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Sun M, Lai H, Na F, Li S, Qiu X, Tian J, Zhang Z, Ge L. Monoclonal Antibody for the Prevention of Respiratory Syncytial Virus in Infants and Children: A Systematic Review and Network Meta-analysis. JAMA Netw Open 2023; 6:e230023. [PMID: 36800182 PMCID: PMC9938429 DOI: 10.1001/jamanetworkopen.2023.0023] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
IMPORTANCE Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection in children younger than 5 years; effective prevention strategies are urgently needed. OBJECTIVE To compare the efficacy and safety of monoclonal antibodies for the prevention of RSV infection in infants and children. DATA SOURCES In this systematic review and network meta-analysis, PubMed, Embase, CENTRAL, and ClinicalTrials.gov were searched from database inception to March 2022. STUDY SELECTION Randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo were included. Keywords and extensive vocabulary related to monoclonal antibodies, RSV, and randomized clinical trials were searched. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used. Teams of 2 reviewers independently performed literature screening, data extraction, and risk of bias assessment. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was used to rate the certainty of evidence. A random-effects model network meta-analysis was conducted using a consistency model under the frequentist framework. MAIN OUTCOMES AND MEASURES The main outcomes were all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use. RESULTS Fifteen randomized clinical trials involving 18 395 participants were eligible; 14 were synthesized, with 18 042 total participants (median age at study entry, 3.99 months [IQR, 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%]). Compared with placebo, with moderate- to high-certainty evidence, nirsevimab, palivizumab, and motavizumab were associated with significantly reduced RSV-related infections per 1000 participants (nirsevimab: -123 [95% CI, -138 to -100]; palivizumab: -108 [95% CI, -127 to -82]; motavizumab: -136 [95% CI, -146 to -125]) and RSV-related hospitalizations per 1000 participants (nirsevimab: -54 [95% CI, -64 to -38; palivizumab: -39 [95% CI, -48 to -28]; motavizumab: -48 [95% CI, -58 to -33]). With moderate-certainty evidence, both motavizumab and palivizumab were associated with significant reductions in intensive care unit admissions per 1000 participants (-8 [95% CI, -9 to -4] and -5 [95% CI, -7 to 0], respectively) and supplemental oxygen use per 1000 participants (-59 [95% CI, -63 to -54] and -55 [95% CI, -61 to -41], respectively), and nirsevimab was associated with significantly reduced supplemental oxygen use per 1000 participants (-59 [95% CI, -65 to -40]). No significant differences were found in all-cause mortality and drug-related adverse events. Suptavumab did not show any significant benefits for the outcomes of interest. CONCLUSIONS AND RELEVANCE In this study, motavizumab, nirsevimab, and palivizumab were associated with substantial benefits in the prevention of RSV infection, without a significant increase in adverse events compared with placebo. However, more research is needed to confirm the present conclusions, especially for safety and cost-effectiveness.
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Affiliation(s)
- Mingyao Sun
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Honghao Lai
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Feiyang Na
- Department of Pediatrics, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Sheng Li
- The First People’s Hospital of Lanzhou City, Lanzhou, Gansu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Zhigang Zhang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
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Caidi H, Miao C, Thornburg NJ, Tripp RA, Anderson LJ, Haynes LM. Anti-respiratory syncytial virus (RSV) G monoclonal antibodies reduce lung inflammation and viral lung titers when delivered therapeutically in a BALB/c mouse model. Antiviral Res 2018; 154:149-157. [PMID: 29678551 DOI: 10.1016/j.antiviral.2018.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/04/2023]
Abstract
RSV continues to be a high priority for vaccine and antiviral drug development. Unfortunately, no safe and effective RSV vaccine is available and treatment options are limited. Over the past decade, several studies have focused on the role of RSV G protein on viral entry, viral neutralization, and RSV-mediated pathology. Anti-G murine monoclonal antibody (mAb) 131-2G treatment has been previously shown to reduce weight loss, bronchoalveolar lavage (BAL) cell number, airway reactivity, and Th2-type cytokine production in RSV-infected mice more rapidly than a commercial humanized monoclonal antibody (mAb) against RSV F protein (Palivizumab). In this study, we have tested two human anti-RSV G mAbs, 2B11 and 3D3, by both prophylactic and therapeutic treatment for RSV in the BALB/c mouse model. Both anti-G mAbs reduced viral load, leukocyte infiltration and IFN-γ and IL-4 expression in cell-free BAL supernatants emphasizing the potential of anti-G mAbs as anti-inflammatory and antiviral strategies.
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Affiliation(s)
- Hayat Caidi
- National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Congrong Miao
- National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Natalie J Thornburg
- National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Ralph A Tripp
- College of Veterinary Medicine, Department of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Larry J Anderson
- Division of Pediatric Infectious Diseases, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lia M Haynes
- National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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New Insights Contributing to the Development of Effective Vaccines and Therapies to Reduce the Pathology Caused by hRSV. Int J Mol Sci 2017; 18:ijms18081753. [PMID: 28800119 PMCID: PMC5578143 DOI: 10.3390/ijms18081753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022] Open
Abstract
Human Respiratory Syncytial Virus (hRSV) is one of the major causes of acute lower respiratory tract infections (ALRTI) worldwide, leading to significant levels of immunocompromisation as well as morbidity and mortality in infants. Its main target of infection is the ciliated epithelium of the lungs and the host immune responses elicited is ineffective at achieving viral clearance. It is thought that the lack of effective immunity against hRSV is due in part to the activity of several viral proteins that modulate the host immune response, enhancing a Th2-like pro-inflammatory state, with the secretion of cytokines that promote the infiltration of immune cells to the lungs, with consequent damage. Furthermore, the adaptive immunity triggered by hRSV infection is characterized by weak cytotoxic T cell responses and secretion of low affinity antibodies by B cells. These features of hRSV infection have meant that, to date, no effective and safe vaccines have been licensed. In this article, we will review in detail the information regarding hRSV characteristics, pathology, and host immune response, along with several prophylactic treatments and vaccine prototypes. We will also expose significant data regarding the newly developed BCG-based vaccine that promotes protective cellular and humoral response against hRSV infection, which is currently undergoing clinical evaluation.
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Wen X, Pickens J, Mousa JJ, Leser GP, Lamb RA, Crowe JE, Jardetzky TS. A Chimeric Pneumovirus Fusion Protein Carrying Neutralizing Epitopes of Both MPV and RSV. PLoS One 2016; 11:e0155917. [PMID: 27224013 PMCID: PMC4880302 DOI: 10.1371/journal.pone.0155917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/06/2016] [Indexed: 11/21/2022] Open
Abstract
Respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) are paramyxoviruses that are responsible for substantial human health burden, particularly in children and the elderly. The fusion (F) glycoproteins are major targets of the neutralizing antibody response and studies have mapped dominant antigenic sites in F. Here we grafted a major neutralizing site of RSV F, recognized by the prophylactic monoclonal antibody palivizumab, onto HMPV F, generating a chimeric protein displaying epitopes of both viruses. We demonstrate that the resulting chimeric protein (RPM-1) is recognized by both anti-RSV and anti-HMPV F neutralizing antibodies indicating that it can be used to map the epitope specificity of antibodies raised against both viruses. Mice immunized with the RPM-1 chimeric antigen generate robust neutralizing antibody responses to MPV but weak or no cross-reactive recognition of RSV F, suggesting that grafting of the single palivizumab epitope stimulates a comparatively limited antibody response. The RPM-1 protein provides a new tool for characterizing the immune responses resulting from RSV and HMPV infections and provides insights into the requirements for developing a chimeric subunit vaccine that could induce robust and balanced immunity to both virus infections.
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Affiliation(s)
- Xiaolin Wen
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jennifer Pickens
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, United States of America
| | - Jarrod J. Mousa
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, United States of America
| | - George P. Leser
- Howard Hughes Medical Institute, Northwestern University, Evanston, IL, United States of America
- Department of Molecular Biosciences, Northwestern University, Evanston, IL, United States of America
| | - Robert A. Lamb
- Howard Hughes Medical Institute, Northwestern University, Evanston, IL, United States of America
- Department of Molecular Biosciences, Northwestern University, Evanston, IL, United States of America
| | - James E. Crowe
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, United States of America
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Theodore S. Jardetzky
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA, United States of America
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Raghunandan R, Lu H, Zhou B, Xabier MG, Massare MJ, Flyer DC, Fries LF, Smith GE, Glenn GM. An insect cell derived respiratory syncytial virus (RSV) F nanoparticle vaccine induces antigenic site II antibodies and protects against RSV challenge in cotton rats by active and passive immunization. Vaccine 2014; 32:6485-92. [PMID: 25269094 PMCID: PMC7172787 DOI: 10.1016/j.vaccine.2014.09.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/12/2014] [Accepted: 09/14/2014] [Indexed: 12/02/2022]
Abstract
Post-infectious immunity to respiratory syncytial virus (RSV) infection results in limited protection as evidenced by the high rate of infant hospitalization in the face of high titer, maternally derived RSV-specific antibodies. By contrast, RSV fusion (F) glycoprotein antigenic site II humanized monoclonal antibodies, palivizumab and motavizumab, have been shown to reduce RSV-related hospitalization in infants. Immunogenicity and efficacy studies were conducted in cotton rats comparing a recombinant RSV F nanoparticle vaccine with palivizumab and controlled with live RSV virus intranasal immunization and, formalin inactivated RSV vaccine. Active immunization with RSV F nanoparticle vaccine containing an alum adjuvant induced serum levels of palivizumab competing antibody (PCA) greater than passive administration of 15 mg/kg palivizumab (human prophylactic dose) in cotton rats and neutralized RSV-A and RSV-B viruses. Immunization prevented detectable RSV replication in the lungs and, unlike passive administration of palivizumab, in the nasal passage of challenged cotton rats. Histology of lung tissues following RSV challenge showed no enhanced disease in the vaccinated groups in contrast to formalin inactivated 'Lot 100' vaccine. Passive intramuscular administration of RSV F vaccine-induced immune sera one day prior to challenge of cotton rats reduced viral titers by 2 or more log10 virus per gram of lung and nasal tissue and at doses less than palivizumab. A recombinant RSV F nanoparticle vaccine protected lower and upper respiratory tract against both RSV A and B strain infection and induced polyclonal palivizumab competing antibodies similar to but potentially more broadly protective against RSV than palivizumab.
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Affiliation(s)
- Rama Raghunandan
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States.
| | - Hanxin Lu
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | - Bin Zhou
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | | | - Michael J Massare
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | - David C Flyer
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | - Louis F Fries
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | - Gale E Smith
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
| | - Gregory M Glenn
- Novavax Inc., 20 Firstfield Road, Gaithersburg MD 20878, United States
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Monoclonal antibodies for prophylactic and therapeutic use against viral infections. ACTA ACUST UNITED AC 2013; 88:T15-T23. [PMID: 32287402 PMCID: PMC7111719 DOI: 10.1016/j.pepo.2013.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 01/15/2013] [Indexed: 11/21/2022]
Abstract
Neutralizing antibodies play an essential part in antiviral immunity and are instrumental in preventing or modulating viral diseases. Polyclonal antibody preparations are increasingly being replaced by highly potent monoclonal antibodies (mAbs). Cocktails of mAbs and bispecific constructs can be used to simultaneously target multiple viral epitopes and to overcome issues of neutralization escape. Advances in antibody engineering have led to a large array of novel mAb formats, while deeper insight into the biology of several viruses and increasing knowledge of their neutralizing epitopes has extended the list of potential targets. In addition, progress in developing inexpensive production platforms will make antiviral mAbs more widely available and affordable.
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Both L, Banyard AC, van Dolleweerd C, Wright E, Ma JKC, Fooks AR. Monoclonal antibodies for prophylactic and therapeutic use against viral infections. Vaccine 2013; 31:1553-9. [PMID: 23370150 PMCID: PMC7115371 DOI: 10.1016/j.vaccine.2013.01.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/01/2013] [Accepted: 01/15/2013] [Indexed: 12/27/2022]
Abstract
Neutralizing antibodies play an essential part in antiviral immunity and are instrumental in preventing or modulating viral diseases. Polyclonal antibody preparations are increasingly being replaced by highly potent monoclonal antibodies (mAbs). Cocktails of mAbs and bispecific constructs can be used to simultaneously target multiple viral epitopes and to overcome issues of neutralization escape. Advances in antibody engineering have led to a large array of novel mAb formats, while deeper insight into the biology of several viruses and increasing knowledge of their neutralizing epitopes has extended the list of potential targets. In addition, progress in developing inexpensive production platforms will make antiviral mAbs more widely available and affordable.
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Affiliation(s)
- Leonard Both
- The Hotung Molecular Immunology Unit, Division of Clinical Sciences, St George's, University of London, London, UK
- Animal Health and Veterinary Laboratories Agency (AHVLA), Wildlife Zoonoses and Vector-borne Diseases Research Group, Department of Virology, Weybridge, Surrey, UK
| | - Ashley C. Banyard
- Animal Health and Veterinary Laboratories Agency (AHVLA), Wildlife Zoonoses and Vector-borne Diseases Research Group, Department of Virology, Weybridge, Surrey, UK
| | - Craig van Dolleweerd
- The Hotung Molecular Immunology Unit, Division of Clinical Sciences, St George's, University of London, London, UK
| | - Edward Wright
- School of Life Sciences, University of Westminster, London, UK
| | - Julian K.-C. Ma
- The Hotung Molecular Immunology Unit, Division of Clinical Sciences, St George's, University of London, London, UK
| | - Anthony R. Fooks
- Animal Health and Veterinary Laboratories Agency (AHVLA), Wildlife Zoonoses and Vector-borne Diseases Research Group, Department of Virology, Weybridge, Surrey, UK
- National Consortium for Zoonosis Research, University of Liverpool, Leahurst, Neston, South Wirral CH64 7TE, UK
- Corresponding author at: Animal Health and Veterinary Laboratories Agency (AHVLA), Wildlife Zoonoses and Vector-borne Diseases Research Group, Department of Virology, Weybridge, Surrey KT15 3NB, UK. Tel.: +44 01932 357840; fax: +44 01932 357239.
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8
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Antiviral activity of diarylheptanoid stereoisomers against respiratory syncytial virus in vitro and in vivo. J Nat Med 2013; 67:773-81. [DOI: 10.1007/s11418-013-0743-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/06/2013] [Indexed: 10/27/2022]
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Costello HM, Ray WC, Chaiwatpongsakorn S, Peeples ME. Targeting RSV with vaccines and small molecule drugs. Infect Disord Drug Targets 2012; 12:110-28. [PMID: 22335496 DOI: 10.2174/187152612800100143] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 01/01/2012] [Indexed: 12/21/2022]
Abstract
Respiratory syncytial virus (RSV) is the most significant cause of pediatric respiratory infections. Palivizumab (Synagis®), a humanized monoclonal antibody, has been used successfully for a number of years to prevent severe RSV disease in at-risk infants. However, despite intense efforts, there is no approved vaccine or small molecule drug for RSV. As an enveloped virus, RSV must fuse its envelope with the host cell membrane, which is accomplished through the actions of the fusion (F) glycoprotein, with attachment help from the G glycoprotein. Because of their integral role in initiation of infection and their accessibility outside the lipid bilayer, these proteins have been popular targets in the discovery and development of antiviral compounds and vaccines against RSV. This review examines advances in the development of antiviral compounds and vaccine candidates.
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Affiliation(s)
- Heather M Costello
- Center for Vaccines & Immunity, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Freitas GRO, Silva DAO, Yokosawa J, Paula NT, Costa LF, Carneiro BM, Ribeiro LZG, Oliveira TFM, Mineo JR, Queiróz DAO. Antibody response and avidity of respiratory syncytial virus-specific total IgG, IgG1, and IgG3 in young children. J Med Virol 2012; 83:1826-33. [PMID: 21837801 DOI: 10.1002/jmv.22134] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Respiratory syncytial virus (RSV) is a major cause of acute respiratory disease in infants and young children. Considering that several aspects of the humoral immune response to RSV infection remain unclear, this study aimed to investigate the occurrence, levels, and avidity of total IgG, IgG1, and IgG3 antibodies against RSV in serum samples from children ≤5 years old. In addition, a possible association between antibody avidity and severity of illness was examined. The occurrence and levels of RSV-specific IgG depended on age, with infants <3 months old displaying high levels of antibodies, which were probably acquired from the mother. Children ≥24 months old also showed frequent occurrence and high levels of IgG, which was produced actively during infection. In addition, the avidity assay showed that the avidity of RSV-specific total IgG and IgG1 was lower in infants <3 months old who had acute respiratory disease than in age-matched controls. The avidity of RSV-specific IgG detected in children ≥24 months old with lower respiratory infection was lower than that in children with upper respiratory infection. These results indicate that the presence of high avidity RSV-specific IgG antibodies may lead to better protection against RSV infection in children <3 months old, who may have a lower probability of developing disease of increased severity. In addition, children ≥24 months old with RSV-specific IgG antibodies of low avidity tended to develop more severe RSV illness. These findings may be helpful in establishing vaccination schedules when a vaccine becomes available.
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Affiliation(s)
- G R O Freitas
- Laboratory of Virology, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, MG, Brazil
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Collins PL, Melero JA. Progress in understanding and controlling respiratory syncytial virus: still crazy after all these years. Virus Res 2011; 162:80-99. [PMID: 21963675 PMCID: PMC3221877 DOI: 10.1016/j.virusres.2011.09.020] [Citation(s) in RCA: 330] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 01/25/2023]
Abstract
Human respiratory syncytial virus (RSV) is a ubiquitous pathogen that infects everyone worldwide early in life and is a leading cause of severe lower respiratory tract disease in the pediatric population as well as in the elderly and in profoundly immunosuppressed individuals. RSV is an enveloped, nonsegmented negative-sense RNA virus that is classified in Family Paramyxoviridae and is one of its more complex members. Although the replicative cycle of RSV follows the general pattern of the Paramyxoviridae, it encodes additional proteins. Two of these (NS1 and NS2) inhibit the host type I and type III interferon (IFN) responses, among other functions, and another gene encodes two novel RNA synthesis factors (M2-1 and M2-2). The attachment (G) glycoprotein also exhibits unusual features, such as high sequence variability, extensive glycosylation, cytokine mimicry, and a shed form that helps the virus evade neutralizing antibodies. RSV is notable for being able to efficiently infect early in life, with the peak of hospitalization at 2-3 months of age. It also is notable for the ability to reinfect symptomatically throughout life without need for significant antigenic change, although immunity from prior infection reduces disease. It is widely thought that re-infection is due to an ability of RSV to inhibit or subvert the host immune response. Mechanisms of viral pathogenesis remain controversial. RSV is notable for a historic, tragic pediatric vaccine failure involving a formalin-inactivated virus preparation that was evaluated in the 1960s and that was poorly protective and paradoxically primed for enhanced RSV disease. RSV also is notable for the development of a successful strategy for passive immunoprophylaxis of high-risk infants using RSV-neutralizing antibodies. Vaccines and new antiviral drugs are in pre-clinical and clinical development, but controlling RSV remains a formidable challenge.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/genetics
- Antibodies, Viral/immunology
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- Antiviral Agents/administration & dosage
- Child
- Communicable Disease Control/organization & administration
- Cytokines/immunology
- Humans
- Immunity, Innate
- Infant
- RNA, Viral/genetics
- RNA, Viral/immunology
- Respiratory Syncytial Virus Infections/drug therapy
- Respiratory Syncytial Virus Infections/immunology
- Respiratory Syncytial Virus Infections/prevention & control
- Respiratory Syncytial Virus Infections/virology
- Respiratory Syncytial Virus Vaccines/administration & dosage
- Respiratory Syncytial Virus, Human/genetics
- Respiratory Syncytial Virus, Human/immunology
- Vaccination
- Vaccines, Attenuated/administration & dosage
- Viral Proteins/chemistry
- Viral Proteins/genetics
- Viral Proteins/immunology
- Virus Replication/genetics
- Virus Replication/immunology
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Affiliation(s)
- Peter L. Collins
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - José A. Melero
- Centro Nacional de Microbiología and CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
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Konno K, Sawamura R, Sun Y, Yasukawa K, Shimizu T, Watanabe W, Kato M, Yamamoto R, Kurokawa M. Antiviral Activities of Diarylheptanoids Isolated from Alpinia officinarum against Respiratory Syncytial Virus, Poliovirus, Measles Virus, and Herpes Simplex Virus Type 1 in vitro. Nat Prod Commun 2011. [DOI: 10.1177/1934578x1100601222] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Alpinia officinarum has been used as a folk medicine and contains diarylheptanoids that have various biological activities. However, their antiviral activities are less elucidated. We examined the antiviral activities of nine diarylheptanoids isolated from A. officinarum against respiratory syncytial virus (RSV), poliovirus, measles virus, and herpes simplex virus type 1 (HSV-1) using a plaque reduction assay. The 50% inhibitory concentrations of seven of the nine diarylheptanoids for RSV were moderately but significantly lower than their 50% cytotoxic concentrations, as determined by a trypan blue exclusion assay. Four diarylheptanoids with anti-RSV activity also showed anti-poliovirus and anti-measles virus activities and three of the four exhibited anti-HSV-1 activity. Thus, seven of the nine diarylheptanoids examined exhibited potential antiviral activity against RSV, and most of the diarylheptanoids with anti-RSV activity, including two diarylheptanoids without anti-RSV activity, were effective against poliovirus, measles virus, and/or HSV-1 in vitro. Diarylheptanoids were suggested to have a broad spectrum of antiviral activity.
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Affiliation(s)
- Katsuhiko Konno
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Rie Sawamura
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Yi Sun
- School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi-shi, Chiba 274-8555, Japan
| | - Ken Yasukawa
- School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi-shi, Chiba 274-8555, Japan
| | - Tomomi Shimizu
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Wataru Watanabe
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Masahiko Kato
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Ryuichi Yamamoto
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
| | - Masahiko Kurokawa
- School of Pharmaceutical Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino, Nobeoka, Miyazaki 882-8508, Japan
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Respiratory syncytial virus pneumonia treated with lower-dose palivizumab in a heart transplant recipient. Case Rep Cardiol 2011; 2012:723407. [PMID: 24826271 PMCID: PMC4008357 DOI: 10.1155/2012/723407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 10/20/2011] [Indexed: 11/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed. This paper describes a 70-year-old man with a remote history of heart transplantation who presented with signs and symptoms of pneumonia. Chest computed tomography (CT) imaging demonstrated new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung, and the RSV direct fluorescence antibody (DFA) was positive. The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab. After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction. There are few data on RSV infections in heart transplant patients, but this case highlights the importance of considering this potentially serious infection and introduces a novel method of treatment.
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Kim NK, Choi JY. Respiratory syncytial virus prevention in children with congenital heart disease: who and how? KOREAN JOURNAL OF PEDIATRICS 2011; 54:197-200. [PMID: 21829410 PMCID: PMC3145903 DOI: 10.3345/kjp.2011.54.5.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/25/2011] [Indexed: 11/27/2022]
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory infection in children. Most of the pediatric population have RSV infection before the age of 2, and recurrent infections are common even within one season. Chronic lung disease, prematurity, along with congenital heart disease (CHD) are major risk factors in severe lower respiratory infection. In hemo-dynamically significant CHD patients with RSV infection, hospitalization is usually needed and the possibility of treatment in intensive care unit and the use of mechanical ventilator support are known to increase. Therefore the prevention of RSV infection in CHD patients is mandatory. The current standard for RSV prevention is immunoprophylaxis by palivizumab. Immunoprophylaxis is recommended monthly in hemodynamically significant CHD patients, up to 5 months. Motabizumab, a second generation drug and newly developing RSV vaccines are also expected to play a key role in RSV prevention in the future. The prophylaxis of RSV infection in CHD patients is cost-effective in both the medical aspect of the patients as well as the socio-economic aspect. Therefore an effort to promote prevention should be made by not only the family of the patients but also by the government.
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Affiliation(s)
- Nam Kyun Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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15
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Kauvar LM, Harcourt JL, Haynes LM, Tripp RA. Therapeutic targeting of respiratory syncytial virus G-protein. Immunotherapy 2011; 2:655-61. [PMID: 20874649 DOI: 10.2217/imt.10.53] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of pneumonia and bronchiolitis in infants and young children and an important pathogen of the elderly and immune suppressed. The only intervention currently available is a monoclonal antibody against the RSV fusion protein, which has shown utility as a prophylactic for high-risk premature infants, but which has not shown postinfection therapeutic efficacy in the specific RSV-infected populations studied. Thus, for the major susceptible populations, there remains a great need for effective treatment. Recent results support monoclonal antibody targeting of the RSV G-protein for therapeutic use. This objective encompasses a dual mechanism: reduction in the ability of RSV G-protein to distort the host innate immune response, and direct complement-mediated antiviral activity.
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Affiliation(s)
- Lawrence M Kauvar
- Trellis Bioscience, 2-B Corporate Drive, South San Francisco, CA 94080, USA.
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16
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Park M, Matsuura H, Lamb RA, Barron AE, Jardetzky TS. A fluorescence polarization assay using an engineered human respiratory syncytial virus F protein as a direct screening platform. Anal Biochem 2011; 409:195-201. [PMID: 20971054 PMCID: PMC3462168 DOI: 10.1016/j.ab.2010.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 09/26/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
Human respiratory syncytial virus (hRSV) typically affects newborns and young children. Even though it can cause severe and, in some cases, lifelong respiratory infections, there are currently no Food and Drug Administration (FDA)-approved therapeutics that control this virus. The hRSV F protein facilitates viral fusion, a critical extracellular event that can be targeted for therapeutic intervention by disrupting the assembly of a postfusion 6-helix bundle (6HB) within the hRSV F protein. Here we report the development of a fluorescence polarization (FP) assay using an engineered hRSV F protein 5-helix bundle (5HB). We generated the 5HB and validated its ability to form a 6HB in an FP assay. To test the potential of 5HB as a screening tool, we then investigated a series of truncated peptides derived from the "missing" sixth helix. Using this FP-based 5HB system, we have successfully demonstrated that short peptides can prevent 6HB formation and serve as potential hRSV fusion inhibitors. We anticipate that this new 5HB system will provide an effective tool to identify and study potential antivirals to control hRSV infection.
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Affiliation(s)
- Minyoung Park
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Hisae Matsuura
- Department of Biochemistry, Molecular Biology and Cell Biology, Northwestern University, Evanston, IL 60208 USA
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Robert A. Lamb
- Department of Biochemistry, Molecular Biology and Cell Biology, Northwestern University, Evanston, IL 60208 USA
- Howard Hughes Medical Institute, USA
| | - Annelise E. Barron
- Department of Bioengineering, Stanford University School of Engineering and Medicine, Stanford, CA 94305 USA
| | - Theodore S. Jardetzky
- Department of Structural Biology, Stanford University School of Medicine, Stanford, CA 94305 USA
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McGivney JB, Bishop E, Miller K, Casas-Finet J, Yang H, Wei Z, Strouse R, Schenerman M. Evaluation of a synthetic peptide as a replacement for the recombinant fusion protein of respiratory syncytial virus in a potency ELISA. J Pharm Biomed Anal 2010; 54:572-6. [PMID: 20943340 DOI: 10.1016/j.jpba.2010.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 08/02/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
Abstract
This report describes the development of a potency ELISA using a peptide derived from the motavizumab binding epitope of respiratory syncytial virus (RSV) F-protein. Motavizumab is an antibody therapeutic studied for the prevention of RSV disease. It binds to the RSV glycoprotein F (F-protein), blocking the ability of RSV to fuse with target cells. This binding is the basis for a potency ELISA, however, due to inefficient F-protein production, development of an alternative ligand for the potency ELISA was investigated. A series of synthetic peptides spanning the motavizumab epitope on F-protein were evaluated for motavizumab binding activity. A 26-mer peptide was identified with desirable motavizumab binding kinetics, as shown by ELISA and surface plasmon resonance. The peptide corresponds to a portion of the motavizumab binding domain on the F-protein, and is referred to as F-peptide. The binding of motavizumab to the F-peptide is used in a new motavizumab potency ELISA, which was shown to be robust and statistically comparable to the F-protein ELISA. In addition, based on a qualitative observation, this new ELISA may be able to detect motavizumab degradation with greater sensitivity compared to the F-protein ELISA.
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Affiliation(s)
- James B McGivney
- Department of Analytical Biochemistry, MedImmune, One MedImmune Way, Gaithersburg, MD 20878, United States.
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