Evaluation of safety and immunogenicity of a group A streptococcus vaccine candidate (MJ8VAX) in a randomized clinical trial.

BACKGROUND: Group A streptococcus (GAS) is a serious human pathogen that affects people of different ages and socio-economic levels. Although vaccination is potentially one of the most effective methods to control GAS infection and its sequelae, few prototype vaccines have been investigated in humans. In this study, we report the safety and immunogenicity of a novel acetylated peptide-protein conjugate vaccine candidate MJ8VAX (J8-DT), when delivered intramuscularly to healthy adults. METHODS: A randomized, double-blinded, controlled Phase I clinical trial was conducted in 10 healthy adult participants. Participants were randomized 4:1 to receive the vaccine candidate (N = 8) or placebo (N = 2). A single dose of the vaccine candidate (MJ8VAX), contained 50 µg of peptide conjugate (J8-DT) adsorbed onto aluminium hydroxide and re-suspended in PBS in a total volume of 0.5 mL. Safety of the vaccine candidate was assessed by monitoring local and systemic adverse reactions following intramuscular administration. The immunogenicity of the vaccine was assessed by measuring the levels of peptide (anti-J8) and toxoid carrier (anti-DT)-specific antibodies in serum samples. RESULTS: No serious adverse events were reported over 12 months of study. A total of 13 adverse events (AEs) were recorded, two of which were assessed to be associated with the vaccine. Both were mild in severity. No local reactogenicity was recorded in any of the participants. MJ8VAX was shown to be immunogenic, with increase in vaccine-specific antibodies in the participants who received the vaccine. The maximum level of vaccine-specific antibodies was detected at 28 days post immunization. The level of these antibodies decreased with time during follow-up. Participants who received the vaccine also had a corresponding increase in anti-DT serum antibodies. CONCLUSIONS: Intramuscular administration of MJ8VAX was demonstrated to be safe and immunogenic. The presence of DT in the vaccine formulation resulted in a boost in the level of anti-DT antibodies. TRIAL REGISTRATION: ACTRN12613000030774.

Preclinical immunogenicity and safety of a Group A streptococcal M protein-based vaccine candidate.

Streptococcus pyogenes (group A streptococcus, GAS) causes a wide range of clinical manifestations ranging from mild self-limiting pyoderma to invasive diseases such as sepsis. Also of concern are the post-infectious immune-mediated diseases including rheumatic heart disease. The development of a vaccine against GAS would have a large health impact on populations at risk of these diseases. However, there is a lack of suitable models for the safety evaluation of vaccines with respect to post-infectious complications. We have utilized the Lewis Rat model for cardiac valvulitis to evaluate the safety of the J8-DT vaccine formulation in parallel with a rabbit toxicology study. These studies demonstrated that the vaccine did not induce abnormal pathology. We also show that in mice the vaccine is highly immunogenic but that 3 doses are required to induce protection from a GAS skin challenge even though 2 doses are sufficient to induce a high antibody titer.

A synthetic M protein peptide synergizes with a CXC chemokine protease to induce vaccine-mediated protection against virulent streptococcal pyoderma and bacteremia.

Infections caused by Streptococcus pyogenes (group A Streptococcus [GAS]) are highly prevalent in the tropics, in developing countries, and in the Indigenous populations of developed countries. These infections and their sequelae are responsible for almost 500,000 lives lost prematurely each year. A synthetic peptide vaccine (J8-DT) from the conserved region of the M protein has shown efficacy against disease that follows i.p. inoculation of bacteria. By developing a murine model for infection that closely mimics human skin infection, we show that the vaccine can protect against pyoderma and subsequent bacteremia caused by multiple GAS strains, including strains endemic in Aboriginal communities in the Northern Territory of Australia. However, the vaccine was ineffective against a hypervirulent cluster of virulence responder/sensor mutant GAS strain; this correlated with the strain's ability to degrade CXC chemokines, thereby preventing neutrophil chemotaxis. By combining J8-DT with an inactive form of the streptococcal CXC protease, S. pyogenes cell envelope proteinase, we developed a combination vaccine that is highly effective in blocking CXC chemokine degradation and permits opsonic Abs to kill the bacteria. Mice receiving the combination vaccine were strongly protected against pyoderma and bacteremia, as evidenced by a 100-1000-fold reduction in bacterial burden following challenge. To our knowledge, a vaccine requiring Abs to target two independent virulence factors of an organism is unique.

Polymer-peptide hybrids as a highly immunogenic single-dose nanovaccine.

AIM: To explore four-arm star poly(t-butyl)acrylate (P(t)BA)-peptide and linear P(t)BA-peptide conjugates as a vaccine-delivery system against Group A Streptococcus. MATERIALS & METHODS: P(t)BA nanoparticles bearing J14 peptide epitopes were prepared via alkyne-azide 1,3-dipolar cycloaddition 'click' reaction. The conjugated products were self-assembled into small or large nanoparticles. These nanoparticle vaccine candidates were evaluated in vivo and J14-specific antibody titers were assessed. RESULTS & DISCUSSION: Mice vaccinated with the nanoparticles were able to produce J14-specific IgG antibodies without the use of an external adjuvant after a single immunization. We have demonstrated for the first time that the immune responses against self-assembled P(t)BA nanoparticles are stronger for the smaller sized (~20 nm) nanoparticles compared with the larger (~500 nm) P(t)BA nanoparticles. CONCLUSION: PtBA analogs have the potential to be developed as potent carrier systems for single-dose synthetic vaccines.

An efficient, chemically-defined semisynthetic lipid-adjuvanted nanoparticulate vaccine development system.

A novel vaccine development platform that enables the site-specific conjugation of synthetic lipid adjuvants to recombinant proteins was produced. This technology facilitates the simple and efficient production of homogeneous, chemically-defined, semisynthetic lipoprotein vaccines. Using a polytope 'string-of-beads' approach, a synthetic gene incorporating seven Streptococcus pyogenes M protein strain-specific antigens, and a conserved M protein antigen (J14) was produced, expressed, and attached to a lipoamino acid based adjuvant (lipid core peptide; LCP). Nanoparticles (40 nm diameter) of an optimal size for stimulating antibody-mediated immunity were formed upon the addition of these lipoproteins to aqueous buffer (PBS). Systemic antigen-specific IgG antibodies were raised against all eight antigens in C57BL/6J mice, without the need to formulate with additional adjuvant. These antibodies bound cell surface M proteins of S. pyogenes strains represented within the polytope sequence, with higher antibody levels observed where a dendritic cell targeting peptide (DCpep) was incorporated within the LCP adjuvant. FROM THE CLINICAL EDITOR: In this study, a novel vaccine development system is presented, combining adjuvants with recombinant protein antigens, and presenting the antigen in a nanoparticle system optimized for antibody production. They demonstrate efficient vaccination in a murine model system without the need for additional adjuvants.

Long-term antibody memory induced by synthetic peptide vaccination is protective against Streptococcus pyogenes infection and is independent of memory T cell help.

Streptococcus pyogenes (group A Streptococcus [GAS]) is a leading human pathogen associated with a diverse array of mucosal and systemic infections. Vaccination with J8, a conserved region synthetic peptide derived from the M-protein of GAS and containing only 12 aa from GAS, when conjugated to diphtheria toxoid, has been shown to protect mice against a lethal GAS challenge. Protection has been previously shown to be Ab-mediated. J8 does not contain a dominant GAS-specific T cell epitope. The current study examined long-term Ab memory and dissected the role of B and T cells. Our results demonstrated that vaccination generates specific memory B cells (MBC) and long-lasting Ab responses. The MBC response can be activated following boost with Ag or limiting numbers of whole bacteria. We further show that these memory responses protect against systemic infection with GAS. T cell help is required for activation of MBC but can be provided by naive T cells responding directly to GAS at the time of infection. Thus, individuals whose T cells do not recognize the short synthetic peptide in the vaccine will be able to generate a protective and rapid memory Ab response at the time of infection. These studies significantly strengthen previous findings, which showed that protection by the J8-diphtheria toxoid vaccine is Ab-mediated and suggest that in vaccine design for other organisms the source of T cell help for Ab responses need not be limited to sequences from the organism itself.

Self-adjuvanting modular virus-like particles for mucosal vaccination against group A streptococcus (GAS).

Group A streptococcus (GAS) causes a wide range of diseases, some of them related to autoimmune diseases triggered by repeated GAS infections. Despite the fact that GAS primarily colonizes the mucosal epithelium of the pharynx, the main mechanism of action of most vaccine candidates is based on development of systemic antibodies that do not cross-react with host tissues, neglecting the induction of mucosal immunity that could potentially block disease transmission. Peptide antigens from GAS M-surface protein can confer protection against infection; however, translation of such peptides into immunogenic mucosal vaccines that can be easily manufactured remains a challenge. In this work, a modular murine polyomavirus (MuPyV) virus-like particle (VLP) was engineered to display a GAS antigenic peptide, J8i. Heterologous modules containing one or two J8i antigen elements were integrated with the MuPyV VLP, and produced using microbial protein expression, standard purification techniques and in vitro VLP assembly. Both modular VLPs, when delivered intranasally to outbred mice without adjuvant, induced significant titers of J8i-specific IgG and IgA antibodies, indicating significant systemic and mucosal responses, respectively. GAS colonization in the throats of mice challenged intranasally was reduced in these immunized mice, and protection against lethal challenge was observed. This study shows that modular MuPyV VLPs prepared using microbial synthesis have potential to facilitate cost-effective vaccine delivery to remote communities through the use of mucosal immunization.

Conserved anchorless surface proteins as group A streptococcal vaccine candidates.

Streptococcus pyogenes (group A Streptococcus (GAS)) causes ∼700 million human infections each year, resulting in over 500,000 deaths. The development of a commercial GAS vaccine is hampered by the occurrence of many unique GAS serotypes, antigenic variation within the same serotype, differences in serotype geographical distribution, and the production of antibodies cross-reactive with human tissue that may lead to autoimmune disease. Several independent studies have documented a number of GAS cell wall-associated or secreted metabolic enzymes that contain neither N-terminal leader sequences nor C-terminal cell wall anchors. Here, we applied a proteomic analysis of serotype M1T1 GAS cell wall extracts for the purpose of vaccine development. This approach catalogued several anchorless proteins and identified two protective vaccine candidates, arginine deiminase and trigger factor. These surface-exposed enzymes are expressed across multiple GAS serotypes exhibiting ≥99% amino acid sequence identity. Vaccine safety concerns are alleviated by the observation that these vaccine candidates lack human homologs, while sera from human populations suffering repeated GAS infections and high levels of autoimmune complications do not recognize these enzymes. Our study demonstrates anchorless cell surface antigens as promising vaccine candidates for the prevention of GAS disease.

Intranasal vaccination with a lipopeptide containing a conformationally constrained conserved minimal peptide, a universal T cell epitope, and a self-adjuvanting lipid protects mice from group A streptococcus challenge and reduces throat colonization.

Infection with group A streptococcus (GAS) may result in a number of human diseases, including potentially life-threatening postinfectious sequelae. In the present study, J14, a conformationally constrained conserved minimal peptide from the M protein, was incorporated into a lipopeptide construct to which a universal T cell epitope and a self-adjuvanting lipid moiety, Pam(2)Cys, were also attached. We demonstrate that this lipopeptide construct, when administered intranasally (inl) without additional adjuvants, protects outbred mice from lethal respiratory GAS challenge. In addition, the lipopeptide was capable of inducing J14-specific mucosal immunoglobulin A, which coincided with reduced throat colonization after respiratory GAS challenge. These preclinical experiments show that this lipopeptide could form the basis of an antidisease and transmission-blocking inl GAS vaccine.

Toward the development of an antidisease, transmission-blocking intranasal vaccine for group a streptococcus.

Infection with group A streptococcus (GAS) may result in a number of clinical conditions, including the potentially life-threatening postinfectious sequelae of rheumatic fever and rheumatic heart disease. As part of the search for a vaccine to prevent GAS infection, a conformationally constrained and minimally conserved peptide, J14, from the M protein of GAS has been defined. In the present study, J14 was formulated with bacterial outer membrane proteins (proteosomes) and then intranasally administered to outbred mice without additional adjuvant. Such immunization led to high titers of J14-specific serum immunoglobulin (Ig) G and mucosal IgA. After upper respiratory tract GAS challenge, immunized mice demonstrated increased survival and reduced GAS colonization of the throat.

Preclinical evaluation of a vaccine based on conserved region of M protein that prevents group A streptococcal infection.

BACKGROUND & OBJECTIVES: Infection with group A Streptococcus (GAS) may result in a number of human diseases ranging from the relatively benign pharyngitis to the potentially life-threatening invasive diseases and post-infectious sequelae. We have previously defined a minimal B-cell epitope from the conserved region of the M-protein. Here we report on the immunogenicity, opsonic potential of the resulting sera and the level of protection induced by this peptide in comparison to a pepsin extract of the M protein. METHODS: Inbred mice were immunized with peptides derived from the M protein. Sera were collected from the immunized mice and its opsonic potential determined for M1 and M6 GAS strains. Mice were then intranasally challenged with a virulent M1 GAS strain to determine the protective efficacy of the peptides. RESULTS: The peptides induced significant antibody responses when delivered subcutaneously and immunized mice demonstrated significantly enhanced survival compared to control groups following challenge. INTERPRETATION & CONCLUSION: The data obtained in the present study indicated that the chimeric peptide J8 from the conserved region of the M protein could form the basis for an anti-streptococcal vaccine in future.

Antibodies to streptococcal inhibitor of complement function and M peptides in a post-streptococcal glomerulonephritis endemic region of Australia.

Post-streptococcal glomerulonephritis (PSGN) is an immune-mediated disease in which an immune complex containing a streptococcal antigen are deposited in affected glomeruli. Strains of only some M types are known to be associated with PSGN. A secretory protein called SIC inhibits complement function. Whereas all M1 and M57 strains express closely related SIC (CRS), all M12 and M55 strains express distantly related SIC (DRS) proteins. Strains belonging to these four M types are historically associated with PSGN. This study used ELISA to analyse 112 sera from individuals with a recorded history of PSGN and 86 sera from individuals who had no such recorded history, all from a PSGN endemic region in tropical Australia. Antibody reactions to CRS, DRS and peptides corresponding to the N-termini of M1, M5, M12, M49, M55 and M57 antigens were assessed. A large proportion of the population showed reactions to each of these antigens and there was no correlation between CRS seropositivity and antibodies to CRS-positive M types. Likewise there was no correlation between DRS seropositivity and antibodies to DRS-positive M types. Interestingly, in this community endemic for PSGN a significantly higher proportion of DRS seropositive subjects had a recorded history of PSGN than did DRS seronegative subjects. DRS may have a predictive value for PSGN diagnosis or a role in PSGN pathogenesis.