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Zambrano B, Peterson J, Deseda C, Julien K, Spiegel CA, Seyler C, Simon M, Hoki R, Anderson M, Brabec B, Áñez G, Shi J, Pan J, Hagenbach A, Von Barbier D, Varghese K, Jordanov E, Dhingra MS. Correction: Quadrivalent meningococcal tetanus toxoid-conjugate booster vaccination in adolescents and adults: phase III randomized study. Pediatr Res 2024; 95:1159. [PMID: 37853068 PMCID: PMC10920185 DOI: 10.1038/s41390-023-02835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Betzana Zambrano
- Global Clinical Development Strategy, Sanofi, Montevideo, Uruguay
| | | | - Carmen Deseda
- Caribbean Travel Medicine Clinic, San Juan, Puerto Rico
| | | | | | | | | | | | | | - Brad Brabec
- Midwest Children's Health Research Institute, Lincoln, NE, USA
| | - Germán Áñez
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
| | - Jiayuan Shi
- Global Biostatistical Sciences, Sanofi, Swiftwater, PA, USA
| | - Judy Pan
- Global Biostatistical Sciences, Sanofi, Swiftwater, PA, USA
| | | | | | | | - Emilia Jordanov
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
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McArthur MA, Bchir S, Dubois E, Gan L, Gerchman E, Gupta S, Liabis O, Perez L, Roche F, Vasquez G, Zambrano B, Gurunathan S, Dhingra MS. "Direct and indirect impacts of the COVID-19 pandemic on operational conduct of pediatric vaccine clinical trials". Hum Vaccin Immunother 2023; 19:2272535. [PMID: 37942563 PMCID: PMC10653681 DOI: 10.1080/21645515.2023.2272535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic, as well as the resulting public health measures, impacted many aspects of society. The conduct of important pediatric vaccine trials was among these. Analyzing data from six ongoing non-COVID-19 pediatric vaccine trials we aimed to assess the operational impact of the COVID-19 pandemic using descriptive analyses. We identified multiple operational disruptions in trial conduct. Additionally, we identified higher percentages of missed routine vaccinations than investigational vaccines throughout the observation period. Overall, the impact of the COVID-19 pandemic was most apparent early in the pandemic period while adaptations to the pandemic were developed; however, some disruptions persisted throughout the observation period. Pediatric vaccine clinical trials are critical to developing new and/or improved vaccines for the pediatric population. Continued evaluation of the impacts of COVID-19 on pediatric vaccine clinical trials is warranted.
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Affiliation(s)
| | - Siham Bchir
- Global Biostatistical Sciences, Sanofi, Marcy l’Etoile, France
| | - Estelle Dubois
- Global Clinical Operations, Sanofi, Marcy l’Etoile, France
| | - Lucia Gan
- Global Biostatistical Sciences, Sanofi, Swiftwater, PA, USA
| | - Eric Gerchman
- Global Clinical Operations, Sanofi, Swiftwater, PA, USA
| | - Sandeep Gupta
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
| | - Olga Liabis
- Global Clinical Development Strategy, Sanofi, Marcy l’Etoile, France
| | - Lucia Perez
- Global Clinical Operations, Sanofi, Swiftwater, PA, USA
| | - Fabienne Roche
- Global Clinical Operations, Sanofi, Marcy l’Etoile, France
| | - Gustavo Vasquez
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
| | - Betzana Zambrano
- Global Clinical Development Strategy, Sanofi, Montevideo, Uruguay
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Neveu D, Mallett Moore T, Zambrano B, Chen A, Kürzinger ML, Marcelon L, Singh Dhingra M. Structured Benefit-Risk Assessment of a New Quadrivalent Meningococcal Conjugate Vaccine (MenACYW-TT) in Individuals Ages 12 Months and Older. Infect Dis Ther 2023; 12:2367-2386. [PMID: 37755671 PMCID: PMC10600069 DOI: 10.1007/s40121-023-00864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION A favorable benefit-risk balance is required to support licensure of biologics, in keeping with regulatory agencies' evolving recommendations, including the United States Food and Drugs Administration. We present a structured semi-quantitative benefit-risk analysis of MenACYW-TT, a quadrivalent meningococcal conjugate vaccine against Neisseria meningitidis serogroups, A, C, W and Y versus licensed comparators in individuals aged ≥ 12 months. METHODS We used data from six MenACYW-TT clinical trials, stratified by age group, versus licensed vaccines: toddlers (12-23 months; Nimenrix® [MCV4-TT]), children (2-9 years; Menveo® [MCV4-CRM]), adolescents (10-17 years; MCV4-CRM or Menactra® [MCV4-DT]), adults (18-55 years; MCV4-DT) and older adults (≥ 56 years; Menomune®-A/C/Y/W-135 [MPSV4]). Eight benefit (seroresponse and seroprotection for A, C, W and Y) and five risk outcomes (any and grade 3 solicited injection site and systemic reactions, and serious adverse events) were measured at Day 30 after initial vaccination. Analyses were conducted by baseline vaccination status (meningococcal vaccine-naïve or vaccine-primed). RESULTS MenACYW-TT showed favorable seroresponse and seroprotection among vaccine-naïve participants aged ≥ 2 years, against all serogroups, compared with MCV4-CRM, MCV4-DT and MPSV4. In vaccine-naïve toddlers, there was a favorable effect for serogroup C, but no difference between MenACYW-TT and MCV4-TT for serogroups A, Y and W. A favorable effect for MenACYW-TT against serogroup C was observed in all vaccine-naïve and combined vaccine-naïve and MenC conjugate vaccine-primed groups. For all risk criteria, there were no differences between MenACYW-TT and MCV4s in toddlers, children, adolescents and adults. Results for solicited injection site and systemic reactions favored MPSV4 in older adults. CONCLUSIONS The benefit-risk profile for MenACYW-TT showed favorable seroresponse and seroprotection in individuals aged ≥ 2 years and no difference in risk criteria between MenACYW-TT and MCV4s. MenACYW-TT may provide an alternative to the standard-of-care for meningococcal disease prevention in those aged ≥ 12 months.
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Affiliation(s)
- David Neveu
- Global Pharmacovigilance, Sanofi, Swiftwater, PA, USA.
| | | | - Betzana Zambrano
- Global Clinical Development Strategy, Sanofi, Montevideo, Uruguay
| | - Aiying Chen
- Global Biostatistical Sciences, Sanofi, 1 Discovery Dr, Swiftwater, PA, 18370, USA
| | | | - Lydie Marcelon
- Global Epidemiology and Benefit-Risk Evaluation, Sanofi, Lyon, France
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Zambrano B, Peterson J, Deseda C, Julien K, Spiegel CA, Seyler C, Simon M, Hoki R, Anderson M, Brabec B, Áñez G, Shi J, Pan J, Hagenbach A, Von Barbier D, Varghese K, Jordanov E, Dhingra MS. Quadrivalent meningococcal tetanus toxoid-conjugate booster vaccination in adolescents and adults: phase III randomized study. Pediatr Res 2023; 94:1035-1043. [PMID: 36899125 PMCID: PMC10000353 DOI: 10.1038/s41390-023-02478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/29/2022] [Accepted: 01/03/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND The immunogenicity and safety of a booster dose of tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MenACYW-TT), alone or co-administered with MenB vaccine, were assessed in healthy 13-25-year olds who received MenACYW-TT or a CRM-conjugate vaccine (MCV4-CRM) 3-6 years earlier. METHODS This phase IIIb open-label trial (NCT04084769) evaluated MenACYW-TT-primed participants, randomized to receive MenACYW-TT alone or with a MenB vaccine, and MCV4-CRM-primed participants who received MenACYW-TT alone. Functional antibodies against serogroups A, C, W and Y were measured using human complement serum bactericidal antibody assay (hSBA). The primary endpoint was vaccine seroresponse (post-vaccination titers ≥1:16 if pre-vaccination titers <1:8; or a ≥4-fold increase if pre-vaccination titers ≥1:8) 30 days post booster. Safety was evaluated throughout the study. RESULTS The persistence of the immune response following primary vaccination with MenACYW-TT was demonstrated. Seroresponse after MenACYW-TT booster was high regardless of priming vaccine (serogroup A: 94.8% vs 93.2%; C: 97.1% vs 98.9%; W: 97.7% vs 98.9%; and Y; 98.9% vs 100% for MenACWY-TT-primed and MCV4-CRM-primed groups, respectively). Co-administration with MenB vaccines did not affect MenACWY-TT immunogenicity. No vaccine-related serious adverse events were reported. CONCLUSIONS MenACYW-TT booster induced robust immunogenicity against all serogroups, regardless of the primary vaccine received, and had an acceptable safety profile. IMPACT A booster dose of MenACYW-TT induces robust immune responses in children and adolescents primed with MenACYW-TT or another MCV4 (MCV4-DT or MCV4-CRM), respectively. Here, we demonstrate that MenACYW-TT booster 3-6 years after primary vaccination induced robust immunogenicity against all serogroups, regardless of the priming vaccine (MenACWY-TT or MCV4-CRM), and was well tolerated. Persistence of the immune response following previous primary vaccination with MenACYW-TT was demonstrated. MenACYW-TT booster with MenB vaccine co-administration did not affect MenACWY-TT immunogenicity and was well tolerated. These findings will facilitate the provision of broader protection against IMD particularly in higher-risk groups such as adolescents.
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Affiliation(s)
- Betzana Zambrano
- Global Clinical Development Strategy, Sanofi, Montevideo, Uruguay
| | | | - Carmen Deseda
- Caribbean Travel Medicine Clinic, San Juan, Puerto Rico
| | | | | | | | | | | | | | - Brad Brabec
- Midwest Children's Health Research Institute, Lincoln, NE, USA
| | - Germán Áñez
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
| | - Jiayuan Shi
- Global Biostatistical Sciences, Sanofi, Swiftwater, PA, USA
| | - Judy Pan
- Global Biostatistical Sciences, Sanofi, Swiftwater, PA, USA
| | | | | | | | - Emilia Jordanov
- Global Clinical Development Strategy, Sanofi, Swiftwater, PA, USA
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Matsuoka O, Ujiie M, Kikuchi H, Otake S, Chansinghakul D, Inoue T, Varghese K, Sirisuphmitr N, Hashiguchi T, Zambrano B, Nakama T, Frago C, Jordanov E, Dhingra MS. Immunogenicity and Safety of a Quadrivalent Meningococcal Tetanus Toxoid-Conjugate Vaccine (MenACYW-TT) in Meningococcal Vaccine-Naïve Participants Across a Broad Age Range (2-55 years) in Japan: A Phase III Randomized Study. Jpn J Infect Dis 2023; 76:174-182. [PMID: 36724939 DOI: 10.7883/yoken.jjid.2022.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MenACYW-TT is a quadrivalent meningococcal tetanus toxoid-conjugate vaccine designed to prevent invasive meningococcal disease. The primary objective of this study was to demonstrate non-inferiority of the vaccine seroresponse to a single dose of MenACYW-TT compared to a licensed Meningococcal quadrivalent diphtheria-conjugate vaccine, MCV4-DT. This Phase III double-blind, multi-center study was conducted in meningococcal vaccine-naive participants aged 2-55 years in Japan (NCT04368429; JapicCTI-205288). Participants were randomized 1:1 to MenACYW-TT (n=180) or MCV4-DT (n=180). Functional antibodies against meningococcal serogroups A, C, W, and Y were measured using a serum bactericidal antibody assay with human complement (hSBA) at baseline (D0) and 30 days after vaccination (D30). Seroresponse was defined as post-vaccination titers ≥1:16 for participants with baseline titers <1:8; or ≥4-fold increase for participants with baseline titers ≥1:8. Safety data were collected for 30 days. Non-inferiority of the vaccine seroresponse vs MCV4-DT was demonstrated at D30 for each serogroup (A: 85.6% vs. 65.4%; C: 96.6% vs. 62.6%; W: 87.4% vs. 49.2%; Y: 97.7% vs. 63.5%, respectively). MenACYW-TT was well-tolerated, with no safety concerns identified. In conclusion, when administered as a single dose, MenACYW-TT was well tolerated with a non-inferior immune response compared to MCV4-DT, providing a potential alternative vaccine for this population.
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Affiliation(s)
| | - Mugen Ujiie
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | | | | | | | - Takahiro Inoue
- Clinical Sciences & Operations, R & D, Sanofi K. K., Japan
| | | | | | | | | | | | - Carina Frago
- Global Clinical Development Strategy, Sanofi, Singapore
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Jost CC, Machalaba C, Karesh WB, Mcdermott JJ, Beltran-Alcrudo D, Bett B, Tago D, Wongsathapornchai K, Plee L, Dhingra MS, Pfeiffer DU. Epidemic disease risks and implications for Veterinary Services. REV SCI TECH OIE 2021; 40:497-509. [PMID: 34542099 DOI: 10.20506/rst.40.2.3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Growth in the livestock sector is associated with heightened risk for epidemic diseases. The increasing spillover of new diseases from wildlife is being driven by wide-scale anthropogenic changes allowing for more frequent and closer wildlife-human and wildlife-livestock contacts. An increasing number of epidemics in livestock are associated with rapid transition of livestock systems from extensive to intensive, and local to global movement of livestock and their products through value chain networks with weak biosecurity. Major livestock epidemics in the past two decades have had substantial economic impacts, and the COVID-19 pandemic highlights the devastating socio-economic consequences that spillovers can have when not identified and controlled early in the process of emergence. This highlights the importance of Veterinary Services to integrated, whole-of-society efforts to control infectious diseases in animals. Emphasis within Veterinary Services must be placed on prevention and preparedness. The authors suggest four areas for continued improvement in Veterinary Services to meet this challenge. These are a) continued development of staff capacity for risk assessment and value chain analysis, together with improved policies and communication, b) appropriate adaptation of approaches to prevention and control in resource-poor settings, c) improved multi-sectoral and transboundary cooperation, which enables the sharing of resources and expertise, and d) systematic approaches that enable Veterinary Services to influence decisionmaking for trade, markets, business, public health, and livelihood development at the national and regional levels.
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Esteves-Jaramillo A, Koehler T, Jeanfreau R, Neveu D, Jordanov E, Singh Dhingra M. Immunogenicity and safety of a quadrivalent meningococcal tetanus toxoid-conjugate vaccine (MenACYW-TT) in ≥56-year-olds: A Phase III randomized study. Vaccine 2020; 38:4405-4411. [PMID: 32387012 DOI: 10.1016/j.vaccine.2020.04.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Invasive meningococcal disease has a high mortality rate in individuals aged ≥56 years, but no vaccine is currently licensed in the USA for this age group. This study assessed the safety and immunogenicity of an investigational quadrivalent meningococcal tetanus toxoid conjugate vaccine (MenACYW-TT) compared with a meningococcal quadrivalent polysaccharide vaccine (MPSV4) in this age group. METHODS This was a Phase III, modified double-blind, randomized, non-inferiority study (NCT02842866) across 35 clinical sites in the USA and Puerto Rico in individuals aged ≥56 years. A single dose of the MenACYW-TT (n = 451) or MPSV4 vaccine (n = 455) was administered on Day 0. A serum bactericidal assay with human (hSBA) and baby rabbit (rSBA) complement was used to measure antibodies against serogroups A, C, W, and Y test strains at baseline and Day 30. Safety data were collected up to six months post-vaccination. RESULTS The seroresponse to MenACYW-TT was non-inferior to MPSV4 for each of the serogroups (A: 58.2% vs. 42.5%; C: 77.1% vs. 49.7%; W: 62.6% vs. 44.8%, Y: 74.4% vs. 43.4%, respectively). At Day 30, participants achieving hSBA titers ≥1:8 were higher for all serogroups after MenACYW-TT vs. MPSV4 (77.4-91.7 vs. 63.1-84.2%, respectively). No safety concerns were identified for either vaccine. CONCLUSION MenACYW-TT was well-tolerated and immunogenic in ≥56-year-olds, offering the potential to replace MPSV4 in this age group.
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Raghava Mohan V, Raj S, Dhingra MS, Aloysia D’Cor N, Singh AP, Saluja T, Kim DR, Midde VJ, Kim Y, Vemula S, Narla SK, Sah B, Ali M. Safety and immunogenicity of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine in adults and children in Vellore, South India. PLoS One 2019; 14:e0218033. [PMID: 31211792 PMCID: PMC6581248 DOI: 10.1371/journal.pone.0218033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/24/2019] [Indexed: 11/18/2022] Open
Abstract
This open-label study assessed the safety and immunogenicity of two doses (14 days apart) of an indigenously manufactured, killed, bivalent (Vibrio cholerae O1 and O139), whole-cell oral cholera vaccine (SHANCHOL; Shantha Biotechnics) in healthy adults (n = 100) and children (n = 100) in a cholera endemic area (Vellore, South India) to fulfill post-licensure regulatory requirements and post-World Health Organization (WHO) prequalification commitments. Safety and reactogenicity were assessed, and seroconversion rates (i.e. proportion of participants with a ≥ 4-fold rise from baseline in serum vibriocidal antibody titers against V. cholerae O1 Inaba, O1 Ogawa and O139, respectively) were determined 14 days after each vaccine dose. No serious adverse events were reported during the study. Commonly reported solicited adverse events were headache and general ill feeling. Seroconversion rates after the first and second dose in adults were 67.7% and 55.2%, respectively, against O1 Inaba; 47.9% and 45.8% against O1 Ogawa; and 19.8% and 20.8% against O139. In children, seroconversion rates after the first and second dose were 80.2% and 68.8%, respectively, against O1 Inaba; 72.9% and 67.7% against O1 Ogawa; and 26.0% and 18.8% against O139. The geometric mean titers against O1 Inaba, O1 Ogawa, and O139 in both adults and children were significantly higher after each vaccine dose compared to baseline titers (P < 0.001; for both age groups after each dose versus baseline). The seroconversion rates for O1 Inaba, O1 Ogawa, and O139 in both age groups were similar to those in previous studies with the vaccine. In conclusion, the killed, bivalent, whole-cell oral cholera vaccine has a good safety and reactogenicity profile, and is immunogenic in healthy adults and children. Trial Registration: ClinicalTrials.gov NCT00760825; CTRI/2012/01/002354.
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Affiliation(s)
| | | | | | | | | | - Tarun Saluja
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Yanghee Kim
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Binod Sah
- International Vaccine Institute, Seoul, South Korea
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Capeding MRZ, Gonzales MLAM, Dhingra MS, D'Cor NA, Midde VJ, Patnaik BN, Thollot Y, Desauziers E. Safety and immunogenicity of the killed bivalent (O1 and O139) whole-cell cholera vaccine in the Philippines. Hum Vaccin Immunother 2017; 13:2232-2239. [PMID: 28910563 PMCID: PMC5975480 DOI: 10.1080/21645515.2017.1342908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 10/25/2022] Open
Abstract
The killed bivalent (O1 and O139) whole cell oral cholera vaccine (OCV) (Shanchol™) was first licensed in India in 2009 and World Health Organization pre-qualified in 2011. We assessed the safety and immunogenicity of this OCV in the Philippines. This was a phase IV, single-arm, descriptive, open-label study. We recruited 336 participants from 2 centers: 112 participants in each age group (1-4, 5-14 and ≥ 15 years). Participants received 2 OCV doses 14 d apart. Safety was monitored throughout the trial. Blood samples were collected at baseline (pre-vaccination) and 14 d after each dose. Serum vibriocidal antibody titers to V. cholerae O1 (El Tor Inaba and El Tor Ogawa) and O139 strains were assessed, with seroconversion defined as ≥ 4-fold increase from baseline in titers. No immediate unsolicited systemic adverse events/reactions were observed. Unsolicited systemic adverse events were mostly grade 1 intensity. One serious adverse event occurred after the first dose, but was unrelated to vaccination. High seroconversion rates (range 69-92%) were achieved against the O1 serotypes with a trend toward higher rates in the 1-4 y (86-92%) and 5-14 y (86-88%) age groups than the ≥ 15 y age group (69-83%). Lower seroconversion rates were achieved against the O139 serotype (35-70%), particularly in those aged ≥ 15 y (35-42%). The 2-dose regimen of the killed bivalent whole cell OCV was well-tolerated in this study conducted in the Philippines, a cholera-endemic country. Robust immune responses were observed even after a single-dose.
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Affiliation(s)
| | | | | | | | - Venkat Jayanth Midde
- Shantha Biotechnics Private Limited (A Sanofi Company), Hyderabad, Telangana, India
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Saluja T, Palkar S, Misra P, Gupta M, Venugopal P, Sood AK, Dhati RM, Shetty A, Dhaded SM, Agarkhedkar S, Choudhury A, Kumar R, Balasubramanian S, Babji S, Adhikary L, Dupuy M, Chadha SM, Desai F, Kukian D, Patnaik BN, Dhingra MS. Live attenuated tetravalent (G1-G4) bovine-human reassortant rotavirus vaccine (BRV-TV): Randomized, controlled phase III study in Indian infants. Vaccine 2017; 35:3575-3581. [PMID: 28536027 DOI: 10.1016/j.vaccine.2017.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/09/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rotavirus remains the leading cause of diarrhoea among children <5years. We assessed immunogenic non-inferiority of a tetravalent bovine-human reassortant rotavirus vaccine (BRV-TV) over the licensed human-bovine pentavalent rotavirus vaccine RV5. METHODS Phase III single-blind study (parents blinded) in healthy infants randomized (1:1) to receive three doses of BRV-TV or RV5 at 6-8, 10-12, and 14-16weeks of age. All concomitantly received a licensed diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b conjugate vaccine (DTwP-HepB-Hib) and oral polio vaccine (OPV). Immunogenic non-inferiority was evaluated in terms of the inter-group difference in anti-rotavirus serum IgA seroresponse (primary endpoint), and seroprotection/seroresponse rates to DTwP-HepB-Hib and OPV vaccines. Seroresponse was defined as a ≥4-fold increase in titers from baseline to D28 post-dose 3. Non-inferiority was declared if the difference between groups (based on the lower limit of the 95% confidence interval [CI]) was above -10%. Each subject was evaluated for solicited adverse events 7days and unsolicited & serious adverse events 28days following each dose of vaccination. RESULTS Of 1195 infants screened, 1182 were randomized (590 to BRV-TV; 592 to RV5). Non-inferiority for rotavirus serum IgA seroresponse was not established: BRV-TV, 47.1% (95%CI: 42.8; 51.5) versus RV5, 61.2% (95%CI: 56.8; 65.5); difference between groups, -14.08% (95%CI: -20.4; -7.98). Serum IgA geometric mean concentrations at D28 post-dose 3 were 28.4 and 50.1U/ml in BRV-TV and RV5 groups, respectively. For all DTwP-HepB-Hib and OPV antigens, seroprotection/seroresponse was elicited in both groups and the -10% non-inferiority criterion between groups was met. There were 16 serious adverse events, 10 in BRV-TV group and 6 in RV5 group; none were classified as vaccine related. Both groups had similar vaccine safety profiles. CONCLUSION BRV-TV was immunogenic but did not meet immunogenic non-inferiority criteria to RV5 when administered concomitantly with routine pediatric antigens in infants.
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Affiliation(s)
- Tarun Saluja
- Shantha Biotechnics Pvt. Ltd., Hyderabad, India.
| | - Sonali Palkar
- Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Puneet Misra
- All India Institute of Medical Sciences, New Delhi, India
| | - Madhu Gupta
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | | | | | | | | | - Sharad Agarkhedkar
- Padmashree Dr. D. Y. Patil Medical College & Research Center, Pune, India
| | | | - Ramesh Kumar
- Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Sundaram Balasubramanian
- Kanchi Kamakoti Child Trust Hospital & The Child Trust Medical Research Foundation, Chennai, India
| | - Sudhir Babji
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Forum Desai
- Shantha Biotechnics Pvt. Ltd., Hyderabad, India
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Saha A, Khan A, Salma U, Jahan N, Bhuiyan TR, Chowdhury F, Khan AI, Khanam F, Muruganandham S, Reddy Kandukuri S, Singh Dhingra M, Clemens JD, Cravioto A, Qadri F. The oral cholera vaccine Shanchol™ when stored at elevated temperatures maintains the safety and immunogenicity profile in Bangladeshi participants. Vaccine 2016; 34:1551-1558. [PMID: 26896684 DOI: 10.1016/j.vaccine.2016.02.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The oral cholera vaccine (OCV), Shanchol™ has shown protective efficacy lasting up to 5 years, however, requirement for a cold chain limits its use in resource poor settings. The study was conducted to determine the safety and immunogenicity of Shanchol in adult participants in Bangladesh when stored at elevated temperatures. METHODS The study was conducted in Mirpur, Dhaka. Four groups of healthy adult participants received two doses of Shanchol™, kept under standard storage temperature (Group A; 2-8°C) or at elevated temperatures (Group B, 25°C; Group C, 37°C; Group D, 42°C) for 14 days, respectively. Vaccine specific antibody responses were determined. FINDINGS 145 participants were assigned to each group. Adverse events were mild not differing among groups. Vaccine stored at elevated temperatures remained stable with cumulative LPS content within admissible limits. Vibriocidal antibody responses were observed in all groups after each dose of vaccine at day 7 and 21 compared to pre-immune levels (P<0.001). Four-fold increases to Vibrio cholerae O1 Ogawa were observed at day 7 and/or day 21 after vaccination in the standard temperature and the three elevated temperature groups, with responder rates of; 76% (95% CI LB; 70%), 80% (95% CI LB; 74%), 69% (95% CI LB; 63%), and 74% (95% CI LB; 68%) in Groups A-D, respectively (P=0.240). Responses were also seen in all groups to V. cholerae O1 Inaba and V. cholerae O139 and in LPS specific IgA response to V. cholerae O1 antigens. INTERPRETATION This is the first report to show that the OCV is stable at elevated temperatures, and the safety and immunogenicity profiles are not altered. This information will help formulate global policies for use of the vaccine at higher temperatures, resulting in easier distribution and vaccination costs and decrease logistical challenges to vaccine delivery. FUNDING Bill & Melinda Gates Foundation. TRIAL REGISTRATION Clinical Trials.gov number NCT01762930.
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Affiliation(s)
- Amit Saha
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; University of New South Wales, SPHCM, NSW, Australia
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Umme Salma
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Jahan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, United States
| | | | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
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Saluja T, Sharma SD, Gupta M, Kundu R, Kar S, Dutta A, Silveira M, Singh JV, Kamath VG, Chaudhary A, Rao JV, Ravi MD, Murthy SRK, Babji S, Prasad R, Gujjula R, Rao R, Dhingra MS. A multicenter prospective hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children less than five years of age in India. Vaccine 2015; 32 Suppl 1:A13-9. [PMID: 25091667 DOI: 10.1016/j.vaccine.2014.03.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Rotavirus is the leading cause of severe, dehydrating diarrhea in children aged <5 years globally, with an estimated 25 million outpatient visits and 2 million hospitalizations attributable to rotavirus infections each year. The aim of this hospital-based surveillance was to summarize the local epidemiological and virological features of rotavirus and to estimate the disease burden in the population under surveillance in India. METHODS During the 16 months surveillance period from April 2011 through July 2012, a total of 4711 children under the age of 5 years were admitted with acute diarrhea at 12 medical centers attached to medical schools throughout India. Stool samples were randomly collected from 2051 (43.5%) subjects and were analyzed for rotavirus positivity using commercial enzyme immunoassay kit (Premier Rotaclone Qualitative Elisa) at the respective study centers. Rotavirus positive samples were genotyped for VP7 and VP4 by reverse-transcription polymerase chain reaction (RT-PCR) at a central laboratory. RESULTS During the study period, maximum number of rotavirus related hospitalizations were reported from December 2011 through February 2012. Out of the 2051 stool samples tested for rotavirus, overall 541 (26.4%) samples were positive for rotavirus VP6 antigen in stool. The highest positivity was observed in the month of December, 2011 (52.5%) and lowest in the month of May, 2011 (10.3%). We found that majority of the rotavirus positive cases (69.7%) were in children <24 months of age. The most common genotypes reported were G1 (38%), G2 (18%), G9 (18%), G12 (9%) and mixed strains (17%). CONCLUSIONS The results of this study confirm the significant burden of acute rotavirus gastroenteritis as a cause of hospitalizations in under five children in India.
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Affiliation(s)
- T Saluja
- Shantha Biotechnics Ltd., Hyderabad, India
| | | | - M Gupta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Kundu
- Institute of Child Health, Kolkata, India
| | - S Kar
- Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - A Dutta
- Kalawati Saran Children's Hospital, New Delhi, India
| | | | - J V Singh
- CSM Medical University, Lucknow, India
| | - V G Kamath
- Kasturba Medical College, Manipal, India
| | | | - J V Rao
- Gandhi Medical College, Hyderabad, India
| | - M D Ravi
- JSS Medical College, Mysore, India
| | - S R K Murthy
- Kempegowda Institute of Medical Sciences, Bangalore, India
| | - S Babji
- Christian Medical College, Vellore, India
| | - R Prasad
- Shantha Biotechnics Ltd., Hyderabad, India
| | - R Gujjula
- Shantha Biotechnics Ltd., Hyderabad, India
| | - R Rao
- Shantha Biotechnics Ltd., Hyderabad, India
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Singh JV, Kamath V, Shetty R, Kumar V, Prasad R, Saluja T, Dhingra MS. Retrospective surveillance for intussusception in children aged less than five years at two tertiary care centers in India. Vaccine 2015; 32 Suppl 1:A95-8. [PMID: 25091688 DOI: 10.1016/j.vaccine.2014.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A rotavirus vaccine could soon become part of India's national immunization program. However the occurrence of intussusception due to rotavirus vaccine is a potential safety concern. This surveillance aimed at the collection of baseline data on childhood intussusception which would facilitate the monitoring of intussusception cases after the introduction of rotavirus vaccines. METHODS We retrospectively reviewed medical records of confirmed intussusception cases in children under the age of five, treated during 2007-2012 at two tertiary care hospitals attached to medical schools in India. Demographic, clinical, diagnostic and treatment practices data were obtained from hospital records. RESULTS Over a five to six year observation period, we identified 187 confirmed cases of intussusception, of which 75% were males. The median age of intussusception was 8 months, and we observed a possible trend in the distribution of cases with the highest number of cases being reported in the month of April and lowest in the month of October. The most common diagnostic methods used were ultrasonography and abdominal radiography with most cases being treated surgically (71%). The median length of hospital stay was 8 days (range 1-40) and mean was 10.2 days. Records of any fatality due to intussusception were not found during the review of the records. CONCLUSIONS This analysis provides an estimate of the baseline data of childhood intussusception prior to the introduction of the rotavirus vaccination as a part of routine immunization in India. A prospective surveillance system using a standardized case definition is needed in order to better examine the incidence of intussusception in developing countries.
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Affiliation(s)
- J V Singh
- CSM Medical University, Lucknow, India
| | - V Kamath
- Kasturba Medical College, Manipal University, Manipal, India
| | - R Shetty
- Kasturba Medical College, Manipal University, Manipal, India
| | - V Kumar
- Kasturba Medical College, Manipal University, Manipal, India
| | - R Prasad
- Shantha Biotechnics Ltd., Hyderabad, India
| | - T Saluja
- Shantha Biotechnics Ltd., Hyderabad, India
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Kanungo S, Desai SN, Nandy RK, Bhattacharya MK, Kim DR, Sinha A, Mahapatra T, Yang JS, Lopez AL, Manna B, Bannerjee B, Ali M, Dhingra MS, Chandra AM, Clemens JD, Sur D, Wierzba TF. Flexibility of oral cholera vaccine dosing-a randomized controlled trial measuring immune responses following alternative vaccination schedules in a cholera hyper-endemic zone. PLoS Negl Trop Dis 2015; 9:e0003574. [PMID: 25764513 PMCID: PMC4357440 DOI: 10.1371/journal.pntd.0003574] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/28/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A bivalent killed whole cell oral cholera vaccine has been found to be safe and efficacious for five years in the cholera endemic setting of Kolkata, India, when given in a two dose schedule, two weeks apart. A randomized controlled trial revealed that the immune response was not significantly increased following the second dose compared to that after the first dose. We aimed to evaluate the impact of an extended four week dosing schedule on vibriocidal response. METHODOLOGY/PRINCIPAL FINDINGS In this double blind randomized controlled non-inferiority trial, 356 Indian, non-pregnant residents aged 1 year or older were randomized to receive two doses of oral cholera vaccine at 14 and 28 day intervals. We compared vibriocidal immune responses between these schedules. Among adults, no significant differences were noted when comparing the rates of seroconversion for V. cholerae O1 Inaba following two dose regimens administered at a 14 day interval (55%) vs the 28 day interval (58%). Similarly, no differences in seroconversion were demonstrated in children comparing the 14 (80%) and 28 day intervals (77%). Following 14 and 28 day dosing intervals, vibriocidal response rates against V. cholerae O1 Ogawa were 45% and 49% in adults and 73% and 72% in children respectively. Responses were lower for V. cholerae O139, but similar between dosing schedules for adults (20%, 20%) and children (28%, 20%). CONCLUSIONS/SIGNIFICANCE Comparable immune responses and safety profiles between the two dosing schedules support the option for increased flexibility of current OCV dosing. Further operational research using a longer dosing regimen will provide answers to improve implementation and delivery of cholera vaccination in endemic and epidemic outbreak scenarios.
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Affiliation(s)
- Suman Kanungo
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sachin N. Desai
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Ranjan Kumar Nandy
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mihir Kumar Bhattacharya
- Division of Clinical Medicine, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Anuradha Sinha
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Tanmay Mahapatra
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jae Seung Yang
- Laboratory Science Division, International Vaccine Institute, Seoul, Republic of Korea
| | - Anna Lena Lopez
- University of the Philippines Manila, National Institutes of Health, Manila, Philippines
| | - Byomkesh Manna
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Barnali Bannerjee
- Division of Data Management, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mohammad Ali
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Mandeep Singh Dhingra
- Clinical Research and Development, Shantha Biotechnics Private Limited, Hyderabad, India
| | | | - John D. Clemens
- Office of the Executive Director, International Centre for Diarrheal Disease Research, Bangladesh
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, United States of America
| | - Dipika Sur
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
- Office of the Scientific Director, PATH India Office, New Delhi, India
| | - Thomas F. Wierzba
- Development and Delivery Unit, International Vaccine Institute, Seoul, Republic of Korea
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15
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Ali M, Sur D, You YA, Kanungo S, Sah B, Manna B, Puri M, Wierzba TF, Donner A, Nair GB, Bhattacharya SK, Dhingra MS, Deen JL, Lopez AL, Clemens J. Herd protection by a bivalent killed whole-cell oral cholera vaccine in the slums of Kolkata, India. Clin Infect Dis 2013; 56:1123-31. [PMID: 23362293 DOI: 10.1093/cid/cit009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We evaluated the herd protection conferred by an oral cholera vaccine using 2 approaches: cluster design and geographic information system (GIS) design. METHODS Residents living in 3933 dwellings (clusters) in Kolkata, India, were cluster-randomized to receive either cholera vaccine or oral placebo. Nonpregnant residents aged≥1 year were invited to participate in the trial. Only the first episode of cholera detected for a subject between 14 and 1095 days after a second dose was considered. In the cluster design, indirect protection was assessed by comparing the incidence of cholera among nonparticipants in vaccine clusters vs those in placebo clusters. In the GIS analysis, herd protection was assessed by evaluating association between vaccine coverage among the population residing within 250 m of the household and the occurrence of cholera in that population. RESULTS Among 107 347 eligible residents, 66 990 received 2 doses of either cholera vaccine or placebo. In the cluster design, the 3-year data showed significant total protection (66% protection, 95% confidence interval [CI], 50%-78%, P<.01) but no evidence of indirect protection. With the GIS approach, the risk of cholera among placebo recipients was inversely related to neighborhood-level vaccine coverage, and the trend was highly significant (P<.01). This relationship held in multivariable models that also controlled for potentially confounding demographic variables (hazard ratio, 0.94 [95% CI, .90-.98]; P<.01). CONCLUSIONS Indirect protection was evident in analyses using the GIS approach but not the cluster design approach, likely owing to considerable transmission of cholera between clusters, which would vitiate herd protection in the cluster analyses. CLINICAL TRIALS REGISTRATION NCT00289224.
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Affiliation(s)
- Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea.
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Agnihotri N, Dhingra MS, Gautam V, Gupta V, Kaushal R, Mehta D. Salmonella typhi septic arthritis of hip--a case report. Jpn J Infect Dis 2005; 58:29-30. [PMID: 15728987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A case of rarely encountered Salmonella Typhi septic arthritis of the hip in a child with no preexisting disease is reported. Salmonella etiology was not suspected in this case, and the diagnosis was made only after bacterial isolation. Arthrotomy was done as an initial mode of management, followed by intravenous ciprofloxacin therapy to which the child responded favorably.
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Affiliation(s)
- Nalini Agnihotri
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
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18
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Bawa SR, Govil G, Dhingra MS, Werner G, Bains HK. Spectroscopic and microscopic studies of buffalo-bull (Bubalus bubalis) spermatozoa. J Submicrosc Cytol Pathol 1993; 25:37-46. [PMID: 8384930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have examined the epididymal (caput, corpus and cauda) and ejaculated spermatozoa of bufallo-bull (Bubalus bubalis) employing microscopic and spectroscopic techniques. Fluorescein isothiocyanate conjugated lectins namely concanavalin A (Con A), Dolichos biflorus (DBA), Maclura pomifera (MPA), peanut agglutinin (PNA), soybean agglutinin (SBA) and wheat germ agglutinin (WGA) were used to study the changes in the sperm surface carbohydrate make up as the spermatozoa mature. Quantitative analysis of the lectin binding was made flow cytometrically. 31P-NMR (nuclear magnetic resonance) spectra of the sperms obtained from different regions (head, body and tail) of the epididymis and of the ejaculate were analyzed to assess their metabolic activity. And the kinetics of spin label reduction of these samples was monitored with ESR (electron spin resonance) spectroscopy. These observations are supplemented with the electron microscopic (SEM and TEM) examination of the epididymal and ejaculated spermatozoa.
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Affiliation(s)
- S R Bawa
- Department of Biophysics, Panjab University, Chandigarh, India
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