Safety, immunogenicity, and efficacy of the mRNA vaccine CS-2034 as a heterologous booster versus homologous booster with BBIBP-CorV in adults aged ≥18 years: a randomised, double-blind, phase 2b trial

BACKGROUND

Heterologous boosting is suggested to be of use in populations who have received inactivated COVID-19 vaccines. We aimed to assess the safety and immunogenicity of a heterologous vaccination with the mRNA vaccine CS-2034 versus the inactivated BBIBP-CorV as a fourth dose, as well as the efficacy against the SARS-CoV-2 omicron (BA.5) variant.

METHODS

This trial contains a randomised, double-blind, parallel-controlled study in healthy participants aged 18 years or older (group A) and an open-label cohort in participants 60 years and older (group B), who had received three doses of inactivated whole-virion vaccines at least 6 months before enrolment. Pregnant women and people with major chronic illnesses or a history of allergies were excluded. Eligible participants in group A were stratified by age (18-59 years and ≥60 years) and then randomised by SAS 9.4 in a ratio of 3:1 to receive a dose of the mRNA vaccine (CS-2034, CanSino, Shanghai, China) or inactivated vaccine (BBIBP-CorV, Sinopharm, Beijing, China). Safety and immunogenicity against omicron variants of the fourth dose were evaluated in group A. Participants 60 years and older were involved in group B for safety observations. The primary outcome was geometric mean titres (GMTs) of the neutralising antibodies against omicron and seroconversion rates against BA.5 variant 28 days after the boosting, and incidence of adverse reactions within 28 days. The intention-to-treat group was involved in the safety analysis, while all patients in group A who had blood samples taken before and after the booster were involved in the immunogenicity analysis. This trial was registered at the Chinese Clinical Trial Registry Centre (ChiCTR2200064575).

FINDINGS

Between Oct 13, and Nov 22, 2022, 320 participants were enrolled in group A (240 in the CS-2034 group and 80 in the BBIBP-CorV group) and 113 in group B. Adverse reactions after vaccination were more frequent in CS-2034 recipients (158 [44·8%]) than BBIBP-CorV recipients (17 [21·3%], p<0·0001). However, most adverse reactions were mild or moderate, with grade 3 adverse reactions only reported by eight (2%) of 353 participants receiving CS-2034. Heterologous boosting with CS-2034 elicited 14·4-fold (GMT 229·3, 95% CI 202·7-259·4 vs 15·9, 13·1-19·4) higher concentration of neutralising antibodies to SARS-CoV-2 omicron variant BA.5 than did homologous boosting with BBIBP-CorV. The seroconversion rates of SARS-CoV-2-specific neutralising antibody responses were much higher in the mRNA heterologous booster regimen compared with BBIBP-CorV homologous booster regimen (original strain 47 [100%] of 47 vs three [18·8%] of 16; BA.1 45 [95·8%] of 48 vs two [12·5%] 16; and BA.5 233 [98·3%] of 240 vs 15 [18·8%] of 80 by day 28).

INTERPRETATION

Both the administration of mRNA vaccine CS-2034 and inactivated vaccine BBIBP-CorV as a fourth dose were well tolerated. Heterologous boosting with mRNA vaccine CS-2034 induced higher immune responses and protection against symptomatic SARS-CoV-2 omicron infections compared with homologous boosting, which could support the emergency use authorisation of CS-2034 in adults.

FUNDING

Science and Technology Commission of Shanghai, National Natural Science Foundation of China, Jiangsu Provincial Science Fund for Distinguished Young Scholars, and Jiangsu Provincial Key Project of Science and Technology Plan.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

[Effect of perioperative accelerated rehabilitation management program for children with congenital spinal deformity]

Objective: To explore the perioperative therapeutic effect of enhanced recovery after surgery (ERAS) in children with congenital spinal deformity and summarize the clinical experience. Methods: Fifty-nine pediatric patients with congenital spinal deformities admitted to Beijing Children's Hospital from May 2020 to January 2021 were included in this study, and all patients underwent posterior spinal osteotomy orthopedic implant fusion with internal fixation. There were 22 males and 37 females, aged (7.4±4.1) years. Patients were divided into ERAS group (n=29) and control group (n=30) according to the management model. Patients in the ERAS group were managed with an accelerated recovery management model during the perioperative period, which mainly included: high protein diet, shortened fasting time, optimized anesthesia protocol, and multimodal analgesia. Patients in the control group received the traditional perioperative management model. The indexes of surgery, diet, pain score and laboratory tests were compared between the two groups. Results: All patients completed the surgery successfully. The mean temperature and pain scores of patients in the ERAS group were lower than those in the control group at 3 days postoperatively (P<0.05). The time to exhaustion and defecation in the ERAS group was (1.0±0.8) d and (2.5±0.9) d postoperatively, both significantly earlier than those in the control group ((3.4±0.8) d and (4.0±1.1) d) (both P<0.05). C-reactive protein was 38(8,46) mg/L in patients of the ERAS group on the day 3 postoperatively, which was significantly lower than that in the control group 47(22,93) mg/L (P=0.023). The hemoglobin level on postoperative day 3 was (110.7±9.6) g/L in the ERAS group, which was significantly higher than that in the control group ((104.5±11.4) g/L) (P=0.029). Postoperative complications occurred in 8(27.6%) and 9(30.0%) patients in the ERAS and control groups, respectively (P=1.000), with mild abdominal pain and bloating being the most common complications in both groups, most of which were not treated specifically. Conclusion: ERAS is a safe and effective perioperative management mode for children with congenital spinal deformity. Compared with the traditional method, it can significantly improve the treatment efficiency and deserve clinical application.

Effects of exogenous melatonin on photosynthesis and physiological characteristics of chry-santhemum seedlings under high temperature stress

We examined the effects of exogenous melatonin (MT) on the resistance of Chrysanthemum morifolium 'Jinba' to high temperature stress. Chrysanthemum leaves were sprayed with 200 μmol·L^-1MT, and then subjected to high temperature stress at 40 ℃ (day)/ 35 ℃ (night). The ultrastructure of chloroplast and thylakoid of chrysanthemum leaves were observed, and the photosynthetic and physiological indices were measured. The results showed that the chloroplast and thyla-koid structures of chrysanthemum were damaged under high temperature stress. The chlorophyll contents and maximum fluorescence (F_m) were significantly reduced, while the OJIP curve changed with the fluorescence of K and J points increased. The net photosynthetic rate (P_n), transpiration rate (T_r) and stomatal conductance (g_s) were significantly decreased, while the internal CO₂ concentration (C_i) was significantly increased. The relative conductivity (REC), malondialdehyde (MDA), reactive oxygen species (ROS), osmotic adjustment substances content and antioxidant enzyme activity all increased significantly. Spraying exogenous MT onto leaves could maintain the integrity of chloroplast and thylakoid structure under high temperature in chrysanthemum and significantly decrease the increment in the K and J points of OJIP curve. Exogenous application of MT alleviated the inhibition of high temperature stress on photosynthesis and fluorescence of chrysanthemum, as indicated by significantly higher F_m, P_n, g_s, T_r and photosynthetic pigment contents and lower C_i. Exogenous MT also significantly reduced the REC, MDA and ROS contents of chrysanthemum under high temperature stress, and enhanced the osmotic adjustment substances content and antioxidant enzyme activity in chrysanthemum leaves. It suggested that exogenous MT could protect the integrity of chloroplast structure of chrysanthemum leaves, enhance photosynthesis, inhibit the excessive production of ROS in the plants under high temperature stress, improve the activity of antioxidant enzyme system, reduce the level of membrane peroxidation and keep the integrity of lipid membrane, and thus improve the ability of chrysanthemum plants to resist high temperature stress.

Microsatellite marker analysis reveals the distinction between the north and south groups of hard clam (Meretrix meretrix) in China

Meretrix meretrix is one of the important commercial bivalves in China. A total of 198 individual clams were collected from 5 locations characteristic of the clam's 5 main natural habitats in China, that is, Shandong, Jiangsu, Fujian, Guangdong, and Guangxi. Ten polymorphic microsatellite markers were selected to examine the genetic diversity and identify genetic differences between the 5 populations. A total of 183 alleles across 10 loci were detected in the individual clams. The observed heterozygosity and expected heterozygosity ranged from 0.197 to 0.7026 and from 0.6264 to 0.9408, respectively. The genetic diversity within samples was high (8.6-11.2 alleles per locus, observed heterozygosity = 0.25-0.875 and expected heterozygosity = 0.6848-0.9259). Most of the genotype distributions significantly deviated from Hardy-Weinberg equilibrium. Genetic structure analysis showed that the 5 populations could be divided into 2 groups, the north and south groups. Neighbor-joining analysis revealed a clear distinction between the north group (Shandong and Jiangsu) and the south group (Fujian, Guangdong, and Guangxi). Locus MM1031 was used to distinguish between groups. Our results can be used for population identification and crossbreeding of M. meretrix.

An elevated plasma level of visfatin increases the risk of myocardial infarction

Visfatin, an adipocytokine involved in metabolic and immune disorders, plays an important role in the etiology of cardiovascular disease. Recent evidence has shown that an elevated plasma level of visfatin may increase the risk of myocardial infarction (MI), but individual published studies have shown inconclusive results. This study aimed to obtain a more precise estimate of the association between the plasma visfatin level and MI risk through a detailed meta-analysis of studies published in peer-reviewed journals. A literature search of articles published before May 1, 2013 was performed on the PubMed, Embase, Web of Science, and China BioMedicine databases. Crude standardized mean differences (SMDs) with 95% confidence intervals (CI) were calculated. Eleven case-control studies comprising 362 MI patients and 322 healthy controls were included. The meta-analysis revealed that an elevated plasma level of visfatin was associated with an increased risk of MI (SMD = 3.82, 95%CI = 2.67-4.98, P < 0.001). Further stratification based on the source of the controls showed that an elevated plasma level of visfatin was significantly associated with increased risk of MI in both hospital-based and population-based studies (SMD = 4.12, 95%CI = 2.23-6.01, P < 0.001 and SMD = 3.65, 95%CI = 2.67- 4.98, P < 0.001, respectively). No publication bias was evident in this meta-analysis. In conclusion, the current meta-analysis indicates that an elevated plasma level of visfatin increases the risk of MI. Therefore, plasma visfatin may be a promising biomarker for the diagnosis of MI.

Toll-like receptor 4 signaling promotes the immunosuppressive cytokine production of human cervical cancer

OBJECTIVES

To investigate the expression of TLR-4 (toll-like receptor) on human cervical cancer and find the biological function of the TLR-4 signal system.

METHODS

The immunohistochemistry method was performed to study the protein expression and distribution of TLR-4. The viability of HeLa cells was determined by cell viability assay. Cell proliferation was detected by FCM, ELISA and Western blot were used to observe the gene and protein expression of IL-6 and TGF-beta1 in Hela cell lines.

RESULTS

TLR-4 was over-expressed in cervix cancer, and its activation by LPS promotes proliferation and anti-apoptosis in Hela cells in vitro. Moreover the cell line proliferation increased in a dose- and time-dependent manner. The production of IL-6 and TGF-beta1 were promoted through the activation of the NF-kappaB signaling pathway.

[Effect of monoclonal or different cell seeding densities on the differentiation potential of immortalized human mesenchymal stem cells in vitro and in vivo]

OBJECTIVE

To determine whether monoclonality or different cell seeding densities could influence the differentiation potential of immortalized human mesenchymal stem cells (hMSC-TERT) and to find an effective cultural method of hMSC-TERT in vitro.

METHODS

From the parental hMSC-TERT cell line, we derived 30 monoclonal cell lines and two independent cell lines based on different plating densities during expansion in culture. Their adipocytic, osteogenic, neuronal differentiation potential in vitro and multidirectional differentiation potential in vivo were analyzed by immunohistochemistry for pathologic tissue markers.

RESULTS

Monoclonal cell lines and the cell line derived at low seeding density had a lower differentiation potential in vitro than the cell line derived at higher cell seeding density. The differentiation potential of monoclonal hMSC-TERT cells were dissimilar. Some of monoclonal hMSC-TERT lines expressed epithelial differentiation potential in vivo while the parental hMSC-TERT cells line did not.

CONCLUSION

Multiclonal hMSC-TERT cells cultured in high seeding density can keep the differentiation potential, cloning the hMSC-TERT cells before transplantation to find the special clones for special purpose of transplantation.

The antioxidant activities of natural sweeteners, mogrosides, from fruits ofSiraitia grosvenori

To search for antioxidant agents from natural resources, in this paper the in vitro antioxidant activities of two natural sweeteners, mogroside V and 11-oxo-mogroside V isolated from the fruits of Siraitia grosvenori, were determined using chemiluminescence (CL). The results showed that these sweet glycosides, having cucurbitane triterpenoid aglycon, exhibited significant inhibitory effects on reactive oxygen species (O2-, H2O2 and *OH) and DNA oxidative damage. 11-oxo-mogroside V showed a higher scavenging effect on O2- (concentration at which 50% of chemiluminescence intensity is inhibited [EC50] =4.79 microg/ml) and H2O2 (EC50 = 16.52 microg/ml) than those of mogroside V. However, mogroside V was more effective in scavenging *OH, with EC50 =48.44 microg/ml compared with that of 11-oxo-mogroside V (EC50 = 146.17 microg/ml). Further, 11 -oxo-mogroside V exhibited a remarkable inhibitory effect on *OH-induced DNA damage with EC50 = 3.09 microg/ml.

Genetic risk identifies multiple myeloma patients who do not benefit from autologous stem cell transplantation

Genetic aberrations have emerged as major prognostic factors for patients with multiple myeloma (MM). We evaluated 126 MM patients for t(4;14) or t(11;14), 13q or p53 deletions and correlated the number of genetic aberrations with patient's clinical outcome following undergoing autologous stem cell transplantation. We demonstrate the significance of genetic-based risk classification that clearly segregate patients into low (no genetic abnormalities or only t(11;14)), intermediate (any one of the genetic abnormalities other than t(11;14)) and high-risk groups (any two or more of the genetic abnormalities other than t(11;14)). High-risk patients do not benefit from stem cell transplant and should be offered alternative therapies.

A study on the electrophysiological heterogeneity of rabbit ventricular myocytes the effect of ischemia on action potentials and potassium currents

With the whole-cell variant patch-clamp technique, action potentials (AP) and outward potassium currents of rabbit ventricular myocytes isolated from subendocardium and subepicardium were recorded and their changes were observed under normal and ischemia conditions. The results showed that (1) under normal condition, there were differences in the AP figures between ventricular subendocardial and subepicardial myocytes. Action potentials recorded from subepicardial myocytes had shorter action potential duration (APD) and a notch between phases 1 and 2, compared with those of subendocardial myocytes. The resting potential had no significant difference between these two populations of the action myocytes; (2) under ischemia condition, the notch of action potentials of subepicardial myocytes disappeared and the APD was shortened even more, compared with that of subendocardial myocytes; (3) under normal condition, the density of steady-state outward potassium currents of subepicardial myocytes was significantly greater than that of subendocardial myocytes; (4) under ischemia condition, the increase of steady-state outward potassium currents of subepicardial myocytes was greater than that of subendocardial myocytes. Glybenclamide could partly reverse the above changes. It is suggested that the increase of steady-state outward potassium currents during ischemia is mainly due to the opening of I(K-ATP) channels as a result of the deficiency of intracellular ATP caused by ischemia.

The association between breast cancer and diet and other factors

To explore the effects of diet and other factors on breast cancer development, a case-control study was conducted in Tianjin between 1986-87. After adjusting for confounding factors, it was found that factors associated with increased risk of breast cancer included --early age at menarche; late age at menopause; late age at first birth; high Qutelet's index; histories of breast wound, disease and benign tumor; and a family history of malignant tumor, high fat, high calorie, low vegetable intake; elevated serum cholesterol and LDL-cholesterol; and lower levels of serum HDL-cholesterol and whole blood selenium.

Spectrophotometric determination of hydrazine, hydrazides, and their mixtures with trinitrobenzenesulfonic acid

A method has been developed to measure hydrazine, hydrazides, and their mixtures using a modification of the trinitrobenzenesulfonic acid method [T. Okuyama and K. Satake (1960) J. Biochem. (Tokyo) 47, 654-660]. After incubation of the sample containing hydrazine and hydrazide with trinitrobenzenesulfonate at pH 8.5 at room temperature for 40 min, the reaction mixture was diluted with a Na2CO3-NaHCO3 buffer (0.1 M, pH 10.8) rather than with 0.5 M HCl. Different chromogens were produced from the reaction of hydrazine (lambda max = 570 nm) and hydrazides (lambda max = 385 and 500 nm) with trinitrobenzenesulfonic acid. The method allowed simultaneous determination of hydrazine (5 to 60 nmol) with hydrazide (10 to 120 nmol) in a mixture with a standard deviation of less than 5%. The presence of amino compounds (except for amino sugars) did not interfere with the measurement of hydrazine or hydrazides. Interference by amino sugars in the determination of hydrazine or hydrazides was eliminated by pretreatment of the sample with NaBH4 to reduce the amino sugars to 2-amino-2-deoxy-hexitols.