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Chakraborty C, Bhattacharya M, Lee SS. Current Status of Microneedle Array Technology for Therapeutic Delivery: From Bench to Clinic. Mol Biotechnol 2023:10.1007/s12033-023-00961-2. [PMID: 37987985 DOI: 10.1007/s12033-023-00961-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
In recent years, microneedle (MN) patches have emerged as an alternative technology for transdermal delivery of various drugs, therapeutics proteins, and vaccines. Therefore, there is an urgent need to understand the status of MN-based therapeutics. The article aims to illustrate the current status of microneedle array technology for therapeutic delivery through a comprehensive review. However, the PubMed search was performed to understand the MN's therapeutics delivery status. At the same time, the search shows the number no of publications on MN is increasing (63). The search was performed with the keywords "Coated microneedle," "Hollow microneedle," "Dissolvable microneedle," and "Hydrogel microneedle," which also shows increasing trend. Similarly, the article highlighted the application of different microneedle arrays for treating different diseases. The article also illustrated the current status of different phases of MN-based therapeutics clinical trials. It discusses the delivery of different therapeutic molecules, such as drug molecule delivery, using microneedle array technology. The approach mainly discusses the delivery of different therapeutic molecules. The leading pharmaceutical companies that produce the microneedle array for therapeutic purposes have also been discussed. Finally, we discussed the limitations and future prospects of this technology.
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Affiliation(s)
- Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal, 700126, India.
| | - Manojit Bhattacharya
- Department of Zoology, Fakir Mohan University, Vyasa Vihar, Balasore, Odisha, 756020, India
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
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2
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Wang J, Lu Z, Cai R, Zheng H, Yu J, Zhang Y, Gu Z. Microneedle-based transdermal detection and sensing devices. LAB ON A CHIP 2023; 23:869-887. [PMID: 36629050 DOI: 10.1039/d2lc00790h] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Microneedles have been expected for the construction of next-generation biosensors towards personalization, digitization, and intellectualization due to their metrics of minimal invasiveness, high integration, and favorable biocompatibility. Herein, an overview of state-of-the-art microneedle-based detection and sensing systems is presented. First, the designs of microneedle devices based on extraction mechanisms are concluded, corresponding to different geometries and materials of microneedles. Second, the targets of equipment-assisted microneedle detections are summarized, as well as the objective significance, revealing the current performance and potential scenarios of these microneedles. Third, the trend towards highly integrated sensors is elaborated by emphasizing the sensing principles (colorimetric, fluorometric and electronic manner). Finally, the key challenges to be tackled and the perspectives on future development are discussed.
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Affiliation(s)
- Junxia Wang
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
| | - Ziyi Lu
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Ruisi Cai
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
| | - Hanqi Zheng
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
| | - Jicheng Yu
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
- Jinhua Institute of Zhejiang University, Jinhua, 321299, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Yuqi Zhang
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
- Department of Burns and Wound Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Zhen Gu
- Zhejiang Provincial Key Laboratory for Advanced Drug Delivery Systems, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, China.
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
- Jinhua Institute of Zhejiang University, Jinhua, 321299, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
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3
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Choo JJY, McMillan CLD, Young PR, Muller DA. Microarray patches: scratching the surface of vaccine delivery. Expert Rev Vaccines 2023; 22:937-955. [PMID: 37846657 DOI: 10.1080/14760584.2023.2270598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Microneedles are emerging as a promising technology for vaccine delivery, with numerous advantages over traditional needle and syringe methods. Preclinical studies have demonstrated the effectiveness of MAPs in inducing robust immune responses over traditional needle and syringe methods, with extensive studies using vaccines targeted against different pathogens in various animal models. Critically, the clinical trials have demonstrated safety, immunogenicity, and patient acceptance for MAP-based vaccines against influenza, measles, rubella, and SARS-CoV-2. AREAS COVERED This review provides a comprehensive overview of the different types of microarray patches (MAPs) and analyses of their applications in preclinical and clinical vaccine delivery settings. This review also covers additional considerations for microneedle-based vaccination, including adjuvants that are compatible with MAPs, patient safety and factors for global vaccination campaigns. EXPERT OPINION MAP vaccine delivery can potentially be a game-changer for vaccine distribution and coverage in both high-income and low- and middle-income countries. For MAPs to reach this full potential, many critical hurdles must be overcome, such as large-scale production, regulatory compliance, and adoption by global health authorities. However, given the considerable strides made in recent years by MAP developers, it may be possible to see the first MAP-based vaccines in use within the next 5 years.
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Affiliation(s)
- Jovin J Y Choo
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Christopher L D McMillan
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - Paul R Young
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
| | - David A Muller
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD, Australia
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Park S, Lee K, Ryu W. Research progress on detachable microneedles for advanced applications. Expert Opin Drug Deliv 2022; 19:1115-1131. [PMID: 36062366 DOI: 10.1080/17425247.2022.2121388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Microneedles (MNs) have undergone great advances in transdermal drug delivery, and commercialized MN applications are currently available in vaccination and cosmetic products. Despite the development of MN technologies, common limitations of MN products still exist. Typical MN patches are applied to target tissues, where the substrate of an MN patch must remain until the drug is delivered, which reduces patients' compliance and hinders the applicability of the MN technique to many diseases in various tissues. MN research is ongoing to solve this issue. AREAS COVERED Most recent MNs developed by combining various biomaterials with appropriate fabrication processes are detachable MNs (DeMNs). Because of advances in biomaterials and fabrication techniques, various DeMNs have been rapidly developed. In this review, we discuss four types of DeMN: substrate-separable, multi-layered, crack-inducing, and shell DeMN. These DeMNs deliver various therapeutic agents ranging from small- and large-molecular-weight drugs to proteins and even stem cells for regeneration therapy. Furthermore, DeMNs are applied to skin as well as non-transdermal tissues. EXPERT OPINION It has become increasingly evident that novel MN technologies can be expected in terms of designs, fabrication methods, materials, and even possible application sites given the recent advances in DeMNs.
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Affiliation(s)
- SeungHyun Park
- Department of Mechanical Engineering, Yonsei University, Republic of Korea
| | - KangJu Lee
- School of Healthcare and Biomedical Engineering, Chonnam National University, Republic of Korea
| | - WonHyoung Ryu
- Department of Mechanical Engineering, Yonsei University, Republic of Korea
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Mamun AA, Zhao F. In-Plane Si Microneedles: Fabrication, Characterization, Modeling and Applications. MICROMACHINES 2022; 13:657. [PMID: 35630124 PMCID: PMC9146885 DOI: 10.3390/mi13050657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 01/26/2023]
Abstract
Microneedles are getting more and more attention in research and commercialization since their advancement in the 1990s due to the advantages over traditional hypodermic needles such as minimum invasiveness, low material and fabrication cost, and precise needle geometry control, etc. The design and fabrication of microneedles depend on various factors such as the type of materials used, fabrication planes and techniques, needle structures, etc. In the past years, in-plane and out-of-plane microneedle technologies made by silicon (Si), polymer, metal, and other materials have been developed for numerous biomedical applications including drug delivery, sample collections, medical diagnostics, and bio-sensing. Among these microneedle technologies, in-plane Si microneedles excel by the inherent properties of Si such as mechanical strength, wear resistance, biocompatibility, and structural advantages of in-plane configuration such as a wide range of length, readiness of integration with other supporting components, and complementary metal-oxide-semiconductor (CMOS) compatible fabrication. This article aims to provide a review of in-plane Si microneedles with a focus on fabrication techniques, theoretical and numerical analysis, experimental characterization of structural and fluidic behaviors, major applications, potential challenges, and future prospects.
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Affiliation(s)
| | - Feng Zhao
- Micro/Nanoelectronics and Energy Laboratory, School of Engineering and Computer Science, Washington State University, Vancouver, WA 98686, USA;
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Valdivia-Olivares RY, Rodriguez-Fernandez M, Álvarez-Figueroa MJ, Kalergis AM, González-Aramundiz JV. The Importance of Nanocarrier Design and Composition for an Efficient Nanoparticle-Mediated Transdermal Vaccination. Vaccines (Basel) 2021; 9:vaccines9121420. [PMID: 34960166 PMCID: PMC8705631 DOI: 10.3390/vaccines9121420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022] Open
Abstract
The World Health Organization estimates that the pandemic caused by the SARS-CoV-2 virus claimed more than 3 million lives in 2020 alone. This situation has highlighted the importance of vaccination programs and the urgency of working on new technologies that allow an efficient, safe, and effective immunization. From this perspective, nanomedicine has provided novel tools for the design of the new generation of vaccines. Among the challenges of the new vaccine generations is the search for alternative routes of antigen delivery due to costs, risks, need for trained personnel, and low acceptance in the population associated with the parenteral route. Along these lines, transdermal immunization has been raised as a promising alternative for antigen delivery and vaccination based on a large absorption surface and an abundance of immune system cells. These features contribute to a high barrier capacity and high immunological efficiency for transdermal immunization. However, the stratum corneum barrier constitutes a significant challenge for generating new pharmaceutical forms for transdermal antigen delivery. This review addresses the biological bases for transdermal immunomodulation and the technological advances in the field of nanomedicine, from the passage of antigens facilitated by devices to cross the stratum corneum, to the design of nanosystems, with an emphasis on the importance of design and composition towards the new generation of needle-free nanometric transdermal systems.
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Affiliation(s)
- Rayen Yanara Valdivia-Olivares
- Departamento de Farmacia, Escuela de Química y Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (R.Y.V.-O.); (M.J.Á.-F.)
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Maria Rodriguez-Fernandez
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - María Javiera Álvarez-Figueroa
- Departamento de Farmacia, Escuela de Química y Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile; (R.Y.V.-O.); (M.J.Á.-F.)
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins No. 340, Santiago 7810000, Chile
- Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 7810000, Chile
- Correspondence: (A.M.K.); (J.V.G.-A.)
| | - José Vicente González-Aramundiz
- Millennium Institute on Immunology and Immunotherapy, Departamento de Farmacia, Escuela de Química y Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
- Centro de Investigación en Nanotecnología y Materiales Avanzados “CIEN-UC”, Pontificia Universidad Católica de Chile, Santiago 7810000, Chile
- Correspondence: (A.M.K.); (J.V.G.-A.)
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7
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Nagarkar R, Singh M, Nguyen HX, Jonnalagadda S. A review of recent advances in microneedle technology for transdermal drug delivery. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101923] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hettinga J, Carlisle R. Vaccination into the Dermal Compartment: Techniques, Challenges, and Prospects. Vaccines (Basel) 2020; 8:E534. [PMID: 32947966 PMCID: PMC7564253 DOI: 10.3390/vaccines8030534] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/06/2023] Open
Abstract
In 2019, an 'influenza pandemic' and 'vaccine hesitancy' were listed as two of the top 10 challenges to global health by the WHO. The skin is a unique vaccination site, due to its immune-rich milieu, which is evolutionarily primed to respond to challenge, and its ability to induce both humoral and cellular immunity. Vaccination into this dermal compartment offers a way of addressing both of the challenges presented by the WHO, as well as opening up avenues for novel vaccine formulation and dose-sparing strategies to enter the clinic. This review will provide an overview of the diverse range of vaccination techniques available to target the dermal compartment, as well as their current state, challenges, and prospects, and touch upon the formulations that have been developed to maximally benefit from these new techniques. These include needle and syringe techniques, microneedles, DNA tattooing, jet and ballistic delivery, and skin permeabilization techniques, including thermal ablation, chemical enhancers, ablation, electroporation, iontophoresis, and sonophoresis.
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Affiliation(s)
| | - Robert Carlisle
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK;
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Xie L, Zeng H, Sun J, Qian W. Engineering Microneedles for Therapy and Diagnosis: A Survey. MICROMACHINES 2020; 11:E271. [PMID: 32150866 PMCID: PMC7143426 DOI: 10.3390/mi11030271] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023]
Abstract
Microneedle (MN) technology is a rising star in the point-of-care (POC) field, which has gained increasing attention from scientists and clinics. MN-based POC devices show great potential for detecting various analytes of clinical interests and transdermal drug delivery in a minimally invasive manner owing to MNs' micro-size sharp tips and ease of use. This review aims to go through the recent achievements in MN-based devices by investigating the selection of materials, fabrication techniques, classification, and application, respectively. We further highlight critical aspects of MN platforms for transdermal biofluids extraction, diagnosis, and drug delivery assisted disease therapy. Moreover, multifunctional MNs for stimulus-responsive drug delivery systems were discussed, which show incredible potential for accurate and efficient disease treatment in dynamic environments for a long period of time. In addition, we also discuss the remaining challenges and emerging trend of MN-based POC devices from the bench to the bedside.
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Affiliation(s)
- Liping Xie
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China;
| | - Hedele Zeng
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110169, China;
| | - Jianjun Sun
- Border Biomedical Research Center, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Wei Qian
- Department of Electrical and Computer Engineering, University of Texas, EI Paso, TX 79968, USA;
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Sabri AH, Kim Y, Marlow M, Scurr DJ, Segal J, Banga AK, Kagan L, Lee JB. Intradermal and transdermal drug delivery using microneedles - Fabrication, performance evaluation and application to lymphatic delivery. Adv Drug Deliv Rev 2020; 153:195-215. [PMID: 31634516 DOI: 10.1016/j.addr.2019.10.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022]
Abstract
The progress in microneedle research is evidenced by the transition from simple 'poke and patch' solid microneedles fabricated from silicon and stainless steel to the development of bioresponsive systems such as hydrogel-forming and dissolving microneedles. In this review, we provide an outline on various microneedle fabrication techniques which are currently employed. As a range of factors, including materials, geometry and design of the microneedles, affect the performance, it is important to understand the relationships between them and the resulting delivery of therapeutics. Accordingly, there is a need for appropriate methodologies and techniques for characterization and evaluation of microneedle performance, which will also be discussed. As the research expands, it has been observed that therapeutics delivered via microneedles has gained expedited access to the lymphatics, which makes them a favorable delivery method for targeting the lymphatic system. Such opportunity is valuable in the area of vaccination and treatment of lymphatic disorders, which is the final focus of the review.
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11
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Expanding the applications of microneedles in dermatology. Eur J Pharm Biopharm 2019; 140:121-140. [DOI: 10.1016/j.ejpb.2019.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022]
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12
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Chablani L, Tawde SA, Akalkotkar A, D'Souza MJ. Evaluation of a Particulate Breast Cancer Vaccine Delivered via Skin. AAPS JOURNAL 2019; 21:12. [PMID: 30604321 DOI: 10.1208/s12248-018-0285-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
Breast cancer impacts female population globally and is the second most common cancer for females. With various limitations and adverse effects of current therapies, several immunotherapies are being explored. Development of an effective breast cancer vaccine can be a groundbreaking immunotherapeutic approach. Such approaches are being evaluated by several clinical trials currently. On similar lines, our research study aims to evaluate a particulate breast cancer vaccine delivered via skin. This particulate breast cancer vaccine was prepared by spray drying technique and utilized murine breast cancer whole cell lysate as a source of tumor-associated antigens. The average size of the particulate vaccine was 1.5 μm, which resembled the pathogenic species, thereby assisting in phagocytosis and antigen presentation leading to further activation of the immune response. The particulate vaccine was delivered via skin using commercially available metal microneedles. Methylene blue staining and confocal microscopy were used to visualize the microchannels. The results showed that microneedles created aqueous conduits of 50 ± 10 μm to deliver the microparticulate vaccine to the skin layers. Further, an in vivo comparison of immune response depicted significantly higher concentration of serum IgG, IgG2a, and B and T cell (CD4+ and CD8+) populations in the vaccinated animals than the control animals (p < 0.001). Upon challenge with live murine breast cancer cells, the vaccinated animals showed five times more tumor suppression than the control animals confirming the immune response activation and protection (p < 0.001). This research paves a way for individualized immunotherapy following surgical tumor removal to prolong relapse episodes.
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Affiliation(s)
- Lipika Chablani
- Department of Pharmaceutical Science, Wegmans School of Pharmacy, St. John Fisher College, 3690 East Ave., Rochester, New York, 14618, USA.
| | - Suprita A Tawde
- Research and Development, Nexus Pharmaceuticals, Vernon Hills, Illinois, 60061, USA
| | | | - Martin J D'Souza
- Vaccine Nanotechnology Laboratory, Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Mercer University, Atlanta, Georgia, 30341, USA
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Hung IFN, Yuen KY. Immunogenicity, safety and tolerability of intradermal influenza vaccines. Hum Vaccin Immunother 2018; 14:565-570. [PMID: 28604266 PMCID: PMC5861844 DOI: 10.1080/21645515.2017.1328332] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/17/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022] Open
Abstract
Intradermal influenza vaccination has been studied for more than 80 y. The revived interest in this strategy of vaccination is a result of the innovative technologies in needle design allowing more precise injection and making the device easier to use. Furthermore, clinical trials on these novel devices have demonstrated significant dose sparing effects, improved immunogenicity and very few adverse effects. This review compares intradermal vaccination with various devices with subcutaneous and intramuscular vaccination. We also discussed the role of topical adjuvant before intradermal vaccination.
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Affiliation(s)
- Ivan F. N. Hung
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection and Division of Infectious Disease, State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, the University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Carol Yu Centre for Infection and Division of Infectious Disease, State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, the University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
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14
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Zhou S, Ren T, Gu H, Wang C, Li M, Zhao Z, Xing L, Zhang L, Sun Y, Yang P, Wang X. Intradermal delivery of a fractional dose of influenza H7N9 split vaccine elicits protective immunity in mice and rats. Hum Vaccin Immunother 2018; 14:623-629. [PMID: 29400997 DOI: 10.1080/21645515.2017.1423156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Vaccination is the most effective method of preventing the spread of the influenza virus. However, the traditional intramuscular (IM) immunization causes fear, pain, and cross infection. In contrast, needle-free (NF) immunization is quick and easy for medical personnel and painless and safe for patients. In this study, we assessed the safety and protective efficacy of NF intradermal (ID) immunization with the influenza H7N9 split vaccine (Anhui H7N9/PR8). A preliminary safety evaluation showed that ID immunization with 15 μg of the H7N9 influenza vaccine was not toxic in rats. Moreover, the antigen was metabolized more rapidly after ID than after IM immunization, as determined by in vivo imaging, and ID immunization accelerated the generation of a specific immune response. Additionally, ID immunization with a 20% dose of the H7N9 split vaccine Anhui H7N9/PR8 offered complete protection against lethal challenge by the live H7N9 virus. Taken together, our findings suggest that NF ID immunization with the H7N9 influenza vaccine induces effective protection, has a good safety profile, requires little antigen, and elicits an immune response more rapidly than does IM immunization. This approach may be used to improve the control of influenza H7N9 outbreaks.
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Affiliation(s)
- Shanshan Zhou
- a Anhui Medical University , HeFei , Anhui , China.,b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Tianyu Ren
- c Department of Hepatobibiary of Beijing Hospital, Beijing , China
| | - Hongjing Gu
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Cheng Wang
- e Department of Orthopedics of Chinese PLA General Hospital , Beijing , China
| | - Min Li
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Zhongpeng Zhao
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Li Xing
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Liangyan Zhang
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
| | - Yi Sun
- d Jiangsu Chengyu Mite Medical Technologies Co. Taizhou , Jiangsu , China
| | - Penghui Yang
- b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China.,c Department of Hepatobibiary of Beijing Hospital, Beijing , China
| | - Xiliang Wang
- a Anhui Medical University , HeFei , Anhui , China.,b State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences , Beijing , China
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15
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Vassilieva EV, Wang S, Li S, Prausnitz MR, Compans RW. Skin immunization by microneedle patch overcomes statin-induced suppression of immune responses to influenza vaccine. Sci Rep 2017; 7:17855. [PMID: 29259264 PMCID: PMC5736694 DOI: 10.1038/s41598-017-18140-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/06/2017] [Indexed: 01/02/2023] Open
Abstract
Recent studies indicated that in elderly individuals, statin therapy is associated with a reduced response to influenza vaccination. The present study was designed to determine effects on the immune response to influenza vaccination induced by statin administration in a mouse model, and investigate potential approaches to improve the outcome of vaccination on the background of statin therapy. We fed middle aged BALB/c mice a high fat “western” diet (WD) alone or supplemented with atorvastatin (AT) for 14 weeks, and control mice were fed with the regular rodent diet. Mice were immunized with a single dose of subunit A/Brisbane/59/07 (H1N1) vaccine, either systemically or with dissolving microneedle patches (MNPs). We observed that a greater age-dependent decline in the hemagglutinin inhibition titers occurred in systemically-immunized mice than in MNP- immunized mice. AT dampened the antibody response in the animals vaccinated by either route of vaccine delivery. However, the MNP-vaccinated AT-treated animals had ~20 times higher total antibody levels to the influenza vaccine than the systemically vaccinated group one month postvaccination. We propose that microneedle vaccination against influenza provides an approach to ameliorate the immunosuppressive effect of statin therapy observed with systemic immunization.
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Affiliation(s)
- Elena V Vassilieva
- Department of Microbiology & Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Shelly Wang
- Department of Microbiology & Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, Georgia
| | - Song Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, Georgia
| | - Mark R Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, Georgia
| | - Richard W Compans
- Department of Microbiology & Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, Georgia.
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Demeulemeester M, Lavis N, Balthazar Y, Lechien P, Heijmans S. Rapid safety assessment of a seasonal intradermal trivalent influenza vaccine. Hum Vaccin Immunother 2016; 13:889-894. [PMID: 27960593 PMCID: PMC5404648 DOI: 10.1080/21645515.2016.1253644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Seasonal influenza vaccine formulations must be updated annually to correspond to the influenza viruses in circulation. This was an uncontrolled, open-label, multi-center phase IV study conducted in Belgium to comply with interim European Medicines Agency (EMA) guidelines for rapidly evaluating the safety of newly formulated seasonal influenza vaccines. Adult volunteers received one dose of the 2014-2015 Northern Hemisphere formulation of licensed intradermal trivalent influenza vaccine at either the standard dose (9µg hemagglutinin/strain for 18−59 year-olds) or the high dose (15µg hemagglutinin/strain for ≥ 60 year-olds). Vaccinees recorded their solicited reactions and unsolicited adverse events for 7 d after vaccination. Solicited reaction frequencies were compared to historical reference values obtained from previous clinical trials to determine if the new formulations were excessively reactogenic or allergenic. A total of 210 participants (105 per age group) were included and vaccinated in October 2014. In both groups, pain, erythema, and pruritus were the most common solicited injection site reactions, and headache and myalgia were the most common solicited systemic reactions. Although the frequencies of shivering in 18−59 year-olds and malaise in ≥ 60 year-olds were higher than historical reference values, they were not considered indicative of excessive reactogenicity because almost all of these reactions were mild. The study design was endorsed by the EMA and permitted the reactogenicity of both vaccine formulations to be assessed within one month by collecting adverse events for 7 d. Both formulations exhibited acceptable safety profiles although this should be confirmed through forthcoming enhanced post-marketing safety surveillance systems.
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Robertson CA, Tsang P, Landolfi VA, Greenberg DP. Fluzone® Intradermal Quadrivalent Influenza Vaccine. Expert Rev Vaccines 2016; 15:1245-53. [PMID: 27457797 DOI: 10.1080/14760584.2016.1215246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An intradermal version of Fluzone® split-virion inactivated trivalent influenza vaccine, containing 9 µg hemagglutinin per strain of A/H1N1, A/H3N2, and one B lineage virus (Fluzone Intradermal, Sanofi Pasteur), became available in the US during the 2011-2012 influenza season for adults 18-64 years of age. In advance of the 2015-2016 season, Fluzone Intradermal was replaced with Fluzone Intradermal Quadrivalent vaccine, which contains 9 µg hemagglutinin per strain of the two A-strain viruses and both B-strain lineage viruses (Victoria and Yamagata). AREAS COVERED This literature review summarizes the history and mechanism of intradermal vaccination, discusses the clinical trial results supporting the immunogenicity and safety of Fluzone Intradermal Quadrivalent vaccine, and describes the unique microinjection system used to deliver Fluzone Intradermal Quadrivalent. Expert commentary: Fluzone Intradermal Quadrivalent may boost confidence in influenza vaccination with the addition of a second B-lineage strain. By using an innovative microinjection system, the vaccine is also designed to address some of the logistic challenges faced by healthcare providers administering immunizations.
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Affiliation(s)
- Corwin A Robertson
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA
| | - Peter Tsang
- b Clinical Development Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - Victoria A Landolfi
- c Late Development and Innovation Department , Sanofi Pasteur Inc ., Swiftwater , PA , USA
| | - David P Greenberg
- a Scientific and Medical Affairs Department , Sanofi Pasteur Inc ., Discovery Drive, Swiftwater , PA , USA.,d Department of Pediatrics , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA
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Bragazzi NL, Orsi A, Ansaldi F, Gasparini R, Icardi G. Fluzone® intra-dermal (Intanza®/Istivac® Intra-dermal): An updated overview. Hum Vaccin Immunother 2016; 12:2616-2627. [PMID: 27246556 DOI: 10.1080/21645515.2016.1187343] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Influenza is a highly contagious respiratory acute viral disease which imposes a very heavy burden both in terms of epidemiology and costs, in the developed countries as well as in the developing ones. It represents a serious public health concern and vaccination constitutes an important tool to reduce or at least mitigate its burden. Despite the existence of a broad armamentarium against influenza and despite all the efforts and recommendations of international organisms to broaden immunization, influenza vaccination coverage is still far from being optimal. This, taken together with logistic and technical difficulties that can result into vaccine shortage, makes intra-dermal (ID) vaccines, such as Fluzone® ID and Intanza®, particularly attractive. ID vaccines are comparable and, in some cases, superior to intra-muscular/sub-cutaneous vaccines in terms of immunogenicity, safety, reactogenicity, tolerability and cross-protection profiles, as well as in terms of patient preference, acceptance and vaccine selection. Further advances, such as Fluzone® ID with alternative B strains and Quadrivalent Fluzone® ID or the possibility of self-administering the vaccines, make influenza ID vaccines even more valuable.
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Affiliation(s)
| | - Andrea Orsi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Filippo Ansaldi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
| | - Roberto Gasparini
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy
| | - Giancarlo Icardi
- a Department of Health Sciences (DISSAL) , University of Genoa , Genoa , Italy.,b Hygiene Unit, IRCCS AOU San Martino - IST of Genoa , Genoa , Italy
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Abstract
Intradermal (ID) vaccination induces a more potent immune response and requires lower vaccine doses as compared with standard vaccination routes. To deliver ID vaccines effectively and consistently, an ID delivery device has been developed and is commercially available for adults. The clinical application of ID vaccines for infants and children is much anticipated because children receive several vaccines, on multiple occasions, during infancy and childhood. However, experience with ID vaccines is limited and present evidence is sparse and inconsistent. ID delivery devices are not currently available for infants and children, but recent studies have examined skin thickness in this population and reported that it did not differ in proportion to body size in infants, children, and adults. These results are helpful in developing new ID devices and for preparing new vaccines in infants and children.
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Affiliation(s)
- Akihiko Saitoh
- a Department of Pediatrics , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
| | - Yuta Aizawa
- a Department of Pediatrics , Niigata University Graduate School of Medical and Dental Sciences , Niigata , Japan
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Marshall S, Sahm LJ, Moore AC. The success of microneedle-mediated vaccine delivery into skin. Hum Vaccin Immunother 2016; 12:2975-2983. [PMID: 27050528 DOI: 10.1080/21645515.2016.1171440] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Microneedles (MNs) are designed to specifically target the outermost, skin barrier layer, the stratum corneum, creating transient pathways for minimally invasive transcutaneous delivery. It is reported that MNs can facilitate delivery without stimulating the pain receptors or damaging blood vessels that lie beneath, thus being perceived as painless and associated with reduced bleeding. This immunocompetence of the skin, coupled with its ease of access, makes this organ an attractive vaccination site. The purpose of this review was to collate primary scientific literature pertaining to MN-mediated in vivo vaccination programmes. A total of 62 original research articles are presented, compiling vaccination strategies in 6 different models (mouse, rat, guinea pig, rabbit, pig, macaque and human). Vaccines tested span a wide range of viral, bacterial and protozoan pathogens and includes 7 of the 13 vaccine-preventable diseases, as defined by the WHO. This review highlights the paucity of available clinical trial data. MN-delivered vaccines have demonstrated safety and immunogenicity in pre-clinical models and boast desirable attributes such as painless administration, thermostability, dose-sparing capacity and the potential for self-administration. These advantages should contribute to enhanced global vaccine access.
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Affiliation(s)
- Sarah Marshall
- a School of Pharmacy, University College Cork , Cork , Ireland
| | - Laura J Sahm
- a School of Pharmacy, University College Cork , Cork , Ireland.,b Department of Pharmacy , Mercy University Hospital , Cork , Ireland
| | - Anne C Moore
- a School of Pharmacy, University College Cork , Cork , Ireland.,c Department of Pharmacology and Therapeutics , University College Cork , Cork , Ireland
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Tozuka M, Oka T, Jounai N, Egawa G, Ishii KJ, Kabashima K, Takeshita F. Efficient antigen delivery to the draining lymph nodes is a key component in the immunogenic pathway of the intradermal vaccine. J Dermatol Sci 2015; 82:38-45. [PMID: 26674124 DOI: 10.1016/j.jdermsci.2015.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND It has been clinically demonstrated that intradermal (ID) vaccines have a potential to confer a superior immunogenic profile compared to intramuscular (IM) or subcutaneous (SC) vaccines. In terms of distribution of a vaccine antigen depending on the administration routes, at least two independent immunogenic pathways of the vaccines have been proposed: (1) the antigen recognition by the immune cells present at the vaccine-administered site and (2) the antigen recognition by the lymph node (LN)-resident immune cells through the lymphatic flow from the vaccine-administered site after the antigen is directly delivered into the draining LNs. OBJECTIVE In order to clarify the key components for the immunogenic pathway of the ID vaccine, the correlation between the kinetics of the antigen distribution to the draining LNs and antibody responses to the antigen were evaluated. METHODS We compared the antibody responses in the groups with by surgical removal of the administration site immediately after the ID administration, and by surgical removal of the draining LNs before the ID administration. RESULTS The results suggested that the efficient and direct antigen delivery to the draining LNs plays an important role in the antibody responses to the ID vaccine. Indeed, it was confirmed that the direct administration into the draining LNs with the antigen elicited comparable levels of the antibody responses with the ID vaccine. At the cellular level, it was shown that the LN-resident immune cells such as B cells, dendritic cells, and macrophages including medullary macrophages and subcapsular sinus macrophages interacting with the antigens following the ID administration. Finally, we demonstrated by immunofluorescence analysis that the lymphatic vessels are more diffusely distributed in the dermis as compared with the subcutaneous area and muscle. CONCLUSION The results of the present study suggested that the skin is an optimal tissue to facilitate the vaccine antigen access to the draining LNs, which is an important immunogenic pathway of the ID vaccine. Further elucidation of regulatory mechanisms underlying such an immunogenic pathway of the ID vaccine would provide us with elements for the development of novel adjuvants and devices to enhance the immunogenicity of the ID vaccines.
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Affiliation(s)
- Miyuki Tozuka
- Kitasato Daiichi Sankyo Vaccine Co., Ltd., 1-16-13 Kitakasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Tatsuya Oka
- Kitasato Daiichi Sankyo Vaccine Co., Ltd., 1-16-13 Kitakasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Nao Jounai
- Kitasato Daiichi Sankyo Vaccine Co., Ltd., 1-16-13 Kitakasai, Edogawa-ku, Tokyo 134-8630, Japan
| | - Gyohei Egawa
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Syogoin-Kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
| | - Ken J Ishii
- Laboratory of Adjuvant Innovation, National Institutes of Biomedical Innovation, 7-6-8 Saito-Asagi, Ibaraki City, Osaka 567-0085, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Syogoin-Kawaramachi, Sakyo-ku, Kyoto 606-8507, Japan
| | - Fumihiko Takeshita
- Daiichi Sankyo Co., Ltd., 3-5-1 Nihonbashi Honcho, Chuo-ku, Tokyo 103-8426, Japan.
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Atmar RL, Keitel WA. Influenza Vaccination of Patients Receiving Statins: Where Do We Go From Here? J Infect Dis 2015; 213:1211-3. [DOI: 10.1093/infdis/jiv459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 11/12/2022] Open
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DiazGranados CA, Robertson CA, Talbot HK, Landolfi V, Dunning AJ, Greenberg DP. Prevention of serious events in adults 65 years of age or older: A comparison between high-dose and standard-dose inactivated influenza vaccines. Vaccine 2015. [PMID: 26212007 DOI: 10.1016/j.vaccine.2015.07.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A recent study showed that a high-dose inactivated influenza vaccine (IIV-HD) was 24.2% more efficacious than a standard-dose inactivated influenza vaccine (IIV-SD) in preventing laboratory-confirmed symptomatic influenza in adults ≥65 years. Here we evaluate the effectiveness of IIV-HD compared to IIV-SD in preventing serious illnesses considered potential sequelae or complications of influenza infection. METHODS The original study was a double-blind, randomized, active-controlled, multicenter trial. Participants were adults ≥65 years randomized to receive IIV-HD or IIV-SD, and followed for 6-8 months post-vaccination for the occurrence of influenza and serious adverse events (SAEs). SAEs were events: leading to death or hospitalization (or its prolongation); considered life-threatening or medically important; or resulting in disability. For the present analysis, reported SAEs were classified as possibly related to influenza by three blinded physicians and rates per 1000 participant-seasons were calculated. Relative vaccine effectiveness (rVE) was estimated as (1-Rate Ratio)×100. RESULTS 31,989 participants were enrolled, with 15,991 and 15,998 randomized to receive IIV-HD and IIV-SD, respectively. IIV-HD was significantly more effective than IIV-SD in preventing SAEs possibly related to influenza overall (rVE, 17.7%; 95% confidence interval [CI], 6.6-27.4%) and serious pneumonia (rVE, 39.8%; 95% CI, 19.3-55.1%). Borderline significance was observed for the efficacy of IIV-HD relative to IIV-SD for the prevention of all-cause hospitalizations (rVE, 6.9%; 95% CI, 0.5-12.8%). CONCLUSIONS Compared to IIV-SD, IIV-HD reduced the risk of SAEs possibly related to influenza. The observed relative effectiveness against serious pneumonia is particularly noteworthy considering the burden of influenza and pneumonia in older adults.
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Affiliation(s)
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, A2200 MCN 1161 21st Ave S, Nashville, TN 37212, USA
| | | | | | - David P Greenberg
- Sanofi Pasteur, 1 Discovery Drive, Swiftwater, PA 18370, USA; Department of Pediatrics, University of Pittsburgh School of Medicine, USA
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Saitoh A, Aizawa Y, Sato I, Hirano H, Sakai T, Mori M. Skin thickness in young infants and adolescents: Applications for intradermal vaccination. Vaccine 2015; 33:3384-91. [DOI: 10.1016/j.vaccine.2015.04.081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/31/2015] [Accepted: 04/22/2015] [Indexed: 11/26/2022]
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Camilloni B, Basileo M, Valente S, Nunzi E, Iorio AM. Immunogenicity of intramuscular MF59-adjuvanted and intradermal administered influenza enhanced vaccines in subjects aged over 60: A literature review. Hum Vaccin Immunother 2015; 11:553-63. [PMID: 25714138 PMCID: PMC4514405 DOI: 10.1080/21645515.2015.1011562] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/06/2014] [Accepted: 11/20/2014] [Indexed: 12/23/2022] Open
Abstract
Because of the age-related immune system decline, 2 potentiated influenza vaccines were specifically licensed for the elderly: Fluad(®), an MF59-adjuvanted vaccine administered intramuscularly (IM-MF59), and Intanza 15 mcg(®), a non adjuvanted vaccine administered intradermally (ID). The objective of this paper was to conduct a systematic review of studies that evaluated antibody responses in the elderly following immunization with IM-MF59 or ID vaccines. The two potentiated vaccines induced immune responses satisfying, in most instances, the European Medicine Agency immunogenicity criteria, both against vaccine antigens and heterovariant drifted strains. Considering pooled data reported in the articles analyzed and papers directly comparing the 2 vaccines, the antibody responses elicited by IM-MF59 and ID were found to be generally comparable. The use of IM-MF59 and ID vaccines can be proposed as an appropriate strategy for elderly seasonal influenza vaccination although further studies are required for a more complete characterization of the 2 vaccines.
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Affiliation(s)
- Barbara Camilloni
- Department of Experimental Medicine; University of Perugia; Perugia, Italy
| | - Michela Basileo
- Department of Experimental Medicine; University of Perugia; Perugia, Italy
| | | | - Emilia Nunzi
- Department of Experimental Medicine; University of Perugia; Perugia, Italy
| | - Anna Maria Iorio
- Department of Experimental Medicine; University of Perugia; Perugia, Italy
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DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, Pollak R, Christoff J, Earl J, Landolfi V, Martin E, Gurunathan S, Nathan R, Greenberg DP, Tornieporth NG, Decker MD, Talbot HK. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med 2014; 371:635-45. [PMID: 25119609 DOI: 10.1056/nejmoa1315727] [Citation(s) in RCA: 546] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND As compared with a standard-dose vaccine, a high-dose, trivalent, inactivated influenza vaccine (IIV3-HD) improves antibody responses to influenza among adults 65 years of age or older. This study evaluated whether IIV3-HD also improves protection against laboratory-confirmed influenza illness. METHODS We conducted a phase IIIb-IV, multicenter, randomized, double-blind, active-controlled trial to compare IIV3-HD (60 μg of hemagglutinin per strain) with standard-dose trivalent, inactivated influenza vaccine (IIV3-SD [15 μg of hemagglutinin per strain]) in adults 65 years of age or older. Assessments of relative efficacy, effectiveness, safety (serious adverse events), and immunogenicity (hemagglutination-inhibition [HAI] titers) were performed during the 2011-2012 (year 1) and the 2012-2013 (year 2) northern-hemisphere influenza seasons. RESULTS A total of 31,989 participants were enrolled from 126 research centers in the United States and Canada (15,991 were randomly assigned to receive IIV3-HD, and 15,998 to receive IIV3-SD). In the intention-to-treat analysis, 228 participants in the IIV3-HD group (1.4%) and 301 participants in the IIV3-SD group (1.9%) had laboratory-confirmed influenza caused by any viral type or subtype associated with a protocol-defined influenza-like illness (relative efficacy, 24.2%; 95% confidence interval [CI], 9.7 to 36.5). At least one serious adverse event during the safety surveillance period was reported by 1323 (8.3%) of the participants in the IIV3-HD group, as compared with 1442 (9.0%) of the participants in the IIV3-SD group (relative risk, 0.92; 95% CI, 0.85 to 0.99). After vaccination, HAI titers and seroprotection rates (the percentage of participants with HAI titers ≥ 1:40) were significantly higher in the IIV3-HD group. Conclusions: Among persons 65 years of age or older, IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza illness than did IIV3-SD. (Funded by Sanofi Pasteur; ClinicalTrials.gov number, NCT01427309.).
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Affiliation(s)
- Carlos A DiazGranados
- From Sanofi Pasteur, Swiftwater (C.A.D., A.J.D., D.K., J.C., V.L., S.G., D.P.G., N.G.T., M.D.D.), ReSearch Pharmaceutical Services, Fort Washington (A.C.), and the Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh (D.P.G.) - all in Pennsylvania; Accelovance, Melbourne, FL (M.K.); University of Rochester, Rochester, NY (J.T.); Endeavor Clinical Trials, San Antonio (R.P.), and Martin Diagnostic Clinic, Tomball (E.M.) - both in Texas; PMG Research of Hickory, Hickory, NC (J.E.); Idaho Falls Infectious Diseases and Snake River Research, Idaho Falls, ID (R.N.); and the Department of Health Policy, Vanderbilt University School of Medicine (M.D.D.) and Vanderbilt University Medical Center (H.K.T.) - both in Nashville
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Tsang P, Gorse GJ, Strout CB, Sperling M, Greenberg DP, Ozol-Godfrey A, DiazGranados C, Landolfi V. Immunogenicity and safety of Fluzone® intradermal and high-dose influenza vaccines in older adults ≥65 years of age: A randomized, controlled, phase II trial. Vaccine 2014; 32:2507-17. [DOI: 10.1016/j.vaccine.2013.09.074] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/19/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023]
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Even-Or O, Samira S, Ellis R, Kedar E, Barenholz Y. Adjuvanted influenza vaccines. Expert Rev Vaccines 2014; 12:1095-108. [PMID: 24053401 DOI: 10.1586/14760584.2013.825445] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Influenza is one of the most common causes of human morbidity and mortality that is preventable by vaccination. Immunization with available vaccines provides incomplete protection against illness caused by influenza virus, especially in high-risk groups such as the elderly and young children. Thus, more efficacious vaccines are needed for the entire population, and all the more so for high-risk groups. One way to improve immune responses and protection is to formulate the vaccine with antigen carriers and/or adjuvants, which can play an important role in improving immune responses and delivery to antigen-presenting cells, especially for a vaccine like influenza that is based on protein antigens usually administered without a carrier or adjuvant. In this review, the authors present an overview of available vaccines, focusing on research and development of new adjuvants used in influenza vaccines, as well as adjuvanted influenza vaccines aimed to improve immune responses, protection and breadth of coverage for influenza.
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Affiliation(s)
- Orli Even-Or
- Laboratory of Membrane and Liposome Research, Department of Biochemistry, The Hebrew University-Hadassah Medical School, P.O. Box 12272, Jerusalem 91120, Israel
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Gill HS, Kang SM, Quan FS, Compans RW. Cutaneous immunization: an evolving paradigm in influenza vaccines. Expert Opin Drug Deliv 2014; 11:615-27. [PMID: 24521050 DOI: 10.1517/17425247.2014.885947] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Most vaccines are administered by intramuscular injection using a hypodermic needle and syringe. Some limitations of this procedure include reluctance to be immunized because of fear of needlesticks, and concerns associated with the safe disposal of needles after their use. Skin delivery is an alternate route of vaccination that has potential to be painless and could even lead to dose reduction of vaccines. Recently, microneedles have emerged as a novel painless approach for delivery of influenza vaccines via the skin. AREAS COVERED In this review, we briefly summarize the approaches and devices used for skin vaccination, and then focus on studies of skin immunization with influenza vaccines using microneedles. We discuss both the functional immune response and the nature of this immune response following vaccination with microneedles. EXPERT OPINION The cutaneous administration of influenza vaccines using microneedles offers several advantages: it is painless, elicits stronger immune responses in preclinical studies and could improve responses in high-risk populations. These dry formulations of vaccines provide enhanced stability, a property of high importance in enabling their rapid global distribution in response to possible outbreaks of pandemic influenza and newly emerging infectious diseases.
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Affiliation(s)
- Harvinder S Gill
- Texas Tech University, Department of Chemical Engineering , Lubbock, TX , USA
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Kashiwagi S, Yuan J, Forbes B, Hibert ML, Lee ELQ, Whicher L, Goudie C, Yang Y, Chen T, Edelblute B, Collette B, Edington L, Trussler J, Nezivar J, Leblanc P, Bronson R, Tsukada K, Suematsu M, Dover J, Brauns T, Gelfand J, Poznansky MC. Near-infrared laser adjuvant for influenza vaccine. PLoS One 2013; 8:e82899. [PMID: 24349390 PMCID: PMC3859633 DOI: 10.1371/journal.pone.0082899] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/05/2013] [Indexed: 12/20/2022] Open
Abstract
Safe and effective immunologic adjuvants are often essential for vaccines. However, the choice of adjuvant for licensed vaccines is limited, especially for those that are administered intradermally. We show that non-tissue damaging, near-infrared (NIR) laser light given in short exposures to small areas of skin, without the use of additional chemical or biological agents, significantly increases immune responses to intradermal influenza vaccination without augmenting IgE. The NIR laser-adjuvanted vaccine confers increased protection in a murine influenza lethal challenge model as compared to unadjuvanted vaccine. We show that NIR laser treatment induces the expression of specific chemokines in the skin resulting in recruitment and activation of dendritic cells and is safe to use in both mice and humans. The NIR laser adjuvant technology provides a novel, safe, low-cost, simple-to-use, potentially broadly applicable and clinically feasible approach to enhancing vaccine efficacy as an alternative to chemical and biological adjuvants.
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Affiliation(s)
- Satoshi Kashiwagi
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Jianping Yuan
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Benjamin Forbes
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Mathew L. Hibert
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Eugene L. Q. Lee
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Laura Whicher
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Calum Goudie
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Yuan Yang
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Tao Chen
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Beth Edelblute
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Brian Collette
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Laurel Edington
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - James Trussler
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Jean Nezivar
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Pierre Leblanc
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Roderick Bronson
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kosuke Tsukada
- Department of Applied Physics and Physico-Informatics, Faculty of Science and Technology, Keio Universtiy, Kohoku-ku, Yokohama-city, Kanagawa, Japan
| | - Makoto Suematsu
- Department of Biochemistry, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Jeffrey Dover
- SkinCare Physicians of Chestnut Hill, Chestnut Hill, Massachusetss, United States of America
| | - Timothy Brauns
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Jeffrey Gelfand
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
| | - Mark C. Poznansky
- Vaccine and Immunotherapy Center, Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Charlestown, Massachusetts, United States of America
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Moro PL, Harrington T, Shimabukuro T, Cano M, Museru OI, Menschik D, Broder K. Adverse events after Fluzone ® Intradermal vaccine reported to the Vaccine Adverse Event Reporting System (VAERS), 2011-2013. Vaccine 2013; 31:4984-7. [PMID: 23994022 DOI: 10.1016/j.vaccine.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/28/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In May 2011, the first trivalent inactivated influenza vaccine exclusively for intradermal administration (TIV-ID) was licensed in the US for adults aged 18-64 years. OBJECTIVE To characterize adverse events (AEs) after TIV-ID reported to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting surveillance system. METHODS We searched VAERS for US reports after TIV-ID among persons vaccinated from July 1, 2011-February 28, 2013. Medical records were requested for reports coded as serious (death, hospitalization, prolonged hospitalization, disability, life-threatening-illness), and those suggesting anaphylaxis. Clinicians reviewed available information and assigned a primary clinical category to each report. Empirical Bayesian data mining was used to identify disproportional AE reporting following TIV-ID. Causality was not assessed. RESULTS VAERS received 466 reports after TIV-ID; 9 (1.9%) were serious, including one reported fatality in an 88-year-old vaccinee. Median age was 43 years (range 4-88 years). The most common AE categories were: 218 (46.8%) injection site reactions; 89 (19.1%) other non-infectious (comprised mainly of constitutional signs and symptoms); and 74 (15.9%) allergy. Eight reports (1.7%) of anaphylaxis were verified by the Brighton criteria or a documented physician diagnosis. Disproportional reporting was identified for three AEs: 'injection site nodule', 'injection site pruritus', and 'drug administered to patient of inappropriate age'. The findings for the first two AEs were expected. Twenty-four reports of vaccinees <18 years or ≥ 65 years were reported, and 14 of 24 were coded with the AE 'drug administered to patient of inappropriate age'. CONCLUSIONS Review of VAERS reports did not identify any new or unexpected safety concerns after TIV-ID. Injection site reactions were the most commonly reported AEs, similar to the pre-licensure clinical trials. Use of TIV-ID in younger and older individuals outside the approved age range highlights the need for education of healthcare providers regarding approved TIV-ID use.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Centers for Disease Control and Prevention, United States.
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Leroux-Roels I, Weber F. Intanza (®) 9 µg intradermal seasonal influenza vaccine for adults 18 to 59 years of age. Hum Vaccin Immunother 2013; 9:115-21. [PMID: 23442585 DOI: 10.4161/hv.22342] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Seasonal influenza in healthy working-age adults accounts for a substantial part of the socioeconomic burden of this disease. Intanza® 9 µg (sanofi pasteur) is a microneedle-delivered intradermal trivalent inactivated influenza vaccine approved in 2009 for the prevention of seasonal influenza in adults 18 to 59 years of age. The microneedle system reliably and reproducibly delivers the vaccine to the dermis. Clinical studies show that Intanza 9 µg is as immunogenic and as well tolerated in working-age adults as a reference intramuscular trivalent inactivated vaccine. Local reactions to Intanza 9 µg, mainly erythema, are transient, mostly mild or moderate, and do not affect acceptability. Intanza 9 µg is considered satisfactory by at least 95% of both vaccinees and prescribers, especially because of the short needle and rapid administration. Because Intanza® 9 µg offers an alternative to intramuscular vaccines, it might help increase influenza vaccine coverage rates.
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Hoon Han S, Hee Woo J, Weber F, Joo Kim W, Ran Peck K, Il Kim S, Hwa Choi Y, Myung Kim J. Immunogenicity and safety of Intanza(®)/IDflu(®) intradermal influenza vaccine in South Korean adults: a multicenter, randomized trial. Hum Vaccin Immunother 2013; 9:1971-7. [PMID: 23778938 DOI: 10.4161/hv.25295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Intanza(®)/IDflu(®) (Sanofi Pasteur, Lyon, France) is an intradermal inactivated trivalent influenza vaccine developed as an alternative to intramuscular influenza vaccine. The objective of this study was to confirm the immunogenicity and safety of Intanza/IDflu in South Korean adults. In a phase IV multicenter trial, South Korean adults 18-59 y old (n = 120) and ≥ 60 y old (n = 120) were randomized 1:1 to receive a single dose of Intanza/IDflu (9 µg for 18-59 y, 15 µg for ≥ 60 y) or trivalent intramuscular vaccine (Vaxigrip(®) 15 µg, Sanofi Pasteur, Lyon, France). Blood was collected on pre-vaccination (day 0) and on day 21. Hemagglutination inhibition titers, seroprotection rates and seroconversion rates were determined on day 21. Geometric mean titers, seroprotection and seroconversion rates were similar between the intradermal and intramuscular vaccines in both age groups for all three vaccine strains (A/H1N1, A/H3N2 and B). Both vaccines met Committee for Medicinal Products for Human Use criteria for all three strains. Solicited systemic reactions of the intradermal groups were generally mild, transient, and similar to those of the intramuscular groups. Solicited injection site reactions were more frequent in the intradermal groups but were mostly mild, transient, and consisted mainly of pain, erythema, and pruritus. No treatment-related serious adverse events or other safety concerns were reported. These results confirm that Intanza/IDflu is an effective and well-tolerated alternative to IM influenza vaccination. (Clinicaltrials.gov NCT ID: NCT01215669).
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Affiliation(s)
- Sang Hoon Han
- Department of Internal Medicine; Yonsei University College of Medicine; Seoul, Korea
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34
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Wing D, Prausnitz MR, Buono MJ. Skin pretreatment with microneedles prior to pilocarpine iontophoresis increases sweat production. Clin Physiol Funct Imaging 2013; 33:436-40. [DOI: 10.1111/cpf.12053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 04/15/2013] [Indexed: 01/04/2023]
Affiliation(s)
- David Wing
- San Diego State University; San Diego; CA; USA
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35
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Gorse GJ, Falsey AR, Fling JA, Poling TL, Strout CB, Tsang PH. Intradermally-administered influenza virus vaccine is safe and immunogenic in healthy adults 18-64 years of age. Vaccine 2013; 31:2358-65. [PMID: 23499604 DOI: 10.1016/j.vaccine.2013.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/12/2013] [Accepted: 03/04/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND To increase vaccine acceptance, intradermal (ID) influenza vaccine (Fluzone(®) Intradermal, Sanofi Pasteur Inc.) may be an attractive alternative to intramuscular (IM) vaccination due to smaller needle and volume injected. METHODS A multicenter, randomized (2:1 ID vs IM vaccines) study, blinded for ID vaccine lots, was conducted among 4292 adults 18-64 years of age enrolled in October 2008. Three lots of investigational trivalent influenza vaccine containing 9μg hemagglutinin (HA) per strain in 0.1mL administered ID with a 30 gauge, 1.5mm long needle were compared to standard dose vaccine (0.5mL containing 15μg HA/strain) given IM. RESULTS The post-vaccination antibody geometric mean titers (GMT) for the ID vaccine were similar to the IM vaccine (H1N1: 193.2 vs. 178.3, H3N2: 246.7 vs. 230.7, and B: 102.5 vs. 126.9). Non-inferiority was met for the ID vaccine compared to IM vaccine as assessed by antibody GMT ratios (IM/ID) for all three virus strains (H1N1: 0.92, H3N2: 0.94, and B: 1.24). Seroconversion rates were non-inferior for H1N1 and H3N2, but not for B (ID vs. IM: H1N1: 61.2% vs. 60.5%, H3N2: 75.3% vs. 74.8%, and B: 46.2% vs. 54.2%). Seroprotection (HAI titer ≥1:40) rates were similar between groups (ID vs. IM, H1N1: 91.1% vs. 91.7%, H3N2: 90.7% vs. 91.4%, and B: 87.4% vs. 89.3%). Local injection site reactions overall were more common with ID than IM vaccine (ID vs. IM: 89.2% vs. 60.2%), but were usually grade 1 or 2 and transient. The frequencies of local injection site pain and systemic reactions were similar between vaccine groups, except more myalgia with IM vaccine. CONCLUSIONS The ID vaccine elicited immune responses comparable to IM vaccine except for the seroconversion rate to B virus. With the exception of pain, local injection site reactions were more common with the ID vaccine, but well-tolerated and of short duration. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00772109.
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Affiliation(s)
- Geoffrey J Gorse
- Saint Louis University School of Medicine, 1100 South Grand Blvd. (DRC-8th floor), St. Louis, MO 63104, USA.
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36
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Depth-resolved characterization of diffusion properties within and across minimally-perturbed skin layers. J Control Release 2013; 166:87-94. [DOI: 10.1016/j.jconrel.2012.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/09/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
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38
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Derhovanessian E, Theeten H, Hähnel K, Van Damme P, Cools N, Pawelec G. Cytomegalovirus-associated accumulation of late-differentiated CD4 T-cells correlates with poor humoral response to influenza vaccination. Vaccine 2012. [PMID: 23196209 DOI: 10.1016/j.vaccine.2012.11.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Influenza vaccination is less effective in the elderly compared to the young. Studies that have attempted to identify immune parameters correlating with satisfactory vaccine responses have yielded inconclusive results. Here, we correlate the distribution of different circulating CD4+ and CD8+ T-cell phenotypes with the humoral response to vaccination with Intanza, an intradermal seasonal vaccine, in 54 individuals of different ages. Subjects were stratified according to age (below or over 60) and presence of a latent infection with Cytomegalovirus (CMV). CMV-seropositivity was significantly associated with a lower response rate to the vaccine in people over but not below 60 yr of age. Unlike reported data, late-differentiated (CD45RA+CCR7-CD27-CD28-) CD4+, but not CD8+ T-cells associated with a poorer vaccine response. Thus, latent CMV infection has a deleterious effect on influenza antibody responses in the elderly, which might be mediated through CD4 T-cells lacking CCR7, CD27 and CD28 and re-expressing CD45RA.
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Affiliation(s)
- Evelyna Derhovanessian
- Department of Internal Medicine II, Centre for Medical Research, University of Tübingen, 72072 Tübingen, Germany.
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39
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Kang SM, Song JM, Kim YC. Microneedle and mucosal delivery of influenza vaccines. Expert Rev Vaccines 2012; 11:547-60. [PMID: 22697052 DOI: 10.1586/erv.12.25] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In recent years with the threat of pandemic influenza and other public health needs, alternative vaccination methods other than intramuscular immunization have received great attention. The skin and mucosal surfaces are attractive sites probably because of both noninvasive access to the vaccine delivery and unique immunological responses. Intradermal vaccines using a microinjection system (BD Soluvia(TM)) and intranasal vaccines (FluMist®) are licensed. As a new vaccination method, solid microneedles have been developed using a simple device that may be suitable for self-administration. Because coated microneedle influenza vaccines are administered in the solid state, developing formulations maintaining the stability of influenza vaccines is an important issue to be considered. Marketable microneedle devices and clinical trials remain to be developed. Other alternative mucosal routes such as oral and intranasal delivery systems are also attractive for inducing cross-protective mucosal immunity, but effective non-live mucosal vaccines remain to be developed.
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Affiliation(s)
- Sang-Moo Kang
- Center for Inflammation, Immunity and Infection, and Department of Biology, Georgia State University, Atlanta, GA 30303, USA.
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40
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Weldon WC, Zarnitsyn VG, Esser ES, Taherbhai MT, Koutsonanos DG, Vassilieva EV, Skountzou I, Prausnitz MR, Compans RW. Effect of adjuvants on responses to skin immunization by microneedles coated with influenza subunit vaccine. PLoS One 2012; 7:e41501. [PMID: 22848514 PMCID: PMC3405087 DOI: 10.1371/journal.pone.0041501] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 06/21/2012] [Indexed: 11/23/2022] Open
Abstract
Recent studies have demonstrated the effectiveness of vaccine delivery to the skin by vaccine-coated microneedles; however there is little information on the effects of adjuvants using this approach for vaccination. Here we investigate the use of TLR ligands as adjuvants with skin-based delivery of influenza subunit vaccine. BALB/c mice received 1 µg of monovalent H1N1 subunit vaccine alone or with 1 µg of imiquimod or poly(I:C) individually or in combination via coated microneedle patches inserted into the skin. Poly(I:C) adjuvanted subunit influenza vaccine induced similar antigen-specific immune responses compared to vaccine alone when delivered to the skin by microneedles. However, imiquimod-adjuvanted vaccine elicited higher levels of serum IgG2a antibodies and increased hemagglutination inhibition titers compared to vaccine alone, suggesting enhanced induction of functional antibodies. In addition, imiquimod-adjuvanted vaccine induced a robust IFN-γ cellular response. These responses correlated with improved protection compared to influenza subunit vaccine alone, as well as reduced viral replication and production of pro-inflammatory cytokines in the lungs. The finding that microneedle delivery of imiquimod with influenza subunit vaccine induces improved immune responses compared to vaccine alone supports the use of TLR7 ligands as adjuvants for skin-based influenza vaccines.
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Affiliation(s)
- William C. Weldon
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Vladimir G. Zarnitsyn
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - E. Stein Esser
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Misha T. Taherbhai
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Dimitrios G. Koutsonanos
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Elena V. Vassilieva
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ioanna Skountzou
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Mark R. Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Richard W. Compans
- Department of Microbiology and Immunology and Emory Vaccine Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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41
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Shastri PN, Kim MC, Quan FS, D'Souza MJ, Kang SM. Immunogenicity and protection of oral influenza vaccines formulated into microparticles. J Pharm Sci 2012; 101:3623-35. [PMID: 22711602 DOI: 10.1002/jps.23220] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/28/2012] [Accepted: 05/10/2012] [Indexed: 01/22/2023]
Abstract
Influenza is a deadly disease affecting humans and animals. It is recommended that every individual should be vaccinated annually against influenza. Considering the frequency of administration of this vaccine, we have explored the oral route of vaccination with a microparticulate formulation. Microparticles containing inactivated influenza A/PR/34/8 H1N1 virus with Eudragit S and trehalose as a matrix were prepared using the Buchi spray dryer. Particle size distribution of microparticles was measured and the bioactivity of vaccine in a microparticle form was analyzed using a hemagglutination activity test. Furthermore, the efficacy of microparticle vaccines was evaluated in vivo in Balb/c mice. Analysis of serum samples showed that microparticles resulted in enhanced antigen-specific immunoglobulin G (IgG), IgG1, and IgG2a antibodies. Upon challenge with homologous and heterologous influenza viruses, microparticle vaccines showed significantly increased levels of protection. Use of microparticles to deliver vaccines could be a promising tool for the development of an oral influenza vaccine.
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Affiliation(s)
- Prathap Nagaraja Shastri
- Nanotechnology Laboratory, College of Pharmacy and Health Sciences, Mercer University, Atlanta, Georgia 30341, USA
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Kumar D, Blumberg EA, Danziger-Isakov L, Kotton CN, Halasa NB, Ison MG, Avery RK, Green M, Allen UD, Edwards KM, Miller G, Michaels MG. Influenza vaccination in the organ transplant recipient: review and summary recommendations. Am J Transplant 2011; 11:2020-30. [PMID: 21957936 DOI: 10.1111/j.1600-6143.2011.03753.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Influenza virus causes a spectrum of illness in transplant recipients with a high rate of lower respiratory disease. Seasonal influenza vaccination is an important public health measure recommended for transplant recipients and their close contacts. Vaccine has been shown to be safe and generally well tolerated in both adult and pediatric transplant recipients. However, responses to vaccine are variable and are dependent on various factors including time from transplantation and specific immunosuppressive medication. Seasonal influenza vaccine has demonstrated safety and no conclusive evidence exists for a link between vaccination and allograft dysfunction. Annually updated trivalent inactivated influenza vaccines have been available and routinely used for several decades, although newer influenza vaccination formulations including high-dose vaccine, adjuvanted vaccine, quadrivalent inactivated vaccine and vaccine by intradermal delivery system are now available or will be available in the near future. Safety and immunogenicity data of these new formulations in transplant recipients requires investigation. In this document, we review the current state of knowledge on influenza vaccines in transplant recipients and make recommendations on the use of vaccine in both adult and pediatric organ transplant recipients.
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Affiliation(s)
- D Kumar
- Transplant Infectious Diseases, University of Alberta, Edmonton, AB, Canada Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA.
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43
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Acceptance of Intanza® 9 μg intradermal influenza vaccine in routine clinical practice in Australia and Argentina. Adv Ther 2011; 28:640-9. [PMID: 21751080 DOI: 10.1007/s12325-011-0042-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Intanza® 9 μg (Sanofi Pasteur SA, Lyon, France), a split virion trivalent influenza vaccine delivered by intradermal injection with a microinjection system, became available as a vaccination for adults aged 18 to 59 years old, as of the 2010 southern hemisphere influenza season. METHODS This study was designed to assess the acceptability of intradermal vaccination with Intanza 9 μg in routine clinical practice by adult vaccinees and their prescribers. Prescribers and healthy adults 18 to 59 years old in Australia and Argentina who had elected to be vaccinated with Intanza 9 μg during the 2010 southern hemisphere influenza season were recruited to complete surveys about their opinions of influenza vaccination and acceptance of the intradermal vaccination. RESULTS 1402 vaccinees and 30 prescribers in Australia, and 264 vaccinees and 16 prescribers in Argentina responded to surveys. In both countries, 98% of vaccinees were satisfied or very satisfied with Intanza 9 μg. The main reasons for satisfaction were that the injection was considered minimally painful and that the vaccination was quickly administered. Most (95%) vaccinees reported that they would prefer to receive the same vaccination next year. Furthermore, 85% of prescribers were satisfied or very satisfied with the intradermal vaccine. CONCLUSION Intradermal vaccination for seasonal influenza using Intanza 9 μg is well accepted both by adult vaccinees and prescribers. By providing an additional, well-accepted method, Intanza 9 μg might help increase seasonal influenza vaccination rates in adults.
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Arnou R, Frank M, Hagel T, Prébet A. Willingness to vaccinate or get vaccinated with an intradermal seasonal influenza vaccine: a survey of general practitioners and the general public in France and Germany. Adv Ther 2011; 28:555-65. [PMID: 21626269 DOI: 10.1007/s12325-011-0035-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The elderly are at high risk of severe seasonal influenza and influenza-related death. Annual vaccination can effectively prevent influenza and its complications, and is recommended in the elderly. In the present study, surveys were undertaken in France and Germany to determine whether INTANZA (sanofi pasteur, Val-de-Reuil, France), the first intradermal influenza vaccine, administered using an innovative microneedle injection system, might influence physicians' likelihood of recommending influenza vaccination or the likelihood that the general public would seek influenza vaccination. METHODS Physicians (France: n=260; Germany: n=223) and members of the general public aged ≥ 50 years (France: n=1706; Germany: n=1072) completed online surveys. Details of the INTANZA delivery system, and a "product profile" based on the properties of INTANZA, were presented. RESULTS Most physicians and the general public found INTANZA and its microneedle injection system appealing. The main benefit of INTANZA, as perceived by physicians and the public, was the small needle size. Physicians also found the high immunogenicity compared with conventional intramuscular (IM) vaccines attractive. The majority of physicians believed that INTANZA would strongly help them to recommend vaccination to their unvaccinated patients (66% to 91%, depending upon patient characteristics); most (61% to 78%) would prefer to prescribe INTANZA rather than an IM vaccine. More than two-thirds of the unvaccinated general public would prefer INTANZA over IM vaccines, and the option of vaccination with INTANZA would encourage a large proportion of them to get vaccinated (60% to 74%), if it was recommended and they were given the choice. Physicians (≥ 82%) agreed that INTANZA may help increase vaccination coverage rates. CONCLUSION The results of these surveys indicate that the availability of INTANZA may encourage physicians to recommend influenza vaccination, and members of the general public to get vaccinated. INTANZA may help to improve seasonal influenza vaccination coverage rates.
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Affiliation(s)
- Robert Arnou
- ALTI Clinical Research Network, 49000, Angers, France
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