against Shigella, but several vaccine candidates are in development. It has been demonstrated that the incidence of disease decreases following a prior Shigella infection and that serum and mucosal antibody responses are predominantly directed against the serotype-specific Shigella O-antigen portion of lipopolysaccharide membrane molecules. Many Shigella vaccine candidates are indeed O-antigen-based. Here we present the journey towards the development of a potential low-cost four-component Shigella vaccine, eliciting broad protection against the most prevalent Shigella serotypes, that makes use of the GMMA (Generalized Modules for Membrane Antigens) technology, a novel platform based on bacterial outer membranes for delivery of the O-antigen to the immune system.
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Affiliation(s)
- Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (U.N.N.); (F.B.S.)
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14
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Tomita T, Sakamoto Y, Saito M, Hashimoto K, Ono Y, Nakamura K. Two Patients with Schizophrenia Treated with Clozapine Developed Neutropenia After Receiving a COVID-19 Vaccine. Int Med Case Rep J 2022; 15:29-33. [PMID: 35115846 PMCID: PMC8805838 DOI: 10.2147/imcrj.s350879] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/20/2022] [Indexed: 01/22/2023] Open
Affiliation(s)
- Tetsu Tomita
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Correspondence: Tetsu Tomita, Tel +81-172 39 5066, Fax +81-172 39 5067, Email
| | - Yui Sakamoto
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Manabu Saito
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kojiro Hashimoto
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Yasuki Ono
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Vella V, Schmidt JE, Cilio GL, De Ryck I, Podda A, Conti V, Auerbach J. The Pitfalls of Abnormal Laboratory Value Interpretation in Vaccine Clinical Trials: The Example of Asymptomatic Transient Neutropenia. Drugs R D 2021; 22:1-8. [PMID: 34921644 PMCID: PMC8684336 DOI: 10.1007/s40268-021-00370-3] [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] [Accepted: 10/28/2021] [Indexed: 11/27/2022] Open
Abstract
Hematological and clinical chemistry measurements are an integral part of vaccine safety monitoring. While adopting a conservative approach is important to exclude potential risks for patients, the rationale and methodology underlying the assessment of given adverse events have to be well grounded to avoid raising unfounded concerns. Using asymptomatic transient neutropenia as an example, this paper aims to address the complexity of interpreting abnormal hematological values in vaccine clinical trials and to evaluate the validity of using neutrophil count cut-off points to assess neutropenia in the context of safety monitoring. The validity of the neutrophil count cut-off point methodology was assessed in terms of content validity (i.e., the extent to which a single neutrophil count below the cut-off point corresponds to a clinically significant adverse event), criterion validity (i.e., the extent to which a neutrophil count below a given cut-off point correlates with another manifestation of neutropenia, namely bacteremia), and construct validity (i.e., the exactness of the assumption that a neutrophil count below a given cut-off point corresponds to a reactogenic event caused by the vaccination). We argue that, because of within-individual physiological fluctuations, variations according to population demographics, and poor predictive potential with regard to neutropenia-associated infection, the application of the cut-off point methodology to neutropenia safety monitoring presents major limitations. Based on this assessment, we conclude that hematological laboratory values must be evaluated on a case-by-case basis by investigators to determine their clinical significance.
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Affiliation(s)
- Venanzio Vella
- GSK Vaccines R&D Center, Via Fiorentina 1, 53100, Siena, Italy.
| | | | - Giulia Luna Cilio
- GSK Vaccines Clinical Safety and Pharmacovigilance (VCSP) Department, Siena, Italy
| | - Iris De Ryck
- GSK Vaccines Clinical Safety and Pharmacovigilance (VCSP) Department, Siena, Italy
| | - Audino Podda
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | - Valentino Conti
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | - Joachim Auerbach
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
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16
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Donzelli A, Alessandria M, Orlando L. Comparison of hospitalizations and deaths from COVID-19 2021 versus 2020 in Italy: surprises and implications. F1000Res 2021; 10:964. [PMID: 34909193 PMCID: PMC8596176 DOI: 10.12688/f1000research.73132.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 12/21/2022] Open
Abstract
Data from the Istituto Superiore di Sanità (ISS) emphasized by the media indicate that COVID-19 vaccination reduces related infections, hospitalizations and deaths. However, a comparison showed significantly more hospitalizations and intensive care unit accesses in the corresponding months and days in 2021 versus 2020 and no significant differences in deaths. The combination of non-alternative hypotheses may help explain the discrepancy between the results in the entire population and the vaccination's success claimed by the ISS in reducing infections, serious cases and deaths: a bias: counting as unvaccinated also "those vaccinated with 1 dose in the two weeks following the inoculation", and as incompletely vaccinated also "those vaccinated with 2 doses within two weeks of the 2nd inoculation".a systematic error: counting as unvaccinated also "vaccinated with 1 dose in the two weeks following the inoculation", and as incompletely vaccinated also "vaccinated with 2 doses within two weeks of the 2nd inoculation". Many reports show an increase in COVID-19 cases in these time-windows, and related data should be separated levels of protective effectiveness in vaccinated people, often considered stable, actually show signs of progressive reduction over time, which could contribute to reducing the overall population resultunvaccinated people show more severe disease than in 2020, supporting also in humans the theory of imperfect vaccines, which offer less resistance to the entry of germs than the resistance later encountered inside the human body. This favors the selection of more resistant and virulent mutants, that can be spread by vaccinated people. This damages first the unvaccinated people, but ultimately the whole community. An open scientific debate is needed to discuss these hypotheses, following the available evidence (as well as to discuss the inconsistent theory of unvaccinated young people as reservoirs of viruses/mutants), to assess the long-term and community impact of different vaccination strategies.
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Affiliation(s)
- Alberto Donzelli
- Scientific Committee of the Foundation Allineare Sanità e Salute, Milan, Italy, Italy
| | - Marco Alessandria
- Dipartimento di Scienze della Vita e Biologia dei Sistemi, Università di Torino, Torino, Italia, Italy
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Wang L, Zhang X, Liu YT. Agranulocytosis following injection of inactivated Japanese encephalitis vaccine (Vero cell): A case report. World J Clin Cases 2021; 9:7468-7471. [PMID: 34616813 PMCID: PMC8464466 DOI: 10.12998/wjcc.v9.i25.7468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 05/25/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Japanese encephalitis virus (JEV), a mosquito borne flavivirus, is the leading cause of viral encephalitis in Asia, in terms of frequency and severity. JEV infection is thought to confer lifelong immunity. With the near eradication of poliomyelitis, JEV is now the continent’s leading cause of childhood viral neurologic infection and disability. The most common clinical manifestation of JEV infection is acute encephalitis, and currently there is no specific antiviral therapy. Japanese Encephalitis Vaccine (JE-VC) is an effective prevention measure, including JE-VC, Live (JE-MB), and Inactivated JE-VC.
CASE SUMMARY A 9-mo-old girl received injection of Inactivated JE-VC (Vero cell) (Liaoning Chengda, batch number 201611B17) on August 31, 2017. On that night, she developed a fever with the body temperature up to 38.5 °C, for which Ibuprofen Suspension Drops 1.25 mL was given as antipyretic treatment. On September 1, the patient developed apocleisis, and her parents noticed herpes in her oral cavity. The patient was sent to our hospital on September 3. Physical examination led to a diagnosis of herpetic stomatitis, for which Stomatitis Spray 1 puff, tid, Kangfuxin Liquid 2 mL, tid, and vitamin B2 0.5 tablet, tid, were prescribed. Routine blood tests for low fever on September 6, 2017 revealed an absolute neutrophil count (ANC) of 0.62 × 109/L, hemoglobin (Hb) of 109 g/L, and platelet count (PLT) of 308 × 1012/L, and the tests were monitored regularly thereafter. The patient was followed until July 26, 2020, when routine blood tests revealed ANC 1.72 × 109/L, Hb 138 g/L, and PLT 309 × 1012/L, indicating that the neutropenia count had normalized.
CONCLUSION This report attempts to bring to clinical attention that Inactivated JE-VC (Vero cell) might cause prolonged granulocytopenia or even agranulocytosis.
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Affiliation(s)
- Li Wang
- Department of Pharmacy, West China Second University Hospital, Sichuan University/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Xu Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China/Department of Pharmacy, Dechang People's Hospital, Liangshan 615500, Sichuan Province, China
| | - Yan-Tao Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University/Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
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Schäfer D, Tomiuk S, Küster LN, Rawashdeh WA, Henze J, Tischler-Höhle G, Agorku DJ, Brauner J, Linnartz C, Lock D, Kaiser A, Herbel C, Eckardt D, Lamorte M, Lenhard D, Schüler J, Ströbel P, Missbach-Guentner J, Pinkert-Leetsch D, Alves F, Bosio A, Hardt O. Identification of CD318, TSPAN8 and CD66c as target candidates for CAR T cell based immunotherapy of pancreatic adenocarcinoma. Nat Commun 2021; 12:1453. [PMID: 33674603 PMCID: PMC7935963 DOI: 10.1038/s41467-021-21774-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
A major roadblock prohibiting effective cellular immunotherapy of pancreatic ductal adenocarcinoma (PDAC) is the lack of suitable tumor-specific antigens. To address this challenge, here we combine flow cytometry screenings, bioinformatic expression analyses and a cyclic immunofluorescence platform. We identify CLA, CD66c, CD318 and TSPAN8 as target candidates among 371 antigens and generate 32 CARs specific for these molecules. CAR T cell activity is evaluated in vitro based on target cell lysis, T cell activation and cytokine release. Promising constructs are evaluated in vivo. CAR T cells specific for CD66c, CD318 and TSPAN8 demonstrate efficacies ranging from stabilized disease to complete tumor eradication with CD318 followed by TSPAN8 being the most promising candidates for clinical translation based on functionality and predicted safety profiles. This study reveals potential target candidates for CAR T cell based immunotherapy of PDAC together with a functional set of CAR constructs specific for these molecules.
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Affiliation(s)
- Daniel Schäfer
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
- University Medical Center Göttingen, Clinic for Hematology and Medical Oncology, Göttingen, Lower Saxony, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Lower Saxony, Germany
| | - Stefan Tomiuk
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Laura N Küster
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Wa'el Al Rawashdeh
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Janina Henze
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
- University Medical Center Göttingen, Clinic for Hematology and Medical Oncology, Göttingen, Lower Saxony, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Lower Saxony, Germany
| | | | - David J Agorku
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Janina Brauner
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Cathrin Linnartz
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Dominik Lock
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Andrew Kaiser
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Christoph Herbel
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Dominik Eckardt
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Melina Lamorte
- Charles River Discovery Research Services GmbH, Freiburg, Baden-Wuerttemberg, Germany
| | - Dorothee Lenhard
- Charles River Discovery Research Services GmbH, Freiburg, Baden-Wuerttemberg, Germany
| | - Julia Schüler
- Charles River Discovery Research Services GmbH, Freiburg, Baden-Wuerttemberg, Germany
| | - Philipp Ströbel
- University Medical Center Göttingen, Institute for Pathology, Göttingen, Lower Saxony, Germany
| | - Jeannine Missbach-Guentner
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Lower Saxony, Germany
| | - Diana Pinkert-Leetsch
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Lower Saxony, Germany
- Max Planck Institute for Experimental Medicine, Translational Molecular Imaging, Göttingen, Lower Saxony, Germany
| | - Frauke Alves
- University Medical Center Göttingen, Clinic for Hematology and Medical Oncology, Göttingen, Lower Saxony, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Lower Saxony, Germany
- Max Planck Institute for Experimental Medicine, Translational Molecular Imaging, Göttingen, Lower Saxony, Germany
| | - Andreas Bosio
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany
| | - Olaf Hardt
- Miltenyi Biotec GmbH, R&D, Bergisch Gladbach, North Rhine-Westphalia, Germany.
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19
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Shaw JL, Nielson CM, Park JK, Marongiu A, Soff GA. The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies. Eur J Haematol 2021; 106:662-672. [PMID: 33544940 PMCID: PMC8248430 DOI: 10.1111/ejh.13595] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To estimate the risk of thrombocytopenia in various cancers and chemotherapy regimens. METHODS Structured patient-level data from the Flatiron Health Electronic Health Record database were used to identify adult patients who received chemotherapy for a solid tumor or hematologic malignancy from 2012 to 2017. Three-month cumulative incidence of thrombocytopenia was assessed based on platelet counts, overall and by grade of thrombocytopenia. Co-occurrence of anemia, neutropenia, and leukopenia was evaluated. RESULTS Of 15,521 patients with solid tumors, 13% had thrombocytopenia within 3 months (platelet count < 100 × 109 /L); 4% had grade 3 (25 to < 50 × 109 /L), and 2% grade 4 (<25 × 109 /L) thrombocytopenia. Of 2537 patients with hematologic malignancies, 28% had any thrombocytopenia, 16% with grade 3, and 12% with grade 4. Among patients with thrombocytopenia, it occurred without another cytopenia in 18% of solid tumors and 7% of hematologic malignancies. CONCLUSIONS In a large, US-representative sample of patients undergoing chemotherapy in clinical practice, thrombocytopenia incidence varied across tumor and regimen types. Despite recommendations to alter chemotherapy to avoid severe thrombocytopenia, 4% of patients with solid tumors and 16% with hematologic malignancies experienced grade 3 thrombocytopenia. Prediction and prevention of thrombocytopenia may help oncologists avoid dose modifications and their adverse effects on survival.
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Affiliation(s)
| | | | | | | | - Gerald A Soff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Beirão BCB, Ingberman M, Mesa D, Salles GBC, Muniz EC, Caron LF. Effects of aroA deleted E. coli vaccine on intestinal microbiota and mucosal immunity. Comp Immunol Microbiol Infect Dis 2021; 75:101612. [PMID: 33477024 DOI: 10.1016/j.cimid.2021.101612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 01/16/2023]
Abstract
E. coli infection of broilers can result in systemic diseases and productivity losses. Use of antimicrobials against this condition is common but other approaches, such as vaccination, are gaining ground. Anecdotal field reports indicate that intestinal health is improved unspecifically following E. coli live vaccination. We hypothesized that the intestine may be an important site for the functionality of the vaccine. Vaccine effects on the intestine were assessed. Spray vaccination induced marked alterations of the caecum microbiota of broilers within 3 days, and this effect gradually waned. However, T cell activation occurred in the spleen, but not in caecal tonsils, and anti-E. coli IgA was concentrated in the respiratory mucosae. Accordingly, IL-6 mRNA was produced in the lungs following immunization. Overall, these data are an initial indication that any vaccine-induced effects on the intestine are greatly associated with the microbiota. However, immunity conferred by vaccination is not primarily induced in gut-associated lymphoid tissues.
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Affiliation(s)
- Breno C B Beirão
- Imunova Análises Biológicas, Setor de Ciências Biológicas UFPR, Curitiba, PR, 81531-980, Brazil; Universidade Federal do Paraná, Setor de Ciências Biológicas UFPR, Curitiba, 81531-980, Brazil.
| | - Max Ingberman
- Imunova Análises Biológicas, Setor de Ciências Biológicas UFPR, Curitiba, PR, 81531-980, Brazil
| | - Dany Mesa
- Universidade Federal do Paraná, Setor de Ciências Biológicas UFPR, Curitiba, 81531-980, Brazil
| | - Gleidson B C Salles
- Zoetis Indústria de Produtos Veterinários Ltda, São Paulo, SP, 04709-111, Brazil
| | - Eduardo C Muniz
- Zoetis Indústria de Produtos Veterinários Ltda, São Paulo, SP, 04709-111, Brazil
| | - Luiz Felipe Caron
- Universidade Federal do Paraná, Setor de Ciências Biológicas UFPR, Curitiba, 81531-980, Brazil
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21
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Wressnigg N, Hochreiter R, Zoihsl O, Fritzer A, Bézay N, Klingler A, Lingnau K, Schneider M, Lundberg U, Meinke A, Larcher-Senn J, Čorbic-Ramljak I, Eder-Lingelbach S, Dubischar K, Bender W. Single-shot live-attenuated chikungunya vaccine in healthy adults: a phase 1, randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:1193-1203. [DOI: 10.1016/s1473-3099(20)30238-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/18/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
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22
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Sapkota B, Shrestha R, Chapagai S, Shakya DK, Bista P. Validation of Risk of Chemotherapy-Induced Neutropenia: Experience from Oncology Hospital of Nepal. Cancer Manag Res 2020; 12:3751-3758. [PMID: 32547211 PMCID: PMC7246329 DOI: 10.2147/cmar.s243916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/07/2020] [Indexed: 01/26/2023] Open
Abstract
Background The majority of cancer patients undergoing chemotherapy show neutropenic condition which is a common side effect of myelosuppressive chemotherapy diagnosed as the reduced complete blood cell count. Such cancer patients have a higher risk of febrile neutropenia. The present study aimed to validate whether there was a risk of neutropenia in cancer patients receiving chemotherapy at Bhaktapur Cancer Hospital, Nepal. Methods Cross-sectional study was performed among 203 cancer patients of all age groups who attended Bhaktapur Cancer Hospital from May 2018 to January 2019 and who received a chemotherapy course. Patients receiving at least one cycle of chemotherapy as the first-line treatment were included. Statistical analysis was performed using SPSS 25. Loglinear analysis was used to analyze more than 2×2 categories among the grades and outcome of neutropenia. Multinomial logistic regression was applied to analyze the impact of various predictor variables such as chemotherapy cycles, grades of neutropenia, and gender on the outcome of neutropenia. Variation in the absolute neutrophil count (ANC) level at various days of chemotherapy cycles was assessed with the multivariate analysis of variance (MANOVA). The p-value <0.05 was considered significant at each condition. Results The main cancer type during the study period was breast cancer (41, 20.2%). Out of 163 neutropenic patients, 149 had severe neutropenia and 14 had mild neutropenia. Most patients were continued up to the 6th cycle of chemotherapy. There was significant association between the grade of neutropenia and the outcome of the condition (p-value 0.017). There were significant relations of the grade of neutropenia and smoking habit with the recovering status (p values 0.033 and 0.001, respectively). The absolute neutrophil count (ANC) level increased and decreased inconsistently (statistically non-significantly) in between treatment period of day 1 to 52. Conclusion Chemotherapy-induced neutropenia was a common occurrence. Majority (133, 66.5%) grade 4 neutropenic patients were recovering after the chemotherapy cycles. The physicians are warranted that they be ready for any unpredictable situation during chemotherapy treatment.
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Affiliation(s)
- Binaya Sapkota
- Nobel College Faculty of Health Sciences, Department of Pharmaceutical Sciences, Sinamangal, Kathmandu, Nepal
| | | | - Safin Chapagai
- Nobel College Faculty of Health Sciences, Department of Pharmaceutical Sciences, Sinamangal, Kathmandu, Nepal
| | - Dip Kiran Shakya
- Nobel College Faculty of Health Sciences, Department of Pharmaceutical Sciences, Sinamangal, Kathmandu, Nepal
| | - Prashant Bista
- Nobel College Faculty of Health Sciences, Department of Pharmaceutical Sciences, Sinamangal, Kathmandu, Nepal
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23
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Palmblad J, Siersma V, Lind B, Bjerrum OW, Hasselbalch H, Andersen CL. Age-related prevalence and clinical significance of neutropenia - isolated or combined with other cytopenias: Real world data from 373 820 primary care individuals. Am J Hematol 2020; 95:521-528. [PMID: 32052479 DOI: 10.1002/ajh.25756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022]
Abstract
Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi- or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi- or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies. Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi- or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.
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Affiliation(s)
- Jan Palmblad
- Department of Hematology and MedicineThe Karolinska Institute at Karolinska University Hospital Huddinge Stockholm Sweden
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
| | - Bent Lind
- Department of Clinical BiochemistryCopenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Ole Weis Bjerrum
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
| | - Hans Hasselbalch
- Department of HematologyRoskilde University Hospital Herlev Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
- Department of HematologyRoskilde University Hospital Herlev Denmark
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24
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Characterization of potential biomarkers of reactogenicity of licensed antiviral vaccines: randomized controlled clinical trials conducted by the BIOVACSAFE consortium. Sci Rep 2019; 9:20362. [PMID: 31889148 PMCID: PMC6937244 DOI: 10.1038/s41598-019-56994-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
Biomarkers predictive of inflammatory events post-vaccination could accelerate vaccine development. Within the BIOVACSAFE framework, we conducted three identically designed, placebo-controlled inpatient/outpatient clinical studies (NCT01765413/NCT01771354/NCT01771367). Six antiviral vaccination strategies were evaluated to generate training data-sets of pre-/post-vaccination vital signs, blood changes and whole-blood gene transcripts, and to identify putative biomarkers of early inflammation/reactogenicity that could guide the design of subsequent focused confirmatory studies. Healthy adults (N = 123; 20-21/group) received one immunization at Day (D)0. Alum-adjuvanted hepatitis B vaccine elicited vital signs and inflammatory (CRP/innate cells) responses that were similar between primed/naive vaccinees, and low-level gene responses. MF59-adjuvanted trivalent influenza vaccine (ATIV) induced distinct physiological (temperature/heart rate/reactogenicity) response-patterns not seen with non-adjuvanted TIV or with the other vaccines. ATIV also elicited robust early (D1) activation of IFN-related genes (associated with serum IP-10 levels) and innate-cell-related genes, and changes in monocyte/neutrophil/lymphocyte counts, while TIV elicited similar but lower responses. Due to viral replication kinetics, innate gene activation by live yellow-fever or varicella-zoster virus (YFV/VZV) vaccines was more suspended, with early IFN-associated responses in naïve YFV-vaccine recipients but not in primed VZV-vaccine recipients. Inflammatory responses (physiological/serum markers, innate-signaling transcripts) are therefore a function of the vaccine type/composition and presence/absence of immune memory. The data reported here have guided the design of confirmatory Phase IV trials using ATIV to provide tools to identify inflammatory or reactogenicity biomarkers.
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25
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Bühler T, Boos N, Leuppi-Taegtmeyer AB, Berger CT. Febrile illness and bicytopenia within hours after tick-borne encephalitis booster vaccination. NPJ Vaccines 2019; 4:52. [PMID: 31871772 PMCID: PMC6917779 DOI: 10.1038/s41541-019-0152-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 12/23/2022] Open
Abstract
We report the case of a 20-year-old male complaining of sudden-onset, severe headaches, fever, chills, and generalized arthralgia. He had no symptoms of a respiratory tract infection. Blood examination revealed severe leukopenia and mild to moderate thrombocytopenia. Onset of symptoms was rapid, intense, and occurred only a few hours after routine tick-borne encephalitis (TBE) booster vaccine. The question of a relationship between booster vaccine administration and the febrile illness with bicytopenia was raised. A broad range of diagnostics excluded infections and other causes for bicytopenia. Symptoms resolved within a few days, and blood counts normalized within two weeks. Due to the close temporal relationship, a transient benign bicytopenia and febrile illness as a systemic reaction to TBE vaccination was assumed. Review of the literature and adverse event reporting systems suggest that this is a very rare reaction.
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Affiliation(s)
- Tim Bühler
- 1Department of Clinical Pharmacology & Toxicology, University and University Hospital Basel, Basel, Switzerland.,2Regional Center of Pharmacovigilance, University Hospital Basel, Basel, Switzerland
| | - Noemi Boos
- 3Medical Outpatient Clinic, University Hospital Basel, Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- 1Department of Clinical Pharmacology & Toxicology, University and University Hospital Basel, Basel, Switzerland
| | - Christoph T Berger
- 4Translational Immunology, Department of Biomedicine, University Basel, Basel, Switzerland.,5Vaccination Clinic, Medical Outpatient Unit, University Hospital Basel, Basel, Switzerland
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26
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Koen A, Jose L, Madhi SA, Fix A, Cryz S, Groome MJ. Neutrophil Counts in Healthy South African Infants: Implications for Enrollment and Adverse Event Grading in Clinical Trials in an African Setting. THE JOURNAL OF PEDIATRICS: X 2019; 1:100005. [PMID: 32734176 PMCID: PMC7376988 DOI: 10.1016/j.ympdx.2019.100005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/09/2019] [Accepted: 06/11/2019] [Indexed: 12/22/2022] Open
Abstract
Absolute neutrophil counts are used to assess eligibility and safety during clinical trials but the toxicity grading scale used can affect enrollment and reporting of adverse events. During a trial investigating a parenteral rotavirus vaccine in South Africa, we excluded otherwise healthy infants without HIV infection from participation owing to neutropenia. Trial registration ClinicalTrials.gov: NCT02109484.
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Affiliation(s)
- Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Jose
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Michelle J Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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27
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Elizaga ML, Li SS, Kochar NK, Wilson GJ, Allen MA, Tieu HVN, Frank I, Sobieszczyk ME, Cohen KW, Sanchez B, Latham TE, Clarke DK, Egan MA, Eldridge JH, Hannaman D, Xu R, Ota-Setlik A, McElrath MJ, Hay CM. Safety and tolerability of HIV-1 multiantigen pDNA vaccine given with IL-12 plasmid DNA via electroporation, boosted with a recombinant vesicular stomatitis virus HIV Gag vaccine in healthy volunteers in a randomized, controlled clinical trial. PLoS One 2018; 13:e0202753. [PMID: 30235286 PMCID: PMC6147413 DOI: 10.1371/journal.pone.0202753] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/03/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The addition of plasmid cytokine adjuvants, electroporation, and live attenuated viral vectors may further optimize immune responses to DNA vaccines in heterologous prime-boost combinations. The objective of this study was to test the safety and tolerability of a novel prime-boost vaccine regimen incorporating these strategies with different doses of IL-12 plasmid DNA adjuvant. METHODS In a phase 1 study, 88 participants received an HIV-1 multiantigen (gag/pol, env, nef/tat/vif) DNA vaccine (HIV-MAG, 3000 μg) co-administered with IL-12 plasmid DNA adjuvant at 0, 250, 1000, or 1500 μg (N = 22/group) given intramuscularly with electroporation (Ichor TriGrid™ Delivery System device) at 0, 1 and 3 months; followed by attenuated recombinant vesicular stomatitis virus, serotype Indiana, expressing HIV-1 Gag (VSV-Gag), 3.4 ⊆ 107 plaque-forming units (PFU), at 6 months; 12 others received placebo. Injections were in both deltoids at each timepoint. Participants were monitored for safety and tolerability for 15 months. RESULTS The dose of IL-12 pDNA did not increase pain scores, reactogenicity, or adverse events with the co-administered DNA vaccine, or following the VSV-Gag boost. Injection site pain and reactogenicity were common with intramuscular injections with electroporation, but acceptable to most participants. VSV-Gag vaccine often caused systemic reactogenicity symptoms, including a viral syndrome (in 41%) of fever, chills, malaise/fatigue, myalgia, and headache; and decreased lymphocyte counts 1 day after vaccination. CONCLUSIONS HIV-MAG DNA vaccine given by intramuscular injection with electroporation was safe at all doses of IL-12 pDNA. The VSV-Gag vaccine at this dose was associated with fever and viral symptoms in some participants, but the vaccine regimens were safe and generally well-tolerated. TRIAL REGISTRATION Clinical Trials.gov NCT01578889.
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Affiliation(s)
- Marnie L. Elizaga
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Shuying S. Li
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Nidhi K. Kochar
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Gregory J. Wilson
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Mary A. Allen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Hong Van N. Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Ian Frank
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Columbia University Medical Center, New York, New York, United States of America
| | - Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Brittany Sanchez
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Theresa E. Latham
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - David K. Clarke
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - Michael A. Egan
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - John H. Eldridge
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - Drew Hannaman
- Ichor Medical Systems, Incorporated, San Diego, California, United States of America
| | - Rong Xu
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - Ayuko Ota-Setlik
- Profectus BioSciences, Incorporated, Pearl River, New York, United States of America
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Christine Mhorag Hay
- Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York, United States of America
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Obiero CW, Ndiaye AGW, Sciré AS, Kaunyangi BM, Marchetti E, Gone AM, Schütte LD, Riccucci D, Auerbach J, Saul A, Martin LB, Bejon P, Njuguna P, Podda A. A Phase 2a Randomized Study to Evaluate the Safety and Immunogenicity of the 1790GAHB Generalized Modules for Membrane Antigen Vaccine against Shigella sonnei Administered Intramuscularly to Adults from a Shigellosis-Endemic Country. Front Immunol 2017; 8:1884. [PMID: 29375556 PMCID: PMC5763125 DOI: 10.3389/fimmu.2017.01884] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/11/2017] [Indexed: 01/08/2023] Open
Abstract
Shigellosis is a mild-to-severe diarrheal infection, caused by the genus Shigella, and is responsible for significant morbidity and mortality worldwide. We evaluated the safety and immunogenicity of an investigational Shigella sonnei vaccine (1790GAHB) based on generalized modules for membrane antigens (GMMA) in Kenya, a Shigella-endemic country. This phase 2a, observer-blind, controlled randomized study (NCT02676895) enrolled 74 healthy adults aged 18–45 years, of whom 72 were vaccinated. Participants received, in a 1:1:1 ratio, two vaccinations with the 1790GAHB vaccine at doses of either 1.5/25 μg of O antigen (OAg)/protein (group 1.5/25 μg) or 5.9/100 μg (group 5.9/100 μg) at day (D) 1 and D29, or vaccination with a quadrivalent meningococcal vaccine at D1 and tetanus, diphtheria, and acellular pertussis vaccine at D29 (control group). Solicited and unsolicited adverse events (AEs), serious AEs (SAEs), and AEs of special interest (neutropenia and reactive arthritis) were collected. Anti-S. sonnei lipopolysaccharide (LPS) serum immunoglobulin G (IgG) geometric mean concentrations (GMC) were evaluated at D1, D29, and D57 and compared to anti-S. sonnei LPS antibody levels in convalescent patients naturally exposed to S. sonnei. The percentages of participants with seroresponse were also calculated. The most frequently reported solicited local and systemic AEs across all groups were pain and headache, respectively. Only one case of severe systemic reaction was reported (severe headache after first vaccination in group 5.9/100 μg). Seven and three episodes of neutropenia, assessed as probably or possibly related to vaccination respectively, were reported in the investigational and control groups, respectively. No other SAEs were reported. Despite very high baseline anti-S. sonnei LPS serum IgG levels, the 1790GAHB vaccine induced robust antibody responses. At D29, GMC increased 2.10- and 4.43-fold from baseline in groups 1.5/25 and 5.9/100 μg, respectively, whereas no increase was observed in the control group. Antibody titers at D57 were not statistically different from those at D29. Seroresponse was 68% at D29 and 90% at D57 in group 1.5/25 μg, and 96% after each vaccination in group 5.9/100 μg. The 1790GAHB vaccine was well tolerated and highly immunogenic in a population of African adults, regardless of the GMMA OAg/protein content used.
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Affiliation(s)
- Christina W Obiero
- KEMRI-Wellcome Trust Research Programme, Clinical Research Department, Kilifi, Kenya
| | | | | | - Bonface M Kaunyangi
- KEMRI-Wellcome Trust Research Programme, Clinical Research Department, Kilifi, Kenya
| | | | - Ann M Gone
- KEMRI-Wellcome Trust Research Programme, Clinical Research Department, Kilifi, Kenya
| | | | | | | | - Allan Saul
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Philip Bejon
- Clinical Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
| | - Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, Clinical Research Department, Kilifi, Kenya.,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
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29
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Launay O, Lewis DJM, Anemona A, Loulergue P, Leahy J, Sciré AS, Maugard A, Marchetti E, Zancan S, Huo Z, Rondini S, Marhaba R, Finco O, Martin LB, Auerbach J, Cohen D, Saul A, Gerke C, Podda A. Safety Profile and Immunologic Responses of a Novel Vaccine Against Shigella sonnei Administered Intramuscularly, Intradermally and Intranasally: Results From Two Parallel Randomized Phase 1 Clinical Studies in Healthy Adult Volunteers in Europe. EBioMedicine 2017; 22:164-172. [PMID: 28735965 PMCID: PMC5552227 DOI: 10.1016/j.ebiom.2017.07.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/14/2017] [Indexed: 01/19/2023] Open
Abstract
Background Approximately 164,000 deaths yearly are due to shigellosis, primarily in developing countries. Thus, a safe and affordable Shigella vaccine is an important public health priority. The GSK Vaccines Institute for Global Health (GVGH) developed a candidate Shigella sonnei vaccine (1790GAHB) using the Generalized Modules for Membrane Antigens (GMMA) technology. The paper reports results of 1790GAHB Phase 1 studies in healthy European adults. Methods To evaluate the safety and immunogenicity profiles of 1790GAHB, we performed two parallel, phase 1, observer-blind, randomized, placebo-controlled, dose escalation studies in France (“study 1”) and the United Kingdom (“study 2”) between February 2014 and April 2015 (ClinicalTrials.gov, number NCT02017899 and NCT02034500, respectively) in 18–45 years old subjects (50 in study 1, 52 in study 2). Increasing doses of Alhydrogel adsorbed 1790, expressed by both O Antigen (OAg) and protein quantity, or placebo were given either by intramuscular route (0.059/1, 0.29/5, 1.5/25, 2.9/50, 5.9/100 μg of OAg/μg of protein; study 1) or by intradermal (ID), intranasal (IN) or intramuscular (IM) route of immunization (0.0059/0.1, 0.059/1, 0.59/10 μg ID, 0.29/5, 1.2/20, 4.8/80 μg IN and 0.29/5 μg IM, respectively; study 2). In absence of serologic correlates of protection for Shigella sonnei, vaccine induced immunogenicity was compared to anti-LPS antibody in a population naturally exposed to S. sonnei. Findings Vaccines were well tolerated in both studies and no death or vaccine related serious adverse events were reported. In study 1, doses ≥ 1.5/25 μg elicited serum IgG median antibody greater than median level in convalescent subjects after the first dose. No vaccine group in study 2 achieved median antibody greater than the median convalescent antibody. Interpretation Intramuscularly administered Shigella sonnei GMMA vaccine is well tolerated, up to and including 5.9/100 μg and induces antibody to the OAg of at least the same magnitude of those observed following natural exposure to the pathogen. Vaccine administered by ID or IN, although well tolerated, is poorly immunogenic at the doses delivered. The data support the use of the GMMA technology for the development of intramuscular multivalent Shigella vaccines. GVGH GMMA vaccine against S. sonnei was well tolerated by IM, IN and ID routes of immunization in young European adults. Doses ≥ 1.5/25 μg elicited serum IgG median antibody greater than median level in convalescent subjects after the first dose. Clinical data support the use of the GMMA technology for the development of intramuscular Shigella multivalent vaccines.
Shigellosis is an important cause of diarrhoea especially in children of developing countries. No vaccine is available. Based on the 2015 Global Burden of Disease, Shigella caused approximately 164,000 deaths due to diarrhoea in 2015, supporting the public health relevance of the disease and the need for a vaccine. The GMMA (Generalized Modules for Membrane Antigens) technology was used for the development of a vaccine against Shigella sonnei which, tested in these trials for the first time, was shown to be well tolerated in young adults and induced specific antibody titres at least as high as after natural infection.
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Affiliation(s)
- Odile Launay
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; Inserm CIC 1417, Paris, France; Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | | | | | - Pierre Loulergue
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; Inserm CIC 1417, Paris, France; Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | - Jo Leahy
- University of Surrey, Guildford, United Kingdom
| | | | - Anaïs Maugard
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; Inserm CIC 1417, Paris, France; Assistance Publique Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
| | | | | | - Zhiming Huo
- University of Surrey, Guildford, United Kingdom
| | | | | | | | | | | | - Daniel Cohen
- Tel Aviv University School of Public Health, Tel Aviv, Israel
| | - Allan Saul
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy.
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