powerpoint presentation - vaccination · • in the 1980s a formalin inactivated rsv was used in...
TRANSCRIPT
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Vaccines
Robert Woodland 6-2465
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Vaccines
• Lecture topics:
• The benefits and risks of vaccination • The immunological basis for protection • Classes of vaccine antigens and adjuvants • Various tactics of vaccine development • Bad vaccine effects • Systems Biology and vaccine development
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A Mini History Lesson
• The knowledge that previous infection can be protective • Eastern and African cultures used variolation in the 16-17th
century • Ideas imported to the West in the 18th century • Use of attenuated pathogen -Jesty 1770 • Application of the scientific method Jenner-1796 • Theory of induced protective immunity • Lack of ethical concerns
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Edward Jenner (1749-1823)
Photo courtesy of the National Library of Medicine.
Jenner and vaccine development Jenner's scientific interests were
varied, but the importance of his work in vaccination has overshadowed his other results. Early in his career he had begun to observe the phenomena of cowpox, a disease common in the rural parts of the western counties of England, and he was familiar with the belief, current among the peasantry, that a person who had suffered from the cowpox could not take smallpox.
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Edward Jenner (1749-1823)
Photo courtesy of the National Library of Medicine.
Jenner and vaccine development Jenner's scientific interests were varied, but
the importance of his work in vaccination has overshadowed his other results. Early in his career he had begun to observe the phenomena of cowpox, a disease common in the rural parts of the western counties of England, and he was familiar with the belief, current among the peasantry, that a person who had suffered from the cowpox could not take smallpox. Finally, in 1796, he made his first experiment in vaccination, inoculating a boy of eight with cowpox, and, after his recovery, with smallpox; with the result that the boy did not take the latter disease.
» Wikapedia
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Vaccination is the most effective method for disease prevention
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Vaccination has eliminated naturally occuring smallpox and polio is almost eliminated.
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Concerns about the safety of vaccines appeared early and often
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Vaccination can cause side effects
• Inflammation and anaphylactic reactions - usually from contaminants in the vaccine preparation-an example being egg proteins in flu vaccine or mercury containing preservatives.
• Infection - from improperly inactivated vaccine preparations or the use of a vaccine containing live-attenuated viruses in immunodeficient patients
• Neurological and autoimmune reactions - perhaps by rare antigen cross reactions or perturbation of immunoregulatory circuits.
• Lawyers - fear of lawsuits is so prevelant that there are only three companies currently making vaccines. (Down from nine in the 80's.
• Oprah- has now decided that MMR vaccination is the cause of the increase in cases of autism.
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Autism
• Recent studies have shown an increase in the frequency of
autism. • Thimerosal is a mercury containing compound used previously
as a preservative in DTP, MMR and other vaccines. • It has been hypothesized that autism is induced by heavy metal
poisoning provoked by vaccination (thimersol). • It has also been suggested that multiple infectious agents in
vaccines induce a unique pathology. • Most recently, it has been suggested that the age of the father is
the greatest risk indicator.
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The beginning of the autism scare
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The “Vaccination Paradox” and public health
• As the pool of vaccinated individuals increases so does herd immunity (population protection due to a reduction in the reservoir of disease susceptible hosts) reducing disease even among the unvaccinated.
• As disease declines because of the efficiency of vaccination, the incidence of deleterious side effects becomes higher and the necessity for vaccination is questioned.
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Cessation of vaccination can increase disease incidence
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How do vaccines work ?
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Humoral responses are specifically enhanced upon reexposure to the same (priming) antigen. This secondary
response shows memory to the initial antigen.
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Germinal Center
Reaction
TD D T
Ag B
TI B Ag
D
B cell activation pathways and consequences
Extra- follicular
Extra- follicular
TD D T
Ag B
SHM CSR Memory B Generation TFH TFR LLPC
SHM CSR restricted Memory B Generation TFH TFR LLPC ?
SHM CSR restricted Memory B Generation ? TFH TFR LLPC
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Vaccination is an attempt to generate immunological memory without disease
pathology
• Memory is induced through immune recognition of vaccine antigens.
• Immune memory allows an accelerated humoral and cellular responses if the vaccine antigen is re-encountered.
• Immune recognition leads to: • Neutralization of the infectious agent before it can enter
cells • Destruction of infected cells before they multiply • Suppression of the spread of the infectious agent to other
cells
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The vaccine response and germinal centers
• The germinal center reaction provides an environment that promotes: the generation of short lived antibody forming cells; the induction of somatic hypermutation, affinity maturation by antigen selection and concurrent deletion of autoreactive cells; the production of immunological memory carried by long-lived antibody forming cells (humoral memory) and by long-lived recirculating small non-antibody secreting lymphocytes (classical precursor B memory cells).
• The chief accesssory cells are follicular dendritic cells and T follicular helper cells
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Cellular events during a T cell dependent response
Y
Bone marrow
Y Y Y
Y Y
Recirculate
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Mechanism of vaccine mediated protection:
• Produce B and T cell memory without disease • B cell memory in the form of quiescent antigen
specific recirculating cells. • B cell memory in the form of long-lived antibody
secreting cells residing in the bone marrow • T (CD4) cells in the form of recirculating and bone
marrow sequestered quiescent cells
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Durable protection
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Durability of vaccine induced antibody responses
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Long term antibody production in four subjects
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Serum antibody and memory B cells are sometimes discordant and it has been shown experimentally that Ab responses persist when
memory B cells are depleted
Serum Ab
Memory B cells
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Types of vaccines
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Types of Vaccine • Killed pathogen - heat or formalin (Salk polio vaccine) • Live-attenuated - selection of less or non pathogenic variants
(Sabin Polio vaccine) • Subunit vaccine - purified or genetically engineered structural
component of a pathogen (Hepititis B vaccine, Hep Bs Ag) • Secreted or extracted bacterial products toxoids- ( are
toxins inactivated by chemical treatment or induced mutation to be immunogenic but not pathogenic) ; cell wall polysaccharides
• Conjugate vaccines - combination of multiple components to increase immunogenicity or memory induction
• DNA vaccine - inject the gene that makes the protein • Infectious agents to accomplish gene delivery (recombinant
vaccinia, adenovirus or bacteria) • Virus-like particles genome free particles assembled from
recombinant proteins expressing vaccine antigens.
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What are the key attributes of an ideal vaccine ?
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Vaccines Infectious agent
Toxic product
Inactivate Attenuate
Subunit protein or
polysaccharide
DNA encoded proteins
Polio Hepatitis A HPV RSV Diptheria toxin Tetenus toxin Pox-HIV
HIV Hepatitis B
Pneumovax 23 VLP
Conjugates Polysaccharide
Protein Hemophilus
polysaccharide-protein
conjugate Pneumococus
polysaccharide-protein
conjugate
HIV SARS
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Attenuation of pathogenic viruses by growth in non-human cells (Rabies and Pasteur)
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Conjugate vaccines facilitate T and B cell collaboration
Preparation of conjugates to make T-independent antigens T dependent *
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Jenner’s success was made possible by antigens shared by cowpox and smallpox
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Adjuvants
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Stimulation through pattern recognition receptors (PRRs) primes the innate immune system and improves
adaptive responses
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TFH cells are a unique helper T cell population with high antigen binding potential
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Adjuvants affect the quantity and quality of TFH cells
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Strategies for making better vaccines and more effective vaccine delivery
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Antigen and adjuvant delivery
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• Pneumococcal disease is treatable, penicillin and trimethoprim sulfate are the drugs of choice.
But - widespread antimicrobial resistance • 90 capsular serotypes based on antiphagocytic capsule. Each Serotype ---- > 46 serogroups based on the structural and
chemical composition of polysaccharides • Pneumococci acquire new phenotypic traits through natural
transformation, frequent recombination between individual strains allows gene mosaicism
• Estimated that pneumococci possess over 100 surface proteins,
many of which play a role in pathogenicity and virulence
Case 1 pnuemococcal vaccines
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Discovery of a novel class of highly conserved vaccine antigens using genomic scale antigenic fingerprinting of
pneumococcus with human antibodies
Carmen Giefing, Andreas L. Meinke, Markus Hanner, Tamás Henics, Duc Bui Minh, Dieter Gelbmann, Urban Lundberg, Beatrice M. Senn, Michael Schunn, Andre Habel,
Birgitta Henriques-Normark, Åke Örtqvist, Mats Kalin, Alexander von Gabain, and Eszter Nagy
Journal of Experimental Medicine Volume 205(1):117-131
January 2, 2008
© 2008 Giefing et.al.
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Characterization and selection of human sera for antigen identification
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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Peptide ELISA with human sera
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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Selection of antigenic pneumococcal proteins
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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PcsB and StkP are highly conserved antigens
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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Protection by PcsB and StkP in models of pneumococcal sepsis and pneumonia
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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Characterization of ΔpcsB and ΔstkP gene deletion mutant strains
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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StkP and PcsB antigens are immunogenic in young children. 88 sera obtained from children not suffering from any infectious disease at the time of sampling were analyzed for
antipneumococcal IgG levels by ELISA using recombinant proteins as coating antigens
Giefing et al. Journal of Experimental Medicine 2008:205:117-131 © 2008 Giefing et.al.
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Antigen-specific immune sera show surface staining and OPK activity
Giefing et al. Journal of Experimental Medicine 2008:205:117-131
© 2008 Giefing et.al.
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Case 2 HIV vaccine
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Thailand HIV Trial
• Canarypox-HIVgp120 prime (AID/VAX) • Boost recombinant gp120 subunit vaccine
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New efforts to produce a vaccine against HIV
Defining target epitopes that facilitate the production of broadly cross reactive neutralizing antibody
• Identify patients with neutralizing antibody • Isolate memory B cells by flow cytometry • Distribute cells ~.1/well and activate by polyclonal stimulation • Test for neutralization on a small virus panel • Use PCR to isolate Ig gene segments for H and L chains • Express Ig segment clones in a producer cell line • Identify target epitopes • Use these insights to produce a vaccine.
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The isolation of broadly neutralizing antibodies to HIV using memory cell selection and Ig cloning strategy
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Detection of effective antibodies may require assays using native ENV structures
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Figure?1 Structure and Antibody Recognition of the HIV Envelope Spike The molecule is a heterotrimer of composition (gp120) 3 (gp41) 3 . Gp41 is a transmembrane protein, and gp120 is the receptor molecule for CD4 and CCR5 (or CXCR4). The model ...
Dennis?R. Burton , Rafi Ahmed , Dan?H. Barouch , Salvatore?T. Butera , Shane Crotty , Adam Godzik , Daniel?E. Kau...
A Blueprint for HIV Vaccine Discovery
Cell Host & Microbe Volume 12, Issue 4 2012 396 - 407
http://dx.doi.org/10.1016/j.chom.2012.09.008
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A Blueprint for HIV Vaccine Discovery
Cell Host & Microbe Volume 12, Issue 4 2012 396 - 407
http://dx.doi.org/10.1016/j.chom.2012.09.008
Co-merging the concepts of breath and potency
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Case 3. Modified bacteria as vaccines
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Deletion of key genes makes a bacterium replication incompetent but viable and metabolically active.
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Induction of T cell responses to a recombinant antigen OVA
cytokine
Antigen
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Protection against recombinant vaccinia
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Protection against Listeria
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Protection against tumor cell challenge following immunization with Listeria expressing a recombinant modified self protein
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Case 4 Inducing immunity with DNA vaccines
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Antigen priming from a DNA vaccine
DNA
protein MHC I
MHC II
Other APC
B cells
TLRs
CD8+
CD4+
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DNA VACCINE
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DNA gag+env
Vaccinia Gag+Env Virus challenge
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Outcomes in infected and immunized or control monkeys
Vaccinated
unvaccinated
Viral RNA
CD4 T cells
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Immunized + Infected
Uninfected
Unimmunized + Infected
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T cell induced responses Tetramer staining or intracellular IFN-γ
Virus
Tetramer binding
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Antibody responses following immunization and challenge
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Bad vaccines
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Bad vaccines: Respiratory syncytial virus
• In the 1980s a formalin inactivated RSV was used in vaccine trials.
• Dozens of children immunized with this vaccine died of resiratory disease when infected with RSV.
• Vaccination had enhanced susceptibility to disease.
• What went wrong ?
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Immunization strategy effects ERD
Delgado et.al. Nature Med. 15: 34 (2009)
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Vaccine ERD : Low affinity antibody is induced by formalin treated virus
Titer Neutralization TH population Affinity
Delgado et.al. Nature Med. 15: 34 (2009)
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Protection against RSV and ERD is dependent on MyD88
Analysis of DC from draining LN after foot pad injectionsa.
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Germinal center responses in RSV or UViRSV treated mice
PNA+
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Immunization with UViRSV plus TLR agonists protects against ERD
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Passive protection against RSV and ERD using antibodies from donors immunized with UViRSV and TLR agonists
µmT recipients
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Impaired TLR signaling a cause of RSV vaccine enhanced disease ?
F protein
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J Virology 84:1110 (2010)
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VLP
Virus like particle (VLP) synthesized using a chimeric HN/G protein
G HN
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Immunization with VLPs produces long-lived protective antibodies
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VLP immunization produces protection without ERD upon RSV challenge
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VLP immunization produces protection without ERD upon RSV challenge
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Vaccination against influenza
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Vaccination against influenza
• Influenza presents unique problems. Generation of new viruses is rapid with birds and pigs providing an enormous reservoir of genetic material for virus recombination.
• Error prone replication constantly produces new virus “species”. • Selection of virus variants for seasonal vaccine production is not
precise resulting in the production of large vaccine stocks lacking the most prevalent virus.
• Varying numbers of vaccine recipients fail to respond to the relevant virus antigens.
• These considerations have prompted a search for vaccine preparations that can elicit broadly neutralizing (multi-seasonal) antibodies.
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Structure of influenza hemagglutinin
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A Strategy for producing influenza anti-stalk antibodies
Phil82 X-31
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Producing anti-stalk antibodies by boosting preexisting anti influenza responses
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Too good to be true?
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Negative effects of vaccination
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Antibody (vaccine) induced enhancement of infection
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Can we predict what vaccines are effective and what proportion of the population will be responsive?
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Systems Vaccinology : • Attempts to identify molecular signatures that can predict
vaccine efficacy. • Blood samples from vaccinated patients provide
information on cytokine induction and antibody production as well as lymphocytes for use in determining T cell responses.
• The genetic analysis utilizes purified RNA from the PBMCs of newly vaccinated patients for determining transcription profiles using DNA arrays or RNA sequencing technologies.
• Limited ability to compare alternative vaccine formulations. • Need large sample sizes due to human genetic variation. • Results impacted by previous immune history.
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The first modeled vaccine YF-17D
B. Pulendran Nature Rev. Immunol. 9:741 (2009)
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The response to YF-17D
B. Pulendran Nature Rev. Immunol. 9:741 (2009)
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Overview of analysis
H. Nakaya. S. Li and B. Pulendran
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Analytical approach
B. Pulendran Nature Rev. Immunol. 9:741 (2009)
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Quantitative assessment of gene expression and subsequent pathway organization
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Establishing antibody response phenotype using gene profiling
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Using systems biology to assess vaccine efficacy
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Predicting the unknown from the known.
B. Pulendran Nature Rev. Immunol. 9:741 (2009)
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Immunization with flu vaccine induces TFH cells
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Relationship between antibody titer and TFH cell number
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TFH cells are uniquely effective at providing help for memory B cells to produce anti-influenza antibody
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The microbiome influences the induction of protective immunity to influenza infection
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The final question is can you predict protection against disease ?
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Getting a vaccine to the patient
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That’s All