Oral Salmonella typhimurium vaccine expressing circumsporozoite protein protects against malaria.

Immunization with radiation-attenuated malaria sporozoites induces potent cellular immune responses, but the target antigens are unknown and have not previously been elicited by subunit vaccines prepared from the circumsporozoite (CS) protein. A method is described here for inducing protective cell-mediated immunity to sporozoites by immunization with attenuated Salmonella typhimurium transformed with the Plasmodium berghei CS gene. These transformants constitutively express CS antigens and, when used to immunize mice orally, colonize the liver, induce antigen-specific cell-mediated immunity, and protect mice against sporozoite challenge in the absence of antisporozoite antibodies. These data indicate that the CS protein contains T cell epitopes capable of inducing protective cell-mediated immunity, and emphasize the importance of proper antigen presentation in generating this response. Analogous, orally administered vaccines against human malaria might be feasible.

Immunopotentiating reconstituted influenza virus virosome vaccine delivery system for immunization against hepatitis A.

Hepatitis A virus (HAV) was purified from MRC-5 human diploid cell cultures, inactivated with formalin, and evaluated for safety and immunogenicity in humans. Three vaccine formulations were produced: (a) a fluid preparation containing inactivated HAV, (b) inactivated HAV adsorbed to Al(OH)3, and (c) inactivated HAV coupled to novel immunopotentiating reconstituted influenza virosomes (IRIV). IRIV were prepared by combining phosphatidylcholine, phosphatidylethanolamine, phospholipids originating from the influenza virus envelope, influenza virus hemagglutinin, and neuraminidase. The HAV-IRIV appeared as unilamellar vesicles with a diameter of approximately 150 nm when viewed by transmission electron microscopy. Upon intramuscular injection, the alum-adsorbed vaccine was associated with significantly (P < 0.01) more local adverse reactions than either the fluid or IRIV formulations. 14 d after a single dose of vaccine, all the recipients of the IRIV formulation seroconverted (> or = 20 mIU/ml) versus 30 and 44% for those who received the fluid and alum-adsorbed vaccines, respectively (P < 0.001). The geometric mean anti-HAV antibody titer achieved after immunization with the IRIV-HAV vaccine was also significantly higher (P < 0.005) compared with the other two vaccines.

Safety and immunogenicity of a Pseudomonas aeruginosa O-polysaccharide toxin A conjugate vaccine in humans.

Lipid A-free polysaccharide (PS) isolated from Pseudomonas aeruginosa immunotype 5 lipopolysaccharide (LPS) was covalently coupled to toxin A via reductive amination. The PS-toxin A conjugate was comprised of 29.8% PS and 70.2% toxin A, possessed a molecular weight of greater than 1 X 10(6), was nontoxic for animals and was nonpyrogenic for rabbits at a dose of 50 micrograms/kg body wt when administered intravenously. The conjugate evoked only mild, transient reactions upon subcutaneous administration to human volunteers. Vaccination engendered immunoglobulin G (IgG) antibody, which neutralized the cytotoxic effect of toxin A and promoted the uptake and killing of P. aeruginosa in the presence of human polymorphonuclear leukocytes. Passively transferred IgG isolated from the serum of immunized donors was far more effective at preventing fatal P. aeruginosa burn wound sepsis than paired preimmunization serum. These studies establish the potential usefulness of such a PS-toxin A conjugate as a vaccine against P. aeruginosa.

Live attenuated vaccines for human use.

Live attenuated vaccines have been successfully used for the prevention of a number of viral and bacterial diseases. Several vaccine strains have been utilized recently as expression vectors for cloned heterologous antigens. Through the use of recombinant DNA technology, candidate vaccine strains and vector systems have been developed and are undergoing clinical evaluation.

Safety and immunogenicity of a V3 loop synthetic peptide conjugated to purified protein derivative in HIV-seronegative volunteers.

OBJECTIVES: To develop a peptide-based model for a preventive vaccine for HIV-1 infection. DESIGN: Phase I trial in HIV-1-seronegative volunteers. PARTICIPANTS: Adult healthy subjects HIV-1-antibody-seronegative in an enzyme-linked immunosorbent assay, screened for tuberculin [purified protein derivative (PPD)] reactivity with 2 tuberculin units PPD-administered intradermally. INTERVENTIONS: Submicrogram doses of a PPD conjugate with a peptide of the primary neutralizing domain (PND) of HIV-1MN (PPD-MN-PND) were administered intradermally to tuberculin skin-test-positive and -negative volunteers. RESULTS: Antibodies to the MN-PND were measured after two immunizations in 10 out of 11 PPD skin-test-positive volunteers. After the fourth immunization high-affinity antibodies were detected, which persisted for over 1 year. High titers of MN-PND-specific immunoglobulin (Ig) G and IgA were detected in the serum and saliva of all volunteers tested. Serum antibodies were cross-reactive with PND peptide from some other HIV-1 strains but neutralized only the HIV-1MN prototype. Human leukocyte antigen (HLA)-B7-restricted MN-PND-specific cytotoxic T lymphocytes (CTL) were also detected. CONCLUSIONS: The PPD-MN-PND vaccine at submicrogram doses is safe and immunogenic in PPD skin-test-positive healthy adult volunteers. Long lasting humoral immune responses in the serum and saliva were possibly accompanied by HLA-B7-restricted CTL responses. This is a vaccine prototype that can be rapidly and inexpensively modified to include other peptide epitopes. It is especially suitable for use in a worldwide multibillion Bacillus Calmette-Guérin (BCG)-primed or tuberculosis-exposed population at risk for HIV-1 infection.

Cloning of the recA gene of Bordetella pertussis and characterization of its product.

A recA gene of Bordetella pertussis was identified in a plasmid library by complementation of a recA mutation in E coli and subcloned as a 2.1-kb Sph I DNA fragment. Southern hybridization experiments showed no similarity to the E coli recA gene, but very strong similarity to other Bordetella species. E coli recA mutant cells containing the B pertussis recA gene at high gene dosage were resistant to DNA-damaging agents such as methyl methane sulfonate or 4-nitroquinoline-N-oxide, displayed induction of SOS functions, and were able to promote DNA recombination, but not induction of phage lambda. The latter phenotype distinguishes the B pertussis recA gene product from the corresponding proteins from most other Gram-negative organisms. Amino acid sequence comparisons revealed a high degree of structural conservation between prokaryotic RecA proteins.

Qualitative analysis of antibody binding. An in vitro assay for the evaluation and development of vaccines.

We describe a rapid in vitro assay for the evaluation of in vivo properties of conjugate vaccines. Using human and murine monoclonal antibodies (mAb) specific for lipopolysaccharides (LPS), isolated from Pseudomonas aeruginosa, we determined in a competitive binding assay the amount of LPS or conjugate vaccine which was required to inhibit the antibody binding to LPS by 50% (I50 values). Furthermore, utilizing a murine burn wound sepsis model, we determined the potential of the same conjugates to induce protection in vivo against infection with the corresponding bacteria. Protective mAb have approximately 100-fold lower I50 values for preparations which are highly effective in inducing protection than for preparations which are ineffective. Furthermore, in the case of potent preparations it was noted that protective mAb exhibit similar I50 values for the conjugates and for the corresponding LPS. These results suggest that the fast and easily interpretable in vitro assay described may significantly facilitate the development and optimization of vaccines.

Clearance of Pseudomonas aeruginosa from normal rat lungs after immunization with somatic antigens or toxin A.

In a recent study we observed that in most Danish CF patients a period of approximately one year of intermittent colonization precedes the onset of chronic P. aeruginosa lung infection. An experimental model of acute P. aeruginosa pneumonia in normal rats was utilized to investigate the possibility of improving bacterial clearance by vaccination. Rats were immunized with either P. aeruginosa whole bacterial sonicate, O-polysaccharide toxin A conjugate, alginate toxin A conjugate or purified alginate. Saliva and serum samples were obtained to investigate the potential of different vaccines to induce local IgA and systemic IgM, IgG and IgA antibodies. In all immunized rats a significant (p < 0.05) rise in antibody titers against the vaccine components could be demonstrated in both saliva and serum. The macroscopic pathological changes observed at 6, 24 and 48 h after bacterial challenge included a pronounced inflammatory reaction in all groups of rats, whether vaccinated or not (p > 0.05). Approximately 99.5% of the initial inoculum was cleared within the first 6 h after challenge in all groups of rats (p > 0.77). Four weeks after challenge no bacteria could be cultured and no sign of previous inflammation could be demonstrated in any of the groups. The results of this study show that the inflammatory reaction and the natural capacity to clear bacteria in the lungs of normal rats are very efficient against P. aeruginosa and could not be improved by immunization.

Escherichia coli and Klebsiella vaccines and immunotherapy.

A polyvalent vaccine has been prepared from the capsular polysaccharide of 24 different serotypes of Klebsiella spp. Nearly 200 volunteers have received this vaccine. It is very well tolerated and elicits both binding (ELISA) and functional antibody to 21 of 24 antigens. Antibodies were also detected against 10 serotypes not included in the vaccine. An immunoglobulin for intravenous use (IVIG) was more protective in mouse lethality assays and enhanced opsonophagocytic killing of bacteria more than standard, nonhyperimmune globulin. A monovalent E. coli conjugate vaccine against O18ac antigen was safe and highly immunogenic in humans. A 12-valent conjugate vaccine elicits good levels of antibody in rabbits, and will soon undergo phase I testing in humans. These vaccines might best be used for inducing antibody in donor plasma that could be made into IVIG for passive administration.

Feasibility of prophylaxis and therapy against gram-negative infections by human monoclonal antibodies.

In a murine model of Gram-negative sepsis, we have shown that the prophylactic application of human monoclonal antibodies (HmAbs) with specificity for lipopolysaccharides (LPS) of Pseudomonas aeruginosa protected against bacterial infection. In this paper we show that the therapeutical application of 5 micrograms of these HmAbs up to 6 h after challenge with a lethal dose of live P. aeruginosa results in a protection rate of 70-90%. Administration 18 h after bacterial challenge, diminished the protection to 43% survival rate. Furthermore, using a mixture of HmAbs recognizing a total of six different P. aeruginosa serotypes, no interference in their protective capacities was found. Finally, these HmAbs also protected galactosamine-sensitized mice against lethal challenge with LPS. Our data show that the described HmAbs confer bactericidal activity as well as anti-endotoxic activity in vivo.

Extension of the volunteer challenge model to study South American cholera in a population of volunteers predominantly with blood group antigen O.

The volunteer challenge model was used to study the virulence of strains of Vibrio cholerae O1 El Tor recently isolated from cases of cholera in South America. Fifteen of the 24 volunteers (62%) were of blood group O, the group most prevalent in South America and the group at increased risk of more severe cholera. Two El T or Inaba strains and 2 El Tor Ogawa strains were given to volunteers at a dose of 1-2 x 10(6) colony-forming units. All 4 strains caused diarrhoea in 67-83% of volunteers. Volunteers with blood group antigen O had an increased attack rate for diarrhoea (P = 0.015) and a marginally increased mean diarrhoeal stool volume (P = 0.08) after challenge. One-third of the volunteers with blood group O, and none of the volunteers with other blood groups, developed severe diarrhoea (> 5 L) (P = 0.01). This study established a model of South American cholera that can be used to predict field efficacy of candidate vaccines among populations with a high prevalence of blood group antigen O.

Patient compliance in the use of Vivotif Berna(R) vaccine, typhoid vaccine, live oral Ty21a.

BACKGROUND: Several live attenuated vaccines against bacterial enteric pathogens have recently been licensed. These include the Salmonella typhi Ty21a typhoid vaccine (Vivotif Berna(R) Vaccine) and Vibrio cholerae CVD103-HgR cholera vaccine (Mutacol Berna(R) Vaccine). They comprise a unique class of biologics in which patient compliance is required for their optimal use. This is of particular importance in the case of the Ty21a vaccine strain of which multiple doses are required. Furthermore, exposure to heat, concomitant use with antibiotics or antimalarial drugs, and timing of vaccination with respect to food intake can affect vaccine potency and/or efficacy. This study was conducted to determine the level of compliance among adult North American travelers and to evaluate compliance errors with respect to potential vaccine efficacy. METHOD: Questionnaires were provided to 1091 travelers at twelve travel clinics in the United States and Canada. The patients were requested to complete forms which asked questions relating to vaccine storage and usage, and to return them to the travel clinic. A total of 762 completed questionnaires were returned. RESULTS: Few compliance errors were made regarding proper storage of the vaccine. The most common compliance errors involved not taking all four capsules on alternate days (10%) and not taking all four doses of vaccine prior to departure (6%). CONCLUSIONS: Pretravel counselling was effective in obtaining a high compliance rate among adult travelers in the use of Vivotif Berna(R) Vaccine. The majority of compliance errors reported would not be expected to negatively impact upon vaccine efficacy.

Optimization of growth and secretion of human monoclonal antibodies by hybridomas cultured in serum-free media.

To facilitate the production and purification of human monoclonal antibodies, we evaluated the ability of human hybridomas to adapt to chemically defined-serum free media. From a panel of human hybridomas secreting antibody against serotype specific lipopolysaccharide determinants of gram-negative bacteria, the growth and secretion properties of the two hybridomas producing antibodies against two strains of Pseudomonas aeruginosa, 4-8KH15 and 4-10KH139, were analysed. Both clones did not grow in protein-free medium. However, it was possible to adapt them to serum-free media consisting of a basal medium supplemented with insulin, transferrin, ethanolamine, and selenite. Antibody secretion rates were equal (4-8KH15: 26-31 micrograms IgM/10(6) cells/day) or higher (4-10KH139: 58-90 micrograms IgM/10(6) cells/day) in serum-free media as compared to conventional serum-supplemented medium. Our studies suggest that adaptation of the described hybridomas to selected serum-free media results in an antibody production which is very high as compared with reports in comparable systems. The establishment of these conditions will significantly facilitate the production of large amounts of human monoclonal antibodies which is a prerequisite for a therapeutical application.

Safety and immunogenicity of a Haemophilus influenzae type B polysaccharide-tetanus toxoid conjugate vaccine combined with diphtheria, tetanus and pertussis vaccines in Thai infants.

A randomized, open, multicenter trial was conducted to determine the safety and immunogenicity of a Haemophilus influenzae type b polysaccharide-tetanus toxoid (PRP-T) conjugate vaccine combined with tetanus, diphtheria and pertussis (DTP) vaccine in 271 Thai infants born to mothers immunized against tetanus during pregnancy. Infants were immunized at approximately 2, 4 and 6 months of age with these vaccines. To determine if elevated levels of anti-tetanus toxin antibodies suppressed the anti-PRP antibody response, a second group of infants were immunized with PRP complexed with outer membrane proteins of Neisseria meningitidis (Pedvax HIB) in one limb at 2 and 4 months of age and DTP vaccine in the other limb at 2, 4 and 6 months of age. A third group of infants received only DTP vaccine at 2, 4 and 6 months of age. The occurrence of both local and systemic adverse reactions were comparable in all 3 groups. The geometric mean anti-tetanus antibody titer was > 1 IU/ml at baseline. Approximately 1 month after the administration of the third dose of vaccine, 98.5%, 99.3% and 9.7% of the children immunized with DTP+Pedvax HIB, DTP-PRP-T or DTP possessed > or = 0.15 microgram of anti-PRP antibody per ml. No child in the DTP group achieved > or = 1 microgram/ml while 74.2% and 89.3% did so after immunization with DTP+Pedvax HIB, or DTP-PRP-T, respectively (p < 0.05). Immune responses to diphtheria, tetanus and pertussis antigens were similar in all vaccine groups. These results demonstrate that elevated tetanus antibody titers do not diminish the anti-PRP antibody response following immunization with a PRP-T conjugate combined with DTP vaccine.

Molecular parasitology: progress towards the development of vaccines for malaria, filariasis, and schistosomiasis.

Advances in molecular biology have allowed for the identification of potential vaccine candidates against several parasitic diseases. Antigens from various life stages of Plasmodium and Schistosoma species and filarial worms have been cloned, sequenced and tested as vaccines. Results to date in animal models have been promising. Modest levels of protection against experimental human malaria have been obtained using both sporozoite and blood-stage antigens. However, a greater understanding of the mechanisms which lead to immunity against parasites is required before effective vaccines can be developed.

Prospects for the prevention and control of gram-negative nosocomial infections.

Nosocomial infections of bacterial origin continue to be a leading cause of morbidity and mortality among virtually all hospitalized patient populations. It is estimated that nearly 5% of all hospitalized individuals will acquire an infection during their stay. Approximately 3% of nosocomial infections will contribute to an eventual fatal outcome. Preeminent among nosocomial pathogens are the aerobic Gram-negative bacilli, with Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp. being the causative agents for the majority of life-threatening infections. This review describes the current situation and future prospects for combatting these infections.