1
|
Bonnin FA, Talarico LB, Ferolla FM, Acosta PL, Phung E, Kumar A, Toledano A, Caratozzolo A, Neira P, Mascardi N, Satragno D, Contrini MM, Graham BS, Ruckwardt TJ, López EL. Antibody levels against respiratory syncytial virus fusion protein conformations and lack of association with life-threatening infection in previously healthy infants. Vaccine 2024; 42:126119. [PMID: 39003106 PMCID: PMC11401757 DOI: 10.1016/j.vaccine.2024.07.020] [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: 10/19/2023] [Revised: 04/13/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Humoral immune response against the pre-fusion (pre-F) conformation of respiratory syncytial virus (RSV) F protein has been proposed to play a protective role against infection. An RSV pre-F maternal vaccine has been recently approved in several countries to protect young infants against RSV. We aimed to assess serum IgG titers against the pre-F and post-F conformations of RSV F protein and their association with life-threatening RSV disease (LTD) in previously healthy infants. METHODS A prospective cohort study including hospitalized infants <12 months with a first RSV infection was conducted during 2017-2019. Patients with LTD required intensive care and mechanical respiratory assistance. RSV pre-F exclusive and post-F antibody responses were determined by post-F competition and non-competition immunoassays, respectively, and neutralizing activity was measured by plaque reduction neutralization test. RESULTS Fifty-eight patients were included; the median age was 3.5 months and 41 % were females. Fifteen patients developed LTD. RSV F-specific antibody titers positively correlated with neutralizing antibody titers in acute and convalescent phases but, importantly, they did not associate with LTD. Acute RSV pre-F exclusive and post-F IgG titers negatively correlated with patient age (P = 0.0007 and P < 0.0001), while a positive correlation was observed between the fold changes in RSV F-specific antibody titers between convalescent and acute phase and patient age (P = 0.0014 and P < 0.0001). Infants ≤2 months exhibited significantly lower fold-changes in RSV F-specific and neutralizing antibody titers between convalescence and acute phase than older infants. Additionally, acute RSV antibody titers showed no correlation with nasal RSV load and, furthermore, nasal viral load was not associated with the development of LTD. CONCLUSIONS This study highlights that protection against life-threatening RSV disease is not necessarily antibody-dependent. Further characterization of the immune response against RSV and its role in protection against severe disease is important for the development of the safest possible preventive strategies.
Collapse
Affiliation(s)
- Florencia A Bonnin
- Laboratory of Infectious Diseases and Molecular Biology, Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina; Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Buenos Aires 1428, Argentina
| | - Laura B Talarico
- Laboratory of Infectious Diseases and Molecular Biology, Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1425, Argentina.
| | - Fausto M Ferolla
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires 1425, Argentina
| | - Patricio L Acosta
- Laboratory of Infectious Diseases and Molecular Biology, Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires 1425, Argentina
| | - Emily Phung
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Azad Kumar
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Analía Toledano
- Laboratory of Infectious Diseases and Molecular Biology, Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina
| | - Ana Caratozzolo
- Laboratory of Infectious Diseases and Molecular Biology, Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina
| | - Pablo Neira
- Intensive Care Unit, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina
| | - Normando Mascardi
- Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina
| | - Daniela Satragno
- Department of Medicine, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires 1425, Argentina
| | - María M Contrini
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires 1425, Argentina
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Tracy J Ruckwardt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eduardo L López
- Department of Medicine, Pediatric Infectious Diseases Program, Hospital de Niños Dr. Ricardo Gutiérrez, Universidad de Buenos Aires, Buenos Aires 1425, Argentina.
| |
Collapse
|
2
|
Zou G, Cao S, Gao Z, Yie J, Wu JZ. Current state and challenges in respiratory syncytial virus drug discovery and development. Antiviral Res 2024; 221:105791. [PMID: 38160942 DOI: 10.1016/j.antiviral.2023.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Human respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) in young children and elderly people worldwide. Recent significant progress in our understanding of the structure and function of RSV proteins has led to the discovery of several clinical candidates targeting RSV fusion and replication. These include both the development of novel small molecule interventions and the isolation of potent monoclonal antibodies. In this review, we summarize the state-of-the-art of RSV drug discovery, with a focus on the characteristics of the candidates that reached the clinical stage of development. We also discuss the lessons learned from failed and discontinued clinical developments and highlight the challenges that remain for development of RSV therapies.
Collapse
Affiliation(s)
- Gang Zou
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China.
| | - Sushan Cao
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Zhao Gao
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Junming Yie
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Jim Zhen Wu
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| |
Collapse
|
3
|
Lakerveld AJ, Gelderloos AT, Schepp RM, de Haan CAM, van Binnendijk RS, Rots NY, van Beek J, van Els CACM, van Kasteren PB. Difference in respiratory syncytial virus-specific Fc-mediated antibody effector functions between children and adults. Clin Exp Immunol 2023; 214:79-93. [PMID: 37605554 PMCID: PMC10711356 DOI: 10.1093/cei/uxad101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Respiratory syncytial virus (RSV) infections are a major cause of bronchiolitis and pneumonia in infants and older adults, for which there is no known correlate of protection. Increasing evidence suggests that Fc-mediated antibody effector functions have an important role, but little is known about the development, heterogeneity, and durability of these functional responses. In light of future vaccine strategies, a clear view of the immunological background and differences between various target populations is of crucial importance. In this study, we have assessed both quantitative and qualitative aspects of RSV-specific serum antibodies, including IgG/IgA levels, IgG subclasses, antibody-dependent complement deposition, cellular phagocytosis, and NK cell activation (ADNKA). Samples were collected cross-sectionally in different age groups (11-, 24-, and 46-month-old children, adults, and older adults; n = 31-35 per group) and longitudinally following natural RSV infection in (older) adults (2-36 months post-infection; n = 10). We found that serum of 24-month-old children induces significantly lower ADNKA than the serum of adults (P < 0.01), which is not explained by antibody levels. Furthermore, in (older) adults we observed boosting of antibody levels and functionality at 2-3 months after RSV infection, except for ADNKA. The strongest decrease was subsequently observed within the first 9 months, after which levels remained relatively stable up to three years post-infection. Together, these data provide a comprehensive overview of the functional landscape of RSV-specific serum antibodies in the human population, highlighting that while antibodies reach adult levels already at a young age, ADNKA requires more time to fully develop.
Collapse
Affiliation(s)
- Anke J Lakerveld
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Medical Microbiology, Leiden University Medical Center, The Netherlands
| | - Anne T Gelderloos
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Rutger M Schepp
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cornelis A M de Haan
- Section Virology, Department Biomolecular Health Sciences, Faculty Veterinary Medicine, Utrecht University, The Netherlands
| | - Robert S van Binnendijk
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nynke Y Rots
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Josine van Beek
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Cécile A C M van Els
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Section Immunology, Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Puck B van Kasteren
- Center for Immunology of Infectious Diseases and Vaccines, Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
4
|
Kachikis AB, Cho H, Englund JA. Respiratory Syncytial Virus-An Update for Prenatal and Primary Health Providers. Obstet Gynecol Clin North Am 2023; 50:421-437. [PMID: 37149320 DOI: 10.1016/j.ogc.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of morbidity and mortality among infants aged younger than 1 year, adults aged 65 years or older, and immunocompromised persons. Limited data exist on RSV infection in pregnancy and further research is needed. Strides are being made to develop vaccines, including vaccines for maternal immunization, as well as monoclonal antibodies for disease prevention.
Collapse
Affiliation(s)
- Alisa B Kachikis
- Department of Obstetrics & Gynecology, University of Washington, 1959 Northeast Pacific Street, Box 356460, Seattle, WA 98195, USA.
| | - Hye Cho
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital Pediatric Infectious Diseases, Seattle Children's Hospital Research Institute, University of Washington, Seattle, WA, USA
| |
Collapse
|
5
|
Bartsch YC, Cizmeci D, Kang J, Zohar T, Periasamy S, Mehta N, Tolboom J, Van der Fits L, Sadoff J, Comeaux C, Callendret B, Bukreyev A, Lauffenburger DA, Bastian AR, Alter G. Antibody effector functions are associated with protection from respiratory syncytial virus. Cell 2022; 185:4873-4886.e10. [PMID: 36513064 DOI: 10.1016/j.cell.2022.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 08/29/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
Respiratory syncytial virus (RSV) infection is a major cause of severe lower respiratory tract infection and death in young infants and the elderly. With no effective prophylactic treatment available, current vaccine candidates aim to elicit neutralizing antibodies. However, binding and neutralization have poorly predicted protection in the past, and accumulating data across epidemiologic cohorts and animal models collectively point to a role for additional antibody Fc-effector functions. To begin to define the humoral correlates of immunity against RSV, here we profiled an adenovirus 26 RSV-preF vaccine-induced humoral immune response in a group of healthy adults that were ultimately challenged with RSV. Protection from infection was linked to opsonophagocytic functions, driven by IgA and differentially glycosylated RSV-specific IgG profiles, marking a functional humoral immune signature of protection against RSV. Furthermore, Fc-modified monoclonal antibodies able to selectively recruit effector functions demonstrated significant antiviral control in a murine model of RSV.
Collapse
Affiliation(s)
- Yannic C Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Tomer Zohar
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Sivakumar Periasamy
- Department of Pathology, Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Nickita Mehta
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Jeroen Tolboom
- Janssen Vaccines & Prevention BV, 2333 Leiden, the Netherlands
| | | | - Jerry Sadoff
- Janssen Vaccines & Prevention BV, 2333 Leiden, the Netherlands
| | - Christy Comeaux
- Janssen Vaccines & Prevention BV, 2333 Leiden, the Netherlands
| | | | - Alexander Bukreyev
- Department of Pathology, Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA.
| |
Collapse
|
6
|
Receveur M, Ottmann M, Reynes J, Eleouet J, Galloux M, Receveur A, Ploin D, Fiorini S, Rivat N, Valette M, Lina B, Casalegno J. Level of maternal antibodies against respiratory syncytial virus (RSV) nucleoprotein at birth and risk of RSV very severe lower respiratory tract infection. Influenza Other Respir Viruses 2022; 17:e13025. [PMID: 36251946 PMCID: PMC9835445 DOI: 10.1111/irv.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The nucleoprotein (N protein) of respiratory syncytial virus (RSV) is a candidate antigen for new RSV vaccine development. The aim of the present study was to investigate the association between maternal antibody titers against the RSV N protein at birth and the newborns' risk of developing very severe lower respiratory tract infection (VS-LRTI). METHODS In this single-center prospective cohort study, 578 infants born during the RSV epidemic season in France were included. Among these, 36 were hospitalized for RSV VS-LRTI. A generalized linear model was used to test the occurrence of a VS-LRTI in function of sex, mode of delivery, parity of the mother, type of pregnancy, date of birth in relation to the peak of the epidemic, and antibody titer against N protein. RESULTS All cord blood samples had detectable antibodies against N protein. The mean titers were significantly lower in newborns with risk factors for RSV severe LRTI (preterm infants, birth before the peak epidemic, multiparous mother). There was no association between antibody titer against the N protein and a protection against VS-LRTI. CONCLUSIONS Further studies are needed to support the hypothesis that transfer of maternal antibodies against the RSV N protein can provide a significant immune protection early in infancy and that N protein candidate vaccine may be a suitable target for maternal vaccine.
Collapse
Affiliation(s)
- Matthieu Receveur
- Hospices Civils de Lyon, Hôpital Femme Mère EnfantService de Réanimation Pédiatrique et d'Accueil des UrgencesBronFrance,Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance
| | - Michèle Ottmann
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Jean‐Marc Reynes
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Unité Environnement et Risques InfectieuxInstitut Pasteur, Université Paris CitéParisFrance
| | - Jean‐François Eleouet
- Université Paris‐Saclay, INRAE, Unité de Virologie et Immunologie MoléculairesJouy‐en‐JosasFrance
| | - Marie Galloux
- Université Paris‐Saclay, INRAE, Unité de Virologie et Immunologie MoléculairesJouy‐en‐JosasFrance
| | - Aurore Receveur
- OFP/FEMAPacific Community, SPCNoumeaNew Caledonia,ENTROPIEUniversité de la Réunion, IRD, CNRS, UMR9220, Université de La Nouvelle‐Calédonie, IfremerNoumeaNew Caledonia
| | - Dominique Ploin
- Hospices Civils de Lyon, Hôpital Femme Mère EnfantService de Réanimation Pédiatrique et d'Accueil des UrgencesBronFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Sylvie Fiorini
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Nathalie Rivat
- Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance
| | - Martine Valette
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
| | - Bruno Lina
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
| | - Jean‐Sebastien Casalegno
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseInstitut des Agents InfectieuxLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon EstLyonFrance,Université de Lyon, Université Claude Bernard Lyon 1, Laboratoire de Virologie et Pathologies Humaines Virpath, École Normale Supérieure de Lyon, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS, UMR5308LyonFrance,Hospices Civils de Lyon, Hôpital de la Croix‐Rousse, Institut des Agents Infectieux (IAI), Laboratoire de Virologie, Centre National de Référence des virus des infections respiratoiresLyonFrance
| |
Collapse
|
7
|
Abu-Raya B, Reicherz F, Lavoie PM. Correlates of Protection Against Respiratory Syncytial Virus Infection in Infancy. Clin Rev Allergy Immunol 2022; 63:371-380. [PMID: 35689745 DOI: 10.1007/s12016-022-08948-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
The highest morbidity and mortality from respiratory syncytial virus (RSV) infection occurs in young infants. Immunization of expectant mothers during pregnancy has the potential to substantially reduce the burden of RSV disease in a majority of infants. Correlates of protection (COP) are important in guiding the development of maternal RSV vaccines and the design of maternal RSV vaccine trials, as immune response to candidate vaccines should mirror protective RSV immunity at birth. Here, we review the literature reporting correlations between RSV immune measures at birth and clinical RSV outcomes during infancy. Less than a dozen studies have investigated immunological COP with RSV disease or related hospitalization, yielding inconsistent findings overall. The differences in findings between studies could be due to differences in inclusion/exclusion criteria (e.g., the inclusion of older infants who may benefit less from maternal antibodies or infants followed during inter-seasonal periods where RSV is absent), differences in semi-quantitative RSV antibody neutralization assays, or differences in RSV outcome measures such as the sensititivity/specificity of diagnostic tests. Future research in this field should seek to standardize RSV immunological measures and outcomes, expand the breadth of functional RSV measures beyond antibody neutralization, and consider infants' age and seasonality of RSV infection.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- BC Children's Hospital Research Institute, Vancouver, Canada. .,Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, Canada.
| | - Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, 950 West 28th Avenue, Vancouver, Canada
| |
Collapse
|
8
|
Nyiro JU, Bukusi E, Mwaengo D, Nyaguara A, Nyawanda B, Otieno N, Bigogo G, Murunga N, Widdowson MA, Verani JR, Chaves SS, Mwangudza H, Odundo C, Berkley JA, Nokes DJ, Munywoki PK. Efficiency of transplacental transfer of respiratory syncytial virus (RSV) specific antibodies among pregnant women in Kenya. Wellcome Open Res 2022; 7:43. [PMID: 35402734 PMCID: PMC8976186 DOI: 10.12688/wellcomeopenres.17636.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 02/15/2024] Open
Abstract
Background: Maternal immunisation to boost respiratory syncytial virus (RSV) antibodies in pregnant women, is a strategy being considered to enhance infant protection from severe RSV associated disease. However, little is known about the efficiency of transplacental transfer of RSV-specific antibodies in a setting with a high burden of malaria and HIV, to guide the implementation of such a vaccination program. Methods: Using a plaque reduction neutralization assay, we screened 400 pairs of cord and maternal serum specimens from pregnant women for RSV-specific antibodies. Participants were pregnant women of two surveillance cohorts: 200 participants from a hospital cohort in Kilifi, Coastal Kenya and 200 participants from a surveillance cohort in Siaya, Western Kenya. Transplacental transfer efficiency was determined by the cord to maternal transfer ratio (CMTR). Logistic regression was used to determine independent predictors of impaired transplacental transfer of RSV-specific antibodies. Results: A total of 800 samples were screened from the 400 participants. At enrollment the median age was 25 years (Interquartile range (IQR): 21-31). Overall, transplacental transfer was efficient and did not differ between Kilifi and Siaya cohort (1.02 vs. 1.02; p=0.946) but was significantly reduced among HIV-infected mothers compared to HIV-uninfected mothers (mean CMTR: 0.98 vs 1.03; p=0.015). Prematurity <33 weeks gestation (Odds ratio [OR]: 0.23, 95% confidence interval [CI] 0.06-0.85; p=0.028), low birth weight <2.5 kgs (OR: 0.25, 95% CI: 0.07-0.94; p=0.041) and HIV infection (OR: 0.47, 95% CI:0.23-0.98; p=0.045) reduced efficiency of transplacental transfer among these women. Conclusions: Transplacental transfer of RSV-specific antibodies among pregnant women in Kenya is efficient. A consideration to integrate other preventive interventions with maternal RSV vaccination targeting infants born premature (<33 weeks gestation), with low birth weight <2.5 kgs, or HIV-infected mothers is likely to improve vaccine outcomes in this setting.
Collapse
Affiliation(s)
- Joyce U. Nyiro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elizabeth Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Amek Nyaguara
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Bryan Nyawanda
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Nickson Murunga
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Jennifer R. Verani
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Sandra S. Chaves
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Influenza Division, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Hope Mwangudza
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Calleb Odundo
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A. Berkley
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D James Nokes
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, Coventry, UK
| | - Patrick K. Munywoki
- Division of Global Health Protection, CDC-Kenya, U.S Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| |
Collapse
|
9
|
Wright PF, Hoen AG, Jarvis JD, Zens MS, Dade EF, Karagas MR, Taube J, Brickley EB. Bronchiolitis hospitalizations in rural New England: clues to disease prevention. Ther Adv Infect Dis 2022; 9:20499361221099447. [PMID: 35651526 PMCID: PMC9150225 DOI: 10.1177/20499361221099447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background An improved understanding of the clinico-epidemiology of bronchiolitis hospitalizations, a clinical surrogate of respiratory syncytial virus (RSV) disease, is critical to inform public health strategies for mitigating the in-patient burden of bronchiolitis in early life. Methods A retrospective chart review was conducted of all bronchiolitis first admissions (N = 295) to the Children's Hospital at Dartmouth-Hitchcock, CHaD, between 1 November 2010 and 31 October 2017 using the relevant International Classification of Diseases (ICD)-9 and ICD-10 codes for this illness. Abstracted data included laboratory confirmation of RSV infection, severity of illness, duration of hospitalization, age at admission in days, weight at admission, prematurity, siblings, and relevant medical pre-existing conditions. Results Admissions for bronchiolitis were strongly associated with age of the child, the calendar month of an infant's birth, and the presence of older children in the family. Medical risk factors associated with admission included premature birth and underlying cardiopulmonary disease. Conclusion The very early age of hospitalization emphasizes the high penetration of RSV in the community, by implication the limited protection afforded by maternal antibody, and the complexity of protecting infants from this infection. Plain Language Summary Although risks for respiratory syncytial virus (RSV)/bronchiolitis hospitalization are well described, few studies have examined, with precision, the age-related frequency and severity of RSV/bronchiolitis. We also explore the implications of RSV clinico-epidemiology for our understanding of the pathogenesis of the disease and development of optimal approaches to prevention.
Collapse
Affiliation(s)
- Peter F. Wright
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Anne G. Hoen
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - J. Dean Jarvis
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael S. Zens
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Erika F. Dade
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
10
|
Takashima MD, Grimwood K, Sly PD, Lambert SB, Chappell KJ, Watterson D, Young P, Kusel M, Holt B, Holt P, Ware RS. Cord-blood respiratory syncytial virus antibodies and respiratory health in first 5 years of life. Pediatr Pulmonol 2021; 56:3942-3951. [PMID: 34549896 DOI: 10.1002/ppul.25688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the potential longer-term effects of maternal antenatal respiratory syncytial virus (RSV) vaccination, we examined the association between cord-blood RSV-neutralizing antibodies (RSV-NA) and RSV infections in the first 2 years of life, RSV-NA at 3 years, and respiratory health to age 5 years. METHODS Two community-based Australian birth cohorts were combined. For children with at least one atopic parent, paired serum RSV-NA levels were compared in cord blood and at age 3 years. Weekly nasal swabs were collected in one cohort and during acute respiratory infections (ARI) in the other. Wheeze history up to age 5 years and physician-diagnosed asthma at 5 years was collected by parent report. RESULTS In 264 children, each log10 increase of cord-blood RSV-NA level was associated with 37% decreased risk (adjusted incidence-rate-ratio [aIRR] 0.63; 95% confidence interval [CI]: 0.40-1.01) of RSV-ARI and 49% decreased risk (aIRR 0.51; 95% CI: 0.25-1.02) of RSV acute lower respiratory infections (ALRI) at 12-24 months of age. However, higher cord-blood RSV-NA was associated with increased risk of all-cause ALRI (aIRR 1.29; 95% CI: 0.99-1.69), wheeze-associated ALRI (aIRR 1.75; 95% CI: 1.08-2.82), and severe ALRI (aIRR 2.76; 95% CI: 1.63-4.70) at age 6-<12 months. Cord-blood RSV-NA was not associated with RSV-ARI in the first 6-months, RSV-NA levels at 3 years, or wheeze or asthma at 5 years. CONCLUSIONS Higher levels of cord-blood RSV-NA did not protect against RSV infections during the first 6-months-of-life, time-to-first RSV-ARI, or wheeze or asthma in the first 5 years of life. Additional strategies to control RSV-related illness in childhood are needed.
Collapse
Affiliation(s)
- Mari D Takashima
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia
| | - Stephen B Lambert
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Keith J Chappell
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Daniel Watterson
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Paul Young
- Australian Infectious Diseases Research Centre, The University of Queensland, St Lucia, Queensland, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Merci Kusel
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Barbara Holt
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Patrick Holt
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland and School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| |
Collapse
|
11
|
Koivisto K, Nieminen T, Mejias A, Capella C, Ye F, Mertz S, Peeples M, Ramilo O, Saxén H. RSV Specific Antibodies in Pregnant Women and Subsequent Risk of RSV Hospitalization in Young Infants. J Infect Dis 2021; 225:1189-1196. [PMID: 34129040 PMCID: PMC8974854 DOI: 10.1093/infdis/jiab315] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background The fusion (F) glycoprotein of respiratory syncytial virus (RSV) represents the major neutralizing antigen, and antibodies against the pre-F conformation have the most potent neutralizing activity. This study aimed to assess the correlation between maternal antibody titers against the pre-F, post-F, and G glycoproteins and the child’s risk of developing severe RSV bronchiolitis early in infancy. Methods We identified previously healthy term infants <3 months of age hospitalized with RSV bronchiolitis from December 2015 to March 2016. We measured IgG antibody titers to pre-F, post-F, and G proteins in maternal sera obtained at 9–12 weeks of pregnancy of these hospitalized infants’ mothers (n = 94) and compared them with serum antibody titers of control pregnant mothers (n = 130) whose children were not hospitalized. Results All maternal samples (n = 224) had detectable pre-F antibodies. Pre-F antibody titers were significantly lower in mothers whose infants were hospitalized with RSV bronchiolitis compared with those mothers whose infants were not hospitalized (23.9 [range (or antibody titer range), 1.4–273.7] µg/L vs 30.6 [XXX, 3.4–220.0] µg/L; P = .0026). There were no significant differences in maternal post-F and G antibody titers between hospitalized and nonhospitalized infants. Conclusions Our findings indicate that maternal pre-F antibodies are fundamental for providing immune protection to the infant.
Collapse
Affiliation(s)
- K Koivisto
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
| | - T Nieminen
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
| | - A Mejias
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - C Capella
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - F Ye
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - S Mertz
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - M Peeples
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - O Ramilo
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - H Saxén
- Helsinki University Hospital and University of Helsinki, Children's Hospital, Helsinki, Finland
| |
Collapse
|
12
|
Abu-Raya B, Maertens K. Protection of the Newborn Through Vaccination in Pregnancy. Neoreviews 2021; 22:e25-e39. [PMID: 33386312 DOI: 10.1542/neo.22-1-e25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Newborns and infants are at risk for severe infections with some pathogens (eg, Bordetella pertussis, influenza, respiratory syncytial virus, group B Streptococcus) during early life. To decrease this window of high susceptibility to some infections during early life and protect young infants, vaccination in pregnancy against some vaccine-preventable diseases (eg, influenza, pertussis, tetanus) has been recommended in an increasing number of countries with notable success. In addition, recent advances have been made in developing vaccines for pregnant women with the aim of reducing the respiratory syncytial virus and group B Streptococcus burden in infancy. In this article, we review the vaccines currently recommended during pregnancy and their benefits to newborns and infants. We also discuss progress made in the development of other vaccines that are expected to be evaluated in pregnant women in the near future.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
13
|
Carbonell-Estrany X, Rodgers-Gray BS, Paes B. Challenges in the prevention or treatment of RSV with emerging new agents in children from low- and middle-income countries. Expert Rev Anti Infect Ther 2020; 19:419-441. [PMID: 32972198 DOI: 10.1080/14787210.2021.1828866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes approximately 120,000 deaths annually in children <5 years, with 99% of fatalities occurring in low- and middle-income countries (LMICs). AREAS COVERED There are numerous RSV interventions in development, including long-acting monoclonal antibodies, vaccines (maternal and child) and treatments which are expected to become available soon. We reviewed the key challenges and issues that need to be addressed to maximize the impact of these interventions in LMICs. The epidemiology of RSV in LMICs was reviewed (PubMed search to 30 June 2020 inclusive) and the need for more and better-quality data, encompassing hospital admissions, community contacts, and longer-term respiratory morbidity, emphasized. The requirement for an agreed clinical definition of RSV lower respiratory tract infection was proposed. The pros and cons of the new RSV interventions are reviewed from the perspective of LMICs. EXPERT OPINION We believe that a vaccine (or combination of vaccines, if practicable) is the only viable solution to the burden of RSV in LMICs. A coordinated program, analogous to that with polio, involving governments, non-governmental organizations, the World Health Organization, the manufacturers and the healthcare community is required to realize the full potential of vaccine(s) and end the devastation of RSV in LMICs.
Collapse
Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
| | | | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
14
|
Griffin MP, Yuan Y, Takas T, Domachowske JB, Madhi SA, Manzoni P, Simões EAF, Esser MT, Khan AA, Dubovsky F, Villafana T, DeVincenzo JP. Single-Dose Nirsevimab for Prevention of RSV in Preterm Infants. N Engl J Med 2020; 383:415-425. [PMID: 32726528 DOI: 10.1056/nejmoa1913556] [Citation(s) in RCA: 349] [Impact Index Per Article: 87.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in infants, and a need exists for prevention of RSV in healthy infants. Nirsevimab is a monoclonal antibody with an extended half-life that is being developed to protect infants for an entire RSV season with a single intramuscular dose. METHODS In this trial conducted in both northern and southern hemispheres, we evaluated nirsevimab for the prevention of RSV-associated lower respiratory tract infection in healthy infants who had been born preterm (29 weeks 0 days to 34 weeks 6 days of gestation). We randomly assigned the infants in a 2:1 ratio to receive nirsevimab, at a dose of 50 mg in a single intramuscular injection, or placebo at the start of an RSV season. The primary end point was medically attended RSV-associated lower respiratory tract infection through 150 days after administration of the dose. The secondary efficacy end point was hospitalization for RSV-associated lower respiratory tract infection through 150 days after administration of the dose. RESULTS From November 2016 through November 2017, a total of 1453 infants were randomly assigned to receive nirsevimab (969 infants) or placebo (484 infants) at the start of the RSV season. The incidence of medically attended RSV-associated lower respiratory tract infection was 70.1% lower (95% confidence interval [CI], 52.3 to 81.2) with nirsevimab prophylaxis than with placebo (2.6% [25 infants] vs. 9.5% [46 infants]; P<0.001) and the incidence of hospitalization for RSV-associated lower respiratory tract infection was 78.4% lower (95% CI, 51.9 to 90.3) with nirsevimab than with placebo (0.8% [8 infants] vs. 4.1% [20 infants]; P<0.001). These differences were consistent throughout the 150-day period after the dose was administered and across geographic locations and RSV subtypes. Adverse events were similar in the two trial groups, with no notable hypersensitivity reactions. CONCLUSIONS A single injection of nirsevimab resulted in fewer medically attended RSV-associated lower respiratory tract infections and hospitalizations than placebo throughout the RSV season in healthy preterm infants. (Funded by AstraZeneca and Sanofi Pasteur; ClinicalTrials.gov number, NCT02878330.).
Collapse
MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antiviral Agents/administration & dosage
- Antiviral Agents/adverse effects
- Female
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Infant
- Infant, Newborn
- Infant, Premature
- Injections, Intramuscular
- Kaplan-Meier Estimate
- Male
- Poisson Distribution
- Respiratory Syncytial Virus Infections/epidemiology
- Respiratory Syncytial Virus Infections/prevention & control
- Respiratory Syncytial Virus, Human
- Respiratory Tract Infections/epidemiology
- Respiratory Tract Infections/prevention & control
- Respiratory Tract Infections/virology
- Viral Fusion Proteins/antagonists & inhibitors
Collapse
Affiliation(s)
- M Pamela Griffin
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Yuan Yuan
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Therese Takas
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Joseph B Domachowske
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Shabir A Madhi
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Paolo Manzoni
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Eric A F Simões
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Mark T Esser
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Anis A Khan
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Filip Dubovsky
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - Tonya Villafana
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| | - John P DeVincenzo
- From AstraZeneca, Gaithersburg, MD (M.P.G., Y.Y., T.T., M.T.E., A.A.K., F.D., T.V.); SUNY Upstate Medical University, Syracuse, NY (J.B.D.); Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation South African Research Chair, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (S.A.M.); the Division of Pediatrics and Neonatology, Department of Maternal, Neonatal, and Infant Medicine, Nuovo Ospedale Degli Infermi, Biella, and Neonatology and NICU, Sant'Anna Hospital, AOU Città della Salute e della Scienza, Turin - both in Italy (P.M.); the University of Colorado School of Medicine, Aurora (E.A.F.S.); and the Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN (J.P.D.V.)
| |
Collapse
|
15
|
Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| |
Collapse
|
16
|
Buchwald AG, Graham BS, Traore A, Haidara FC, Chen M, Morabito K, Lin BC, Sow SO, Levine MM, Pasetti MF, Tapia MD. RSV neutralizing antibodies at birth predict protection from RSV illness in infants in the first three months of life. Clin Infect Dis 2020; 73:e4421-e4427. [PMID: 32463443 PMCID: PMC8662775 DOI: 10.1093/cid/ciaa648] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/22/2020] [Indexed: 01/03/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading cause of viral pneumonia and bronchiolitis during the first 6 months of life. Placentally transferred antibodies can prevent severe RSV illness, and maternal immunization may reduce illness in young infants. Identification of protective antibody levels facilitates the advancement of vaccine candidates and maternal immunization. Methods We conducted a nested case-control study with 587 Malian mother–infant pairs, followed from birth to age 6 months. RSV cases were infants who developed influenza-like illness (ILI) or pneumonia and were RSV-positive by polymerase chain reaction. Cases were matched to healthy controls and RSV-negative ILI controls. RSV-A and RSV-B neutralizing antibodies were measured in maternal, cord blood, and infant sera at age 3 and 6 months. Results Maternal antibodies were efficiently transferred to infants. Maternal and infant RSV titers were strongly correlated. Infant antibody titers against RSV-A were 3 times higher than those against RSV-B. At birth, infants who remained healthy had significantly higher RSV-A and RSV-B titers compared with infants who subsequently contracted RSV. RSV-A inhibitory concentration (IC)80 titer >239 or RSV-B titer >60 at birth was significantly associated with being a healthy control compared with an RSV case within the first 3 months of life. RSV-A IC80 titers in cord blood were associated with decreased episodes of pneumonia. Conclusions Maternally acquired RSV antibodies were associated with protection of infants against community-detected cases of RSV-ILI and pneumonia. RSV titers in cord blood can predict whether an infant will be infected with RSV or remain uninfected.
Collapse
Affiliation(s)
- Andrea G Buchwald
- Department of Environmental and Occupational Health, Colorado School of Public Health, Denver, USA
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Awa Traore
- Centre pour le Développement des Vaccins - Mali, Bamako, Mali
| | | | - Man Chen
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Kaitlyn Morabito
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Bob C Lin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Samba O Sow
- Centre pour le Développement des Vaccins - Mali, Bamako, Mali
| | - Myron M Levine
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Marcela F Pasetti
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
17
|
van Erp EA, Lakerveld AJ, de Graaf E, Larsen MD, Schepp RM, Hipgrave Ederveen AL, Ahout IM, de Haan CA, Wuhrer M, Luytjes W, Ferwerda G, Vidarsson G, van Kasteren PB. Natural killer cell activation by respiratory syncytial virus-specific antibodies is decreased in infants with severe respiratory infections and correlates with Fc-glycosylation. Clin Transl Immunology 2020; 9:e1112. [PMID: 32099650 PMCID: PMC7029726 DOI: 10.1002/cti2.1112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives Respiratory syncytial virus (RSV) is a major cause of severe lower respiratory tract infections in infants, and there is no vaccine available. In early life, the most important contributors to protection against infectious diseases are the innate immune response and maternal antibodies. However, antibody-mediated protection against RSV disease is incompletely understood, as both antibody levels and neutralisation capacity correlate poorly with protection. Since antibodies also mediate natural killer (NK) cell activation, we investigated whether this functionality correlates with RSV disease. Methods We performed an observational case-control study including infants hospitalised for RSV infection, hernia surgery or RSV-negative respiratory viral infections. We determined RSV antigen-specific antibody levels in plasma using a multiplex immunoassay. Subsequently, we measured the capacity of these antibodies to activate NK cells. Finally, we assessed Fc-glycosylation of the RSV-specific antibodies by mass spectrometry. Results We found that RSV-specific maternal antibodies activate NK cells in vitro. While concentrations of RSV-specific antibodies did not differ between cases and controls, antibodies from infants hospitalised for severe respiratory infections (RSV and/or other) induced significantly less NK cell interferon-γ production than those from uninfected controls. Furthermore, NK cell activation correlated with Fc-fucosylation of RSV-specific antibodies, but their glycosylation status did not significantly differ between cases and controls. Conclusion Our results suggest that Fc-dependent antibody function and quality, exemplified by NK cell activation and glycosylation, contribute to protection against severe RSV disease and warrant further studies to evaluate the potential of using these properties to evaluate and improve the efficacy of novel vaccines.
Collapse
Affiliation(s)
- Elisabeth A van Erp
- Centre for Infectious Disease Control National Institute for Public Health and the Environment (RIVM) Bilthoven The Netherlands.,Section Pediatric Infectious Diseases Laboratory of Medical Immunology Radboud Institute for Molecular Life Sciences, Radboudumc Nijmegen The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc Nijmegen The Netherlands
| | - Anke J Lakerveld
- Centre for Infectious Disease Control National Institute for Public Health and the Environment (RIVM) Bilthoven The Netherlands
| | - Erik de Graaf
- Department of Experimental Immunohematology Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam Amsterdam The Netherlands
| | - Mads D Larsen
- Department of Experimental Immunohematology Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam Amsterdam The Netherlands
| | - Rutger M Schepp
- Centre for Infectious Disease Control National Institute for Public Health and the Environment (RIVM) Bilthoven The Netherlands
| | | | - Inge Ml Ahout
- Section Pediatric Infectious Diseases Laboratory of Medical Immunology Radboud Institute for Molecular Life Sciences, Radboudumc Nijmegen The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc Nijmegen The Netherlands
| | - Cornelis Am de Haan
- Department of Infectious Diseases and Immunology Virology Division Faculty of Veterinary Medicine Utrecht University Utrecht The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics Leiden University Medical Center Leiden The Netherlands
| | - Willem Luytjes
- Centre for Infectious Disease Control National Institute for Public Health and the Environment (RIVM) Bilthoven The Netherlands
| | - Gerben Ferwerda
- Section Pediatric Infectious Diseases Laboratory of Medical Immunology Radboud Institute for Molecular Life Sciences, Radboudumc Nijmegen The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc Nijmegen The Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology Sanquin Research and Landsteiner Laboratory Amsterdam University Medical Center, University of Amsterdam Amsterdam The Netherlands
| | - Puck B van Kasteren
- Centre for Infectious Disease Control National Institute for Public Health and the Environment (RIVM) Bilthoven The Netherlands
| |
Collapse
|
18
|
Walsh EE, Wang L, Falsey AR, Qiu X, Corbett A, Holden-Wiltse J, Mariani TJ, Topham DJ, Caserta MT. Virus-Specific Antibody, Viral Load, and Disease Severity in Respiratory Syncytial Virus Infection. J Infect Dis 2019; 218:208-217. [PMID: 29546402 DOI: 10.1093/infdis/jiy106] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/09/2018] [Indexed: 11/12/2022] Open
Abstract
Background Maternally derived serum antibody and viral load are thought to influence disease severity in primary respiratory syncytial virus (RSV) infection. As part of the AsPIRES study of RSV pathogenesis, we correlated various serum antibody concentrations and viral load with disease severity. Methods Serum neutralizing antibody titers and levels of immunoglobulin G (IgG) to RSV fusion protein (F), attachment proteins of RSV group A and B, the CX3C region of G, and nasal viral load were measured in 139 full-term previously healthy infants with primary RSV infection and correlated with illness severity. Results Univariate analysis showed no relationship between measures of serum antibody and severity. However, a multivariate model adjusting for age at the time of infection found a significant 0.56 decrease in severity score for each 2-fold increase in antibody concentration to RSV F. The benefit of antibody was greatest in infants ≤ 2 months of age. Additionally, estimated antibody titer at birth was correlated with age at infection, suggesting that higher antibody titers delay infection. Viral load did not differ by illness severity. Conclusion Our data support the concept of maternal immunization with an RSV vaccine during pregnancy as a strategy for reducing the burden of RSV infection in full-term healthy infants exposed to RSV during their first winter.
Collapse
Affiliation(s)
- Edward E Walsh
- Department of Medicine, University of Rochester School of Medicine.,Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Lu Wang
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine
| | - Ann R Falsey
- Department of Medicine, University of Rochester School of Medicine.,Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Xing Qiu
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine
| | - Anthony Corbett
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine
| | - Jeanne Holden-Wiltse
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine
| | - Thomas J Mariani
- Department of Neonatology, University of Rochester School of Medicine.,Program in Pediatric Molecular and Personalized Medicine, University of Rochester School of Medicine.,Department of Pediatrics, University of Rochester School of Medicine
| | - David J Topham
- Department of Microbiology and Immunology, University of Rochester School of Medicine
| | - Mary T Caserta
- Department of Pediatrics, University of Rochester School of Medicine
| |
Collapse
|
19
|
van Erp EA, Luytjes W, Ferwerda G, van Kasteren PB. Fc-Mediated Antibody Effector Functions During Respiratory Syncytial Virus Infection and Disease. Front Immunol 2019; 10:548. [PMID: 30967872 PMCID: PMC6438959 DOI: 10.3389/fimmu.2019.00548] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of severe lower respiratory tract infections and hospitalization in infants under 1 year of age and there is currently no market-approved vaccine available. For protection against infection, young children mainly depend on their innate immune system and maternal antibodies. Traditionally, antibody-mediated protection against viral infections is thought to be mediated by direct binding of antibodies to viral particles, resulting in virus neutralization. However, in the case of RSV, virus neutralization titers do not provide an adequate correlate of protection. The current lack of understanding of the mechanisms by which antibodies can protect against RSV infection and disease or, alternatively, contribute to disease severity, hampers the design of safe and effective vaccines against this virus. Importantly, neutralization is only one of many mechanisms by which antibodies can interfere with viral infection. Antibodies consist of two structural regions: a variable fragment (Fab) that mediates antigen binding and a constant fragment (Fc) that mediates downstream effector functions via its interaction with Fc-receptors on (innate) immune cells or with C1q, the recognition molecule of the complement system. The interaction with Fc-receptors can lead to killing of virus-infected cells through a variety of immune effector mechanisms, including antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP). Antibody-mediated complement activation may lead to complement-dependent cytotoxicity (CDC). In addition, both Fc-receptor interactions and complement activation can exert a broad range of immunomodulatory functions. Recent studies have emphasized the importance of Fc-mediated antibody effector functions in both protection and pathogenesis for various infectious agents. In this review article, we aim to provide a comprehensive overview of the current knowledge on Fc-mediated antibody effector functions in the context of RSV infection, discuss their potential role in establishing the balance between protection and pathogenesis, and point out important gaps in our understanding of these processes. Furthermore, we elaborate on the regulation of these effector functions on both the cellular and humoral side. Finally, we discuss the implications of Fc-mediated antibody effector functions for the rational design of safe and effective vaccines and monoclonal antibody therapies against RSV.
Collapse
Affiliation(s)
- Elisabeth A. van Erp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Willem Luytjes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Gerben Ferwerda
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Puck B. van Kasteren
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| |
Collapse
|
20
|
Scheltema NM, Kavelaars XM, Thorburn K, Hennus MP, van Woensel JB, van der Ent CK, Borghans JAM, Bont LJ, Drylewicz J. Potential impact of maternal vaccination on life-threatening respiratory syncytial virus infection during infancy. Vaccine 2018; 36:4693-4700. [PMID: 29941327 DOI: 10.1016/j.vaccine.2018.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is an important cause of infant mortality. Here, we estimated the potential impact of maternal vaccination against RSV on life-threatening RSV infection in infants. METHODS We developed a mathematical model for maternal vaccine-induced antibody dynamics and used characteristics of a maternal RSV vaccine currently in phase 3 of clinical development. The model was applied to data from two cohorts of children younger than 12 months with RSV-related paediatric intensive care unit (PICU) admission in the United Kingdom (n = 370) and the Netherlands (n = 167), and a cohort of 211 children younger than 12 months with RSV-related in-hospital death from 20 countries worldwide. RESULTS Our model predicted that, depending on vaccine efficiency, maternal vaccination at 30 weeks' gestational age could have prevented 62-75% of RSV-related PICU admissions in the United Kingdom and 76-87% in the Netherlands. For the global mortality cohort, the model predicted that maternal vaccination could have prevented 29-48% of RSV-related in-hospital deaths. Preterm children and children with comorbidities were predicted to benefit less than (healthy) term children. CONCLUSIONS Maternal vaccination against RSV may substantially decrease life-threatening RSV infections in infants.
Collapse
Affiliation(s)
- Nienke M Scheltema
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Xynthia M Kavelaars
- Department of Methods and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Kentigern Thorburn
- Department of Paediatric Intensive Care, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Marije P Hennus
- Department of Paediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Job B van Woensel
- Department of Paediatric Intensive Care, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Cornelis K van der Ent
- Department of Paediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands
| | - José A M Borghans
- Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louis J Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Julia Drylewicz
- Laboratory of Translational Immunology, Department of Immunology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
21
|
Trento A, Rodríguez-Fernández R, González-Sánchez MI, González-Martínez F, Mas V, Vázquez M, Palomo C, Melero JA. The Complexity of Antibody Responses Elicited against the Respiratory Syncytial Virus Glycoproteins in Hospitalized Children Younger than 2 Years. Front Microbiol 2017; 8:2301. [PMID: 29213258 PMCID: PMC5702767 DOI: 10.3389/fmicb.2017.02301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022] Open
Abstract
The influence of age and maternal antibodies on the antibody responses to human respiratory syncytial virus (hRSV) glycoproteins in very young children has been a matter of controversy. Both, immaturity of the immune system at very early age and suppression of the host immune response by high level of maternal antibodies have been claimed to limit the host antibody response to virus infection and to jeopardize the use of hRSV vaccines under development in that age group. Hence, the antibody responses to the two major hRSV glycoproteins (F and G) were evaluated in children younger than 2 years, hospitalized with laboratory confirmed hRSV bronchiolitis. A strong negative correlation was found between the titre of circulating ELISA antibodies directed against either prefusion or postfusion F in the acute phase, but not age, and their fold change at convalescence. These changes correlated also with the level of circulating neutralizing antibodies in sera. As reported in adults, most neutralizing antibodies in a subset of tested sera could not be depleted with postfusion F, suggesting that they were mostly directed against prefusion-specific epitopes. In contrast, a weak negative association was found for group-specific anti-G antibodies in the acute phase and their fold change at convalescence only after correcting for the antigenic group of the infecting virus. In addition, large discrepancies were observed in some individuals between the antibody responses specific for F and G glycoproteins. These results illustrate the complexity of the anti-hRSV antibody responses in children experiencing a primary severe infection and the influence of preexisting maternal antibodies on the host response, factors that should influence hRSV serological studies as well as vaccine development.
Collapse
Affiliation(s)
- Alfonsina Trento
- Unidad de Biología Viral, Centro Nacional de Microbiología, Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Rodríguez-Fernández
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón - CIBEREHD, Madrid, Spain
| | - María I González-Sánchez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón - CIBEREHD, Madrid, Spain
| | - Felipe González-Martínez
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón - CIBEREHD, Madrid, Spain
| | - Vicente Mas
- Unidad de Biología Viral, Centro Nacional de Microbiología, Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Mónica Vázquez
- Unidad de Biología Viral, Centro Nacional de Microbiología, Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Concepción Palomo
- Unidad de Biología Viral, Centro Nacional de Microbiología, Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - José A Melero
- Unidad de Biología Viral, Centro Nacional de Microbiología, Madrid, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
22
|
In Vitro Enhancement of Respiratory Syncytial Virus Infection by Maternal Antibodies Does Not Explain Disease Severity in Infants. J Virol 2017; 91:JVI.00851-17. [PMID: 28794038 PMCID: PMC5640862 DOI: 10.1128/jvi.00851-17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/12/2017] [Indexed: 01/09/2023] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of severe respiratory illness in infants. At this young age, infants typically depend on maternally transferred antibodies (matAbs) and their innate immune system for protection against infections. RSV-specific matAbs are thought to protect from severe illness, yet severe RSV disease occurs mainly below 6 months of age, when neutralizing matAb levels are present. To investigate this discrepancy, we asked if disease severity is related to antibody properties other than neutralization. Some antibody effector functions are mediated via their Fc binding region. However, it has been shown that this binding may lead to antibody-dependent enhancement (ADE) of infection or reduction of neutralization, both possibly leading to more disease. In this study, we first showed that high levels of ADE of RSV infection occur in monocytic THP-1 cells in the presence of RSV antibodies and that neutralization by these antibodies was reduced in Vero cells when they were transduced with Fc gamma receptors. We then demonstrated that antibodies from cotton rats with formalin-inactivated (FI)-RSV-induced pulmonary pathology were capable of causing ADE. Human matAbs also caused ADE and were less neutralizing in vitro in cells that carry Fc receptors. However, these effects were unrelated to disease severity because they were seen both in uninfected controls and in infants hospitalized with different levels of RSV disease severity. We conclude that ADE and reduction of neutralization are unlikely to be involved in RSV disease in infants with neutralizing matAbs.IMPORTANCE It is unclear why severity of RSV disease peaks at the age when infants have neutralizing levels of maternal antibodies. Additionally, the exact reason for FI-RSV-induced enhanced disease, as seen in the 1960s vaccine trials, is still unclear. We hypothesized that antibodies present under either of these conditions could contribute to disease severity. Antibodies can have effects that may lead to more disease instead of protection. We investigated two of those effects: antibody-dependent enhancement of infection (ADE) and neutralization reduction. We show that ADE occurs in vitro with antibodies from FI-RSV-immunized RSV-infected cotton rats. Moreover, passively acquired maternal antibodies from infants had the capacity to induce ADE and reduction of neutralization. However, no clear association with disease severity was seen, ruling out that these properties explain disease in the presence of maternal antibodies. Our data contribute to a better understanding of the impact of antibodies on RSV disease in infants.
Collapse
|
23
|
Transplacental transfer of maternal respiratory syncytial virus (RSV) antibody and protection against RSV disease in infants in rural Nepal. J Clin Virol 2017; 95:90-95. [PMID: 28903080 PMCID: PMC5625849 DOI: 10.1016/j.jcv.2017.08.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most important viral cause of pneumonia in children. RSV-specific antibody (ab) protects infants from disease, and may be increased by a potential strategy of maternal RSV vaccination. OBJECTIVES To describe the effect of RSV antibody on RSV infection risk in infants in a resource-limited setting. STUDY DESIGN In a prospective study in Nepal, women were enrolled during pregnancy and maternal and infant cord blood were collected at birth. Weekly surveillance for respiratory illness was performed from birth to 180days. Nasal swabs were tested for RSV by PCR and serum was tested using an RSV antibody microneutralization assay. Antibody concentrations at time of RSV infection were estimated based on a decay rate of 0.026 log2/day. RESULTS Cord:maternal RSV antibody transfer ratio was 1.03 (0.88-1.19), with RSV antibody concentration of log2 11.3 and log2 11.7 in 310 paired maternal and infant samples, respectively. Cord blood RSV antibody was log2 12.1 versus 11.6 in those with or without RSV infection (P=0.86). Among infants with RSV infection, estimated RSV antibody concentration at time of infection did not differ in infants with upper (n=8; log2 10.7) versus lower respiratory tract infection (n=21; log2 9.8; P=0.37). Cord blood RSV antibody concentrations did not correlate with age at primary RSV infection (R=0.11; P=0.57). CONCLUSIONS Transplacental transfer of RSV antibody from mother to the fetus was highly efficient in mother-infant pairs in rural Nepal, though higher antibody concentrations were not protective against earlier or more severe RSV infection in infants.
Collapse
|
24
|
Schepens B, Saelens X. IgG3 Snitcher of RSV Infections in the Very Young. EBioMedicine 2017; 16:10-11. [PMID: 28159571 PMCID: PMC5474517 DOI: 10.1016/j.ebiom.2017.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 10/27/2022] Open
|