EA042219B1 - POLYVALENT PNEUMOCOCCAL POLYSACCHARIDE-PROTEIN CONJUGATE COMPOSITION - Google Patents

Description

Cross-reference to related applications

This application claims priority based on (and relies on) U.S. Provisional Application No. 62/371,553 filed Aug. this application by reference.

Technical field

The present application generally relates to mixed carrier polyvalent pneumococcal conjugate compositions, vaccines containing them, and methods of using these compositions and vaccines to prevent Streptococcus pneumoniae infection or disease caused by it in a subject.

State of the art

Pneumococcus (Streptococcus pneumoniae) is a Gram-positive, lanceolate, facultative anaerobic bacterium with over 90 known serotypes. Most serotypes of S. pneumoniae have been shown to cause disease, with the 23 most common serotypes responsible for approximately 90% of invasive disease worldwide. Serotypes are classified based on the serological response of capsular polysaccharides, the most important virulence factor for pneumococcus. Capsular polysaccharides are T-independent antigens that induce antibody production in the absence of T-helpers. T-independent antigens typically induce antibodies with low affinity and transient immune responses with little or no immunological memory.

The original pneumococcal vaccines included combinations of capsular polysaccharides from different serotypes. These vaccines can confer immunity against S. pneumoniae in patients with strong or healthy immune systems, but they are ineffective in infants, who lack a strong immune system, and in the elderly, whose immune function is often compromised. To improve the immune response to pneumococcal vaccines, especially in infants and the elderly, who are at higher risk of developing S. pneumoniae infection, capsular polysaccharides have been conjugated to suitable carrier proteins, thus creating pneumococcal conjugate vaccines. Conjugation to a suitable carrier protein changes the capsular polysaccharide from a T-independent antigen to a T-dependent antigen. Thus, the immune response against the conjugated capsular polysaccharide recruits T-helper cells, which help to induce a stronger and faster immune response upon repeated contact with the capsular polysaccharide.

There are at least two approaches to the development of pneumococcal conjugate vaccines: the single carrier approach and the mixed carrier approach. The immunogenicity of the various capsular polysaccharide conjugates may vary depending on the pneumococcal serotype and carrier protein used. In the single carrier approach, capsular polysaccharides from different serotypes are conjugated to a single carrier protein. An example of a single vehicle approach is the Pfizer PREVNAR series of vaccines, where various capsular polysaccharides are conjugated to the carrier protein CRM ₁₉₇ , a non-toxic diphtheria toxoid variant having a single amino acid substitution of glutamic acid for glycine. The semivalent PREVNAR vaccine (PREVNAR) was first approved in 2000 and contains capsular polysaccharides from the seven most common serotypes: 4, 6B, 9V, 14, 18C, 19F, and 23F. In the 13-valent vaccine, PREVNAR 13, serotypes 1, 5, 7F, 3, 6A and 19A are added to the CRM ₁₉₇ carrier protein. The carrier protein, CRM ₁₉₇ , used as the sole carrier in PREVNAR vaccines, has never been used as a component of the mixed carrier system in the pneumococcal conjugate vaccine.

The second approach to pneumococcal vaccine involves the use of mixed carriers. In the mixed carrier approach, instead of using a single carrier protein, two or more carrier proteins are used, with capsular polysaccharides of certain serotypes conjugated to a first carrier protein and capsular polysaccharides of other serotypes conjugated to at least a second different carrier protein. For example, GlaxoSmithKline has developed SYNFLORIX, a 10-valent (serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F) pneumococcal mixed-vehicle conjugate vaccine that uses protein D from the bacterium H as carrier proteins. influenzae, tetanus toxoid and diphtheria toxoid. In SYNFLORIX, serotypes 1, 4, 5, 6B, 7F, 9V, 14 and 23F are conjugated to protein D; serotype 18C conjugated with tetanus toxoid; and serotype 19F is conjugated with diphtheria toxoid [7]. Serotype 3 was removed from the 11-valent prototype SYNFLORIX vaccine because it did not demonstrate serotype-specific efficacy in trials for acute otitis media [1]. Another group, Aventis Pasteur, has developed an 11-valent (serotypes 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F) pneumococcal conjugate mixed-vehicle vaccine using diphtheria toxoid and tetanus toxoid as proteins. -carriers [2, 3]. Capsular polysaccharides of serotypes 3, 9V, 14, and 18C may induce a better response when conjugated with diphtheria toxoid than when conjugated with tetanus toxoid [2, 6]. Therefore, serotypes 3, 6B, 14, and 18C were conjugated with diphtheria toxin, and serotypes 1, 4, 5, 7F, 9V, 19F, and 23F were conjugated with tetanus toxoid. The development of this mixed-vehicle pneumococcal vaccine was discontinued, in particular for technical reasons and because of the potential for reduced response when combined with acellular pertussis vaccines [3]. It has recently been reported that serotype 5, like 1, has one of the lowest observed OPA (opsonophagocytic activity) titers of all 13 PREVNAR serotypes in which a correlation between IgG titer and OPA activity was found [4]. It has also been suggested that in the case of serotype 3, a much higher serum IgG concentration would be required for protection [5].

Brief description of the invention

This application provides new and improved polyvalent mixed carrier pneumococcal conjugate compositions and vaccines containing them. In one aspect of the present invention, there is provided a mixed-carrier pneumococcal polysaccharide conjugate polyvalent composition comprising 20 different pneumococcal capsular polysaccharide-protein conjugates, wherein each pneumococcal capsular polysaccharide-protein conjugate comprises a carrier protein conjugated to a capsular polysaccharide from different streptococcal serotypes, wherein the serotypes of Streptococcus pneumoniae are selected from 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F, and the carrier protein is CRM ₁₉₇ or tetanus toxoid, two of these capsular polysaccharides conjugated with tetanus toxoid, and the remaining capsular polysaccharides conjugated with CRM ₁₉₇ , while two capsular polysaccharides conjugated with tetanus toxoid are selected from the group consisting of serotypes 1, 3 and 5.

In one aspect, such a polyvalent pneumococcal mixed-carrier conjugate composition comprises 20 different pneumococcal capsular polysaccharide-protein conjugates, wherein each pneumococcal capsular polysaccharide-protein conjugate comprises a carrier protein conjugated to a capsular polysaccharide from different pneumococcal serotypes, wherein the serotypes of Streptococcus pneumoniae are selected from 1 , 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F, and the carrier protein is CRM ₁₉₇ or tetanus toxoid , wherein two of the capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ , wherein the two capsular polysaccharides conjugated to tetanus toxoid are selected from the group consisting of serotypes 1, 3 and 5.

In some embodiments of a mixed carrier 20-valent pneumococcal conjugate composition, capsular polysaccharides from serotypes 1 and 5 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 3, 4, 6A, 6B, 7F, 8, 9B, 10A, 11A, 12F , 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F conjugated with CrM ₁₉₇ .

In another embodiment of the mixed carrier 20-valent pneumococcal conjugate composition, the capsular polysaccharides from serotypes 1 and 3 are conjugated with tetanus toxoid and the capsular polysaccharides from serotypes 4, 5, 6A, 6B, 7F, 8, 9B, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM ₁₉₇ .

In yet another embodiment of the mixed carrier 20-valent pneumococcal conjugate composition, capsular polysaccharides from serotypes 3 and 5 are conjugated with tetanus toxoid and capsular polysaccharides from serotypes 1, 4, 6A, 6B, 7F, 8 9B, 10A, 11A, 12F, 14 , 15B, 18C, 19A, 19F, 22F, 23F and 33F conjugated with CrM ₁₉₇ .

In some embodiments, the mixed carrier polyvalent pneumococcal conjugate composition further comprises an adjuvant, such as an aluminum-based adjuvant, including, but not limited to, aluminum phosphate, aluminum sulfate, and aluminum hydroxide.

Another aspect relates to the use of said mixed carrier 20-valent pneumococcal conjugate composition as a vaccine.

Another aspect relates to a vaccine containing the mixed carrier 20-valent pneumococcal conjugate composition and a pharmaceutically acceptable excipient.

Another aspect relates to a method of preventing Streptococcus pneumoniae infection or a corresponding disease in a subject, such as a human, said method comprising administering a prophylactically effective amount of mixed carrier 20-valent pneumococcal conjugate compositions or vaccines containing them to said subject.

In certain embodiments, the subject is a human who is at least 50 years old and the disease is pneumonia or invasive pneumococcal disease (IPD).

In other embodiments, the subject is a human who is at least 6 weeks old and the disease is pneumonia, invasive pneumococcal disease (IPD), or acute otitis media (AOM).

In some embodiments, the subject is 6 weeks to 5 years old. In other embodiments, the subject is 2 to 15 months old, or 6 to 17 years old.

In some embodiments, the 20-valent pneumococcal conjugate composition or mixed carrier vaccine is administered by intramuscular injection. In some embodiments, a 20-valent pneumococcal conjugate composition or mixed carrier vaccine

- 2 042219 administered as part of a series of vaccinations.

The above and other objects, features and advantages of 20-valent mixed carrier pneumococcal conjugate compositions will become more apparent from the following detailed description.

Brief description of the drawings

The drawings included in this application, which consist of the following figures, are for illustrative purposes only and not for limitation. In FIG. A-D shows the dose-dependent in vivo antibody response of serotype 8 (Fig. A), serotype 10A (Fig. B), serotype 11A (Fig. C), and serotype 15B (Fig. D) monoconjugates as measured by geometric mean titer (GMT).

Definitions

To make the present invention more clear, to begin with, some terms are defined below. Additional definitions for the following terms and other terms may be provided later in this specification.

As used in the present description and the appended claims, the singular forms also include references to the plural, unless the context clearly dictates otherwise. Thus, for example, reference to a method includes one or more methods and/or steps of the type described herein, which will become apparent to those skilled in the art upon reading this disclosure, and so on.

Adjuvant. As used herein, the term adjuvant refers to a substance or carrier that non-specifically enhances an immune response to an antigen.

Introduction. Used in this application, the term introduction of the composition to the subject means to give, apply or bring the composition into contact with the subject. Administration can be by any of a number of routes, such as, for example, topical, oral, subcutaneous, intramuscular, intraperitoneal, intravenous, intrathecal, and intradermal.

Approximately. Used in this application, the term approximately or approximately in relation to one or more of the considered values refers to a value that is close to the specified nominal value. In some embodiments, the term approximately or approximately refers to a range of values that are within 25, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5 , 4, 3, 2, 1% or less in any direction (more or less) of the declared nominal value, unless otherwise indicated or obvious from the context (except when such a number would exceed 100% of the possible value).

Conjugate. As used herein and understood from the proper context, the terms conjugate(s) or glycoconjugate(s) refer to a Streptococcus pneumoniae polysaccharide conjugated to a carrier protein by any covalent or non-covalent bioconjugation strategy.

Auxiliary substance. Used in this application, the term excipient refers to a non-therapeutic agent that can be included in the composition, for example, to provide or assist in achieving the desired consistency or stabilizing effect.

Mixed media. As used herein, the term mixed carrier pneumococcal conjugate composition refers to a pneumococcal conjugate composition having more than one type of carrier protein.

Polyvalent. As used herein, the term polyvalent refers to a pneumococcal conjugate composition containing pneumococcal capsular polysaccharides from more than one serotype of Streptococcus pneumoniae.

Mixed carrier 16-valent pneumococcal conjugate composition. As used herein, the term mixed carrier 16-valent pneumococcal conjugate composition(s) refers to a composition containing 16 different pneumococcal capsular polysaccharide protein conjugates, wherein each pneumococcal capsular polysaccharide protein conjugate contains a carrier protein conjugated to a capsular polysaccharide from different serotypes. Streptococcus pneumoniae, and these Streptococcus pneumoniae serotypes are 1, 5, 6A, 6B, 7F, 9V, 12F, 14, 18C, 19A, 19F, 22F, 23F and 33F, and the carrier protein is CRM ₁₉₇ or tetanus toxoid, and two of the capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ (also referred to herein as PCV16-15TT). In another embodiment, the capsular polysaccharides from serotypes 1 and 3 are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ (also referred to herein as PCV16-13TT). In yet another embodiment, the capsular polysaccharides from serotypes 3 and 5 are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ (also referred to herein as PCV16-35TT).

20-valent pneumococcal conjugate composition with a mixed carrier. As used herein, the term mixed carrier 20-valent pneumococcal conjugate composition(s) refers to a composition containing 20 different capsular polysaccharide-protein conjugates, in which each pneumococcal capsular polysaccharide-protein conjugate contains a carrier protein conjugated to the capsular polysaccharide. from different serotypes of Streptococcus pneumoniae, wherein these serotypes of Streptococcus pneumoniae are 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F, wherein the carrier protein is CRM ₁₉₇ or tetanus toxoid, wherein two of the capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ , wherein the two capsular polysaccharides that are conjugated to tetanus toxoid are selected from the group , consisting of serotypes 1, 3, and 5. In some embodiments, capsular polysaccharides from serotypes 1 and 5 are conjugated with tetanus toxoid and other capsular polysaccharides conjugated with CRM ₁₉₇ . In another embodiment, the capsular polysaccharides from serotypes 1 and 3 are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ . In yet another embodiment, the serotypes 3 and 5 capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ .

Pharmaceutically acceptable excipient. Pharmaceutically acceptable excipients used in this description are traditional. Remington's Pharmaceutical Sciences Handbook, E.W. Martin, Mack Publishing Co., Easton, PA, 15th edition (1975), describes compositions and formulations suitable for pharmaceutical delivery of one or more therapeutic compositions, including vaccines and additional pharmaceutical agents. Suitable pharmaceutical excipients include, for example, starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, skimmed milk powder, glycerin, propylene, glycol, water , ethanol, etc. In general, the nature of the excipient will depend on the particular route of administration employed. For example, parenteral preparations typically contain injectable liquids that include pharmaceutically and physiologically acceptable liquids such as water, saline, balanced salt solutions, buffers, aqueous dextrose, glycerol, or the like as carriers. For solid formulations (eg, in the form of a powder, pill, tablet, or capsule), conventional non-toxic solid excipients may include, for example, pharmaceutical grades of mannitol, lactose, starch, or magnesium stearate. In addition to biologically neutral carriers, pharmaceutical compositions for administration may contain minor amounts of non-toxic excipients such as wetting or emulsifying agents, surfactant, preservatives and pH buffering agents and the like, for example sodium acetate or sorbitan monolaurate.

A prophylactically effective amount. As used herein, the term prophylactically effective amount or prophylactically effective dose refers to the amount or dose necessary to induce an immune response sufficient to delay the onset and/or reduce the frequency and/or severity of one or more symptoms caused by Streptococcus pneumoniae infection.

Prevention. As used herein, the term prophylaxis refers to preventing the onset of a disease, delaying the onset, and/or reducing the frequency and/or severity of one or more symptoms of a particular disease, disorder, or condition (eg, Streptococcus pneumoniae infection). In some embodiments, prophylaxis is evaluated on a population basis such that an agent is considered to provide prophylaxis against a particular disease, disorder, or condition if there is a statistically significant reduction in the development, frequency, and/or intensity of one or more symptoms of said disease, disorder, or condition in a susceptible population. to the specified disease, disorder or condition.

Subject. Used in this application, the term subject means any mammal, including mice, rabbits and humans. In certain embodiments, the subject is an adult, adolescent, or child. In some embodiments, the terms individual or patient are used, which are intended to be interchangeable with the term subject.

Detailed description

The following description of the disclosed embodiments and examples is purely illustrative in nature and is not intended to limit the invention, its applicability, or uses in any way.

The present application provides new and improved mixed carrier pneumococcal conjugate compositions and vaccines containing them. Although the carrier protein, CRM ₁₉₇ , has previously been used in single carrier pneumococcal conjugate vaccines, this application describes for the first time the use of CRM ₁₉₇ in a mixed carrier pneumococcal conjugate vaccine.

As discussed above, the immunogenicity of various capsular polysaccharide conjugates may vary depending on the pneumococcal serotype and carrier protein used. This application describes the successful conjugation of serotype 3 to tetanus toxoid in a mixed carrier vaccine despite previous notions that serotype 3 is more immunogenic when conjugated to diphtheria toxoid rather than tetanus toxoid [2, 6]. This application also discloses the surprising discovery that the antibody response to serotype 3 conjugated with tetanus toxoid in a polyvalent pneumococcal conjugate composition with a mixed carrier was approximately 4-fold and approximately 7-fold higher in compositions with PCV16 and PCV20, respectively, than when serotype 3 was conjugated to

CRM ₁₉₇ in a 13-valent pneumococcal single carrier conjugate formulation (PREVNAR 13).

Further, this unexpected finding was not limited to serotype 3, but was also observed for other serotypes conjugated to tetanus toxoid in a mixed vehicle polyvalent pneumococcal conjugate composition. As shown in the examples, conjugation of serotypes 1 and 3, 1 and 5, or 3 and 5 with tetanus toxoid in a 16-valent or 20-valent pneumococcal mixed vehicle conjugate composition with the remaining serotypes conjugated to CRM ₁₉₇ (e.g., PCV16 -13TT, PCV16-15TT and PCV16-35TT or PCV20-35TT, PCV20-13TT and PCV20-15TT) consistently induced significantly enhanced antibody responses to tetanus toxoid-conjugated serotypes compared to antibody responses (IgG response or MOPA titers) against the same serotypes conjugated to CRM ₁₉₇ in a single vehicle pneumococcal conjugate formulation (PREVNAR 13), demonstrating the effectiveness of the specific mixed vehicle approach (tetanus toxoid and CRM197). The antibody response to polyvalent pneumococcal mixed carrier conjugate formulations is shown in the table below.

Table 1

Multifold increase in antibody response to tetanus toxoid conjugated serotypes in a mixed vehicle vaccine compared to PREVNAR 13

fold increase in antibody response compared to PREVNAR 13 Serotype PCV16- PCV16- PCV16- PCV20- PCV20- PCV20- 13TT 15TT 35TT 13TT 15TT 35TT 1 (igG) ZX 3.9X N/A 4.9X 1.7X N/A 1 (MORA) 6,ZX 6,ZX N/A 19X 8.9X N/A h (IgG) 5.5X N/A 2.8X 1X N/A 7.5X 3 (MORA) 4X N/A 4X 7.9X N/A 4.4X 5 (IgG) N/A 8.7X 3.2X N/A 2.5X 1X 5 (MORA) N/A 5X 4X N/A 3.6X 2X

The mixed carrier 20-valent pneumococcal conjugate composition described herein also includes pneumococcal serotypes not covered by the three pneumococcal conjugate vaccines currently available on the world market: PREVNAR (called Prevenar in some countries), SYNFLORIX and PREVNAR 13. caused by pneumococcal serotypes, which are currently not covered, is increasing in part due to the development of antibacterial resistance, an increase in the number of immunocompromised patients and a lack of immune pressure. For example, none of the currently available pneumococcal conjugate vaccines includes serotype 12F. In addition, none of the currently available pneumococcal conjugate vaccines includes serotypes 8, 10A, 11A, 15B, 22F, and 33F. The present invention demonstrates the successful introduction of serotypes 8, 10A, 11A, 12F, 15B, 22F and 33F into a mixed carrier pneumococcal conjugate vaccine (tetanus toxoid and CRM ₁₉₇ ).

Mixed-carrier polyvalent pneumococcal conjugate compositions and methods for their manufacture.

In one aspect, the present invention provides a mixed carrier polyvalent pneumococcal conjugate composition comprising 20 different pneumococcal capsular polysaccharide protein conjugates, wherein each pneumococcal capsular polysaccharide protein conjugate comprises a carrier protein conjugated to a capsular polysaccharide from different serotypes. Streptococcus pneumoniae, where the serotypes of Streptococcus pneumoniae are 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F, where the carrier protein is CRM ₁₉₇ or tetanus toxoid, with two capsular polysaccharides conjugated with tetanus toxoid and the remaining capsular polysaccharides conjugated with CRM ₁₉₇ , with two capsular polysaccharides conjugated with tetanus toxoid selected from the group consisting of serotypes 1, 3 and 5 .

In some embodiments, capsular polysaccharides from serotypes 1 and 5 are conjugated to tetanus toxoid, and capsular polysaccharides from the remaining serotypes are conjugated to CRM ₁₉₇ . In another embodiment, the capsular polysaccharides from serotypes 1 and 3 are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ . In yet another embodiment, the serotypes 3 and 5 capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM ₁₉₇ . In a polysaccharide-protein conjugate vaccine, the carrier protein is conjugated to the polysaccharide antigen primarily to enhance the immune response (eg, antibody response) to the polysaccharide antigen. Carrier proteins

- 5 042219 are preferably non-toxic proteins having little or no immunogenicity. The carrier proteins must be conjugable to the pneumococcal polysaccharide using standard conjugation procedures, as discussed in more detail below. The protein carriers used in the mixed carrier 20-valent pneumococcal conjugate formulation are tetanus toxoid (TT) and CRM ₁₉₇ , both of which have already been used in the development of pneumococcal conjugate vaccines but have never been used in a single mixed carrier vaccine. CRM ₁₉₇ is a non-toxic variant (ie, toxoid) of diphtheria toxin that retains the immunological properties of wild-type diphtheria toxin. CRM ₁₉₇ differs from wild-type diphtheria toxin at one base in the structural gene, resulting in a single amino acid substitution of glutamic acid for glycine. CRM ₁₉₇ is usually isolated from cultures of the Corynebacterium diphtheria C7 (β197) strain grown on casamino acids and yeast extract medium. CRM ₁₉₇ can be purified by ultrafiltration, ammonium sulfate precipitation and ion exchange chromatography. Alternatively, CRM ₁₉₇ can be obtained recombinantly in accordance with US patent No. 5614382, which is fully incorporated into the present description by reference. CRM197 has previously been used in the development of pneumococcal conjugate vaccines but has never been a component of a mixed vehicle vaccine.

Tetanus toxoid is produced and used throughout the world for large scale immunization against tetanus caused by Clostridium tetani. Tetanus toxoid is also used alone or in combination with diphtheria and/or whooping cough vaccines. The parent protein, tetanus toxin, is usually obtained from cultures of Clostridium tetani. Tetanus toxin is an approximately 150 kDa protein and consists of two subunits (approximately 100 kDa and approximately 50 kDa) linked by a sulfide bond. The toxin is usually detoxified with formaldehyde and purified from culture filtrates using known methods such as ammonium sulfate precipitation (see eg [7, 8]) or chromatography methods as described in eg WO 1996/025425. Tetanus toxin can also be inactivated by recombinant genetic means.

Tetanus toxoid has also been used as a carrier protein in other vaccines, including pneumococcal conjugate vaccines. But it has never been used in mixed carrier pneumococcal conjugate formulation in combination with CRM ₁₉₇ . Conjugation of serotype 3 to tetanus toxoid in a mixed carrier pneumococcal conjugate composition is also not recommended in the art, as serotype 3 has been shown to be more immunogenic when conjugated to diphtheria toxoid compared to tetanus toxoid [2, 6].

Pneumococcal capsular polysaccharides used in the compositions and vaccines described herein, including capsular polysaccharides from serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A . , WO 2006/110352 and U.S. Published Application Nos. 2006/0228380, 2006/0228381, 2007/0184071, 2007/0184072, 2007/0231340, 2008/0102498 and 2008/0286838, and are incorporated by reference in their entirety . For example, each pneumococcal capsular polysaccharide serotype can be grown in a culture medium (eg, soy-based medium). The cells are lysed and individual polysaccharides can be purified from the lysate by centrifugation, precipitation, ultrafiltration and/or column chromatography. In addition, pneumococcal capsular polysaccharide can be obtained using synthetic protocols.

The capsular polysaccharides of Streptococcus pneumoniae contain repeating oligosaccharide units that can contain up to 8 sugar residues. The capsular saccharide antigen may be a full length polysaccharide or it may be reduced in size (eg, a single oligosaccharide unit or shorter than the natural saccharide chain length of the oligosaccharide repeat units). The size of capsular polysaccharides can be reduced by various methods known in the art, such as acid hydrolysis treatment, hydrogen peroxide treatment, size separation with a high pressure homogenizer, optionally followed by hydrogen peroxide treatment to obtain oligosaccharide moieties, or microfluidization.

A pneumococcal conjugate of each serotype can be prepared by conjugating the capsular polysaccharide of each serotype to a carrier protein. Various pneumococcal conjugates can be formulated into a single dose composition.

To prepare the polysaccharide-protein conjugate, the capsular polysaccharides derived from each pneumococcal serotype can be chemically activated so that the capsular polysaccharides can react with the carrier protein. After activation, each capsular polysaccharide can be individually conjugated to a carrier protein to form a glycoconjugate. Chemical activation of polysaccharides and subsequent conjugation to a carrier protein can be achieved by conventional methods. For example, vicinal hydroxyl groups at the end of capsular polysaccharides can

- 6 042219 be oxidized to aldehyde groups with oxidizing agents such as periodates (including sodium periodate, potassium periodate or periodic acid), as described, for example, in US patents No. 4365170, 4673574 and 4902506, which are fully incorporated into the present description by reference . Polysaccharides can also be activated with 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP) to form a cyanate ester. The activated polysaccharide is then linked directly or via a spacer or linker group to an amino group on the carrier protein.

Such a spacer may be, for example, cystamine or cysteamine to form a thiolated polysaccharide, which may be coupled to the carrier via a thioether bond formed after reaction with a maleimide-activated carrier protein (e.g., using the N[y-maleimidobutyrloxy]succinimide ester (GMBS), or a haloacetylated carrier protein (e.g., using iodoacetimide, N-succinimidyl bromoacetate (SBA; SIB), N-succinimidyl(4-iodoacetyl)aminobenzoate (SIAB), sulfosuccinimidyl(4-iodoobenzoaceto(4iodoacetyl)aminobenzoate (sulfo-SIAB)) , N-succinimidylium iodoacetate (SIA) or succinimidyl-3[bromoacetamido]propionate (SBAP)). using a carbodiimide (e.g. EOAC or EOC) through a carboxyl group on the carrier protein Such conjugates are described, for example For example, in WO 93/15760, WO 95/08348 and WO 96/129094. Conjugation of activated capsular polysaccharides and carrier proteins can be achieved, for example, by reductive amination, as described, for example, in US Published Application Nos. , WO 2008/079653 and WO 2008/143709, all of which are incorporated by reference in their entirety. For example, the activated capsular polysaccharides and carrier protein can be reacted with a reducing agent to form a conjugate. Suitable reducing agents include borohydrides such as sodium cyanoborohydride, borane-pyridine, sodium triacetoxyborohydride, sodium borohydride or borohydride exchange resin. At the end of the reduction reaction, unreacted aldehyde groups may remain in the conjugates. Unreacted aldehyde groups can be copied using a suitable capping agent such as sodium borohydride (NaBH ₄ ). In one embodiment, the reduction reaction is carried out in an aqueous solvent. In another embodiment, the reaction is carried out in an aprotic solvent. In one embodiment, the reduction reaction is carried out in a DMSO (dimethyl sulfoxide) solvent or in a DMF (dimethylformamide) solvent. The activated capsular polysaccharides can be conjugated directly to a carrier protein or indirectly through the use of a spacer or linker such as a bifunctional linker. The linker is optionally heterobifunctional or homobifunctional having, for example, an amino reactive group and a carboxylic acid reactive group, 2 amino reactive groups, or two carboxylic acid reactive groups.

Other suitable conjugation methods use carbodiimides, hydrazides, active esters, norborane, p-nitrobenzoic acid, N-hydroxysuccinimide, S-NHS, EOC, TSTU, as described, for example, in Published International Patent Application No. WO 98/42721. The conjugation may include a carbonyl linker which may be formed by reacting the free hydroxyl group of the saccharide with 1,1'-carbonyldiimidazole (CD1) (see Bethell et al. (1979) J. Biol. Chem., 254:2572-2574; Hearn et al (1981), J. Chromatogr., 218:509-518) followed by reaction with the protein to form a carbamate bond. This may include reducing the anomeric end to a primary hydroxyl group, optionally protecting/deprotecting the primary hydroxyl group, reacting the primary hydroxyl group with CDI to form a CDI carbamate intermediate, and linking the CD1 carbamate intermediate to an amino group on the protein.

The ratio of polysaccharide to carrier protein for pneumococcal conjugate vaccines is usually in the range of 0.3-3.0 (w/w), but may vary depending on serotype. Such a ratio can be determined either by independent measurement of the amount of protein and polysaccharide present, or by methods known in the art to directly measure such a ratio. These methods include 1H NMR spectroscopy or using SEC-HPLC-UV/RI (SEC-HPLC-UV/Refractive Index) with dual monitoring (i.e. refractive index and UV for total material and protein content, respectively), to profile the saccharide/protein ratio by conjugate size distribution, as well as using SEC-HPLC-MALLS (Size-Exclusion Chromatography with Multiple Angle Laser Scattering Detection) or MALDI-TOF-MS (Time-of-Flight Mass Spectrometry with Laser Ionization and Desorption from liquid matrix). The polysaccharide-protein conjugates thus obtained can be purified and enriched in various ways. These methods include concentration/diafiltration, column chromatography and depth filtration. The purified polysaccharide-protein conjugates are combined together to form a mixed carrier 16-valent pneumococcal conjugate composition which can be

- 7 042219 to be used as a vaccine. The formulation of the vaccine composition can be performed using methods known in the art. The composition of the vaccine is chosen to be compatible with the intended route of administration. Individual pneumococcal capsular polysaccharide-protein conjugates may be mixed with a physiologically acceptable carrier to prepare such a composition. Examples of such carriers include, but are not limited to, water, buffered saline, polyols (eg, glycerol, propylene glycol, liquid polyethylene glycol), and dextrose solutions. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition further comprises an adjuvant. Adjuvants may include a suspension of minerals (alum, aluminum salts such as aluminum hydroxide, aluminum phosphate, aluminum sulfate, aluminum hydroxyphosphate sulfate, etc.) on which the antigen is adsorbed; or an oil-in-water emulsion in which a solution of the antigen is emulsified in mineral oil (eg incomplete Freund's adjuvant), sometimes including killed mycobacteria (complete Freund's adjuvant) to further enhance antigenicity. Immunostimulatory oligonucleotides (eg, those that include a CpG motif) can also be used as adjuvants (eg, see US Pat. Adjuvants also include biological molecules such as lipids and costimulatory molecules. Typical biological adjuvants include AS04 [9], IL-2, RANTES, GM-CSF, TNF-α, IFN-γ, G-CSF, LFA-3, CD72, B7-1, B7-2, OX40L and 41 BBL.

In some embodiments, the adjuvant is an aluminum based adjuvant. Typically, a 0.5 ml unit dose formulation of a vaccine contains approximately 0.1 to 2.5 mg of an aluminum-based adjuvant. In other embodiments, the 0.5 ml unit dose formulation of the vaccine contains 0.1 to 2 mg, 0.1 to 1 mg, 0.1 to 0.5 mg, 0.1 to 0.2 mg, 0.125 to 2.5 mg, 0.125 to 0.5 mg, 0.125 to 0.2 mg, or 0.125 to 0.25 mg aluminum adjuvant. In certain embodiments, the 0.5 ml unit dose formulation of the vaccine contains approximately 0.125 mg of aluminum-based adjuvant.

In private embodiments, the adjuvant is selected from the group consisting of aluminum phosphate, aluminum sulfate and aluminum hydroxide. In private embodiments, the adjuvant is aluminum phosphate. In some embodiments, the composition is for use as a vaccine against Streptococcus pneumoniae infection.

Ways of prevention and application.

In one aspect, the invention relates to a vaccine comprising a mixed carrier 20-valent pneumococcal conjugate composition and a pharmaceutically acceptable excipient. In some embodiments, the pharmaceutically acceptable excipient includes at least a buffer, such as a succinate buffer, a salt, such as sodium chloride, and/or a surfactant, such as a polyoxyethylene sorbitan ester (eg, polysorbate 80). In some embodiments, capsular polysaccharides from serotypes 1 and 5 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 3, 4, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F , 22F, 23F and 33F are conjugated to CRM ₁₉₇ . In another embodiment, capsular polysaccharides from serotypes 1 and 3 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F , 22F, 23F and 33F are conjugated to CRM ₁₉₇ .

In another embodiment, capsular polysaccharides from serotypes 3 and 5 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 1, 4, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM ₁₉₇ . In some embodiments, the vaccine elicits a protective immune response in a human against a disease caused by Streptococcus pneumoniae infection.

According to another aspect, the invention provides a method for preventing an infection or disease caused by Streptococcus pneumoniae, comprising administering to a human subject a prophylactically effective amount of a mixed carrier 20-valent pneumococcal conjugate composition or a vaccine containing the same. The mixed carrier 20-valent pneumococcal conjugate composition, or vaccine containing the same, may be administered by any route, including, for example, systemic or mucosal administration, as described in more detail below.

In some embodiments, the human subject is an elderly subject and the disease is pneumonia or invasive pneumococcal disease (IPD). In certain embodiments, said elderly subject is at least 50 years old. In other embodiments, the elderly subject is at least 55 years old. In still other embodiments, the elderly subject is at least 60 years old.

In other embodiments, the human subject is an infant and the disease is pneumonia, invasive pneumococcal disease (IPD), or acute otitis media (AOM). In certain embodiments, the infant is 0-2 years old. In other embodiments, the infant is between 2 and 15 months old.

In yet another embodiment, said human subject is 6 weeks to 17 years of age and is

- 8 042219 is pneumonia, invasive pneumococcal disease (IPD) or acute otitis media (AOM). In certain embodiments, said human subject is between 6 weeks and 5 years old. In other embodiments, the subject is between 5 and 17 years old. The amount of conjugate in each vaccine dose, or a prophylactically effective amount of the mixed carrier polyvalent pneumococcal conjugate composition, may be selected as an amount that provides prophylaxis without significant side effects. This number may vary depending on the pneumococcal serotype. Typically, each dose may include from about 0.1 µg to about 100 µg of the polysaccharide, in particular from about 0.1 to 10 µg, and more particularly from about 1 µg to about 5 µg. The optimal amounts of components for a particular vaccine can be established using standard studies, including the observation of appropriate immune responses in subjects. For example, the amount to vaccinate a person can be determined by extrapolating the results of animal tests. In addition, the dose can be determined empirically.

In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain from about 1 μg to about 5 μg of each capsular polysaccharide; about 1 µg to about 25 µg TT; about 20 to about 75 μg CRM197; and optionally about 0.1 to about 2.5 mg of elemental aluminum adjuvant. In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain from about 2 μg to about 2.5 μg of each capsular polysaccharide other than serotype 6B; from about 4 µg to about 8 µg, and optionally from about 4 µg to about 5 µg. In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain approximately 2.0 μg of each capsular polysaccharide except for serotype 6B, which is present at approximately 4 .0 μg. In other embodiments, the vaccine or 20-valent pneumococcal vaccine conjugate or mixed carrier composition may be a 0.5 ml single dose formulated to contain approximately 2.2 μg of each capsular polysaccharide except for serotype 6B, which is present in an amount of approximately 4.4 mcg. In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain from about 2 μg to about 2.5 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F, 23F, and 33F, and about 4 μg to about 5 μg of serotype 1, 3, 6B, 12F, 19A, and 19F capsular polysaccharides. In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain approximately 2.0 µg of serotypes 4, 5, 6A, 7F, 8, 9V capsular polysaccharides , 10A, 11A, 14, 15B, 18C, 22f, 23F and 33F and approximately 4.0 μg of capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F. In other embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain approximately 2.2 µg of serotypes 4, 5, 6A, 7F, 8, 9V capsular polysaccharides , 10A, 11A, 14, 15B, 18C, 22F, 23F and 33F and approximately 4.4 μg of capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F. In some embodiments, the mixed carrier vaccine or 20-valent pneumococcal conjugate composition may be a single 0.5 ml dose formulated to contain from about 2 μg to about 2.5 μg of capsular polysaccharides serotypes 4, 5, 6a, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F, 23F and 33F; from about 4 μg to about 5 μg of capsular polysaccharides of serotypes 1, 3, 6B, 12F, 19A and 19F; about 5 µg to about 15 µg TT; about 50 µg to about 60 µg CRM ₁₉₇ ; and optionally about 0.1 to about 0.2 mg of elemental aluminum adjuvant. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition or vaccine containing the same additionally contains sodium chloride and sodium succinate as excipients. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid formulation wherein each of the pneumococcal capsular polysaccharides serotypes 1 and 3 is conjugated to TT and each of the pneumococcal capsular polysaccharides serotypes 4, 5, 6A, 6B , 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F conjugated to CRM ₁₉₇ . In one embodiment, each 0.5 ml dose may be formulated as a liquid composition containing approximately 2.2 μg of each polysaccharide except for 6B in an amount of approximately 4.4 μg; about 10 µg to about 15 µg TT carrier protein (serotypes 1 and 3 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride and sodium succinate buffer as

- 9 042219 excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid composition containing approximately 2.0 μg of each polysaccharide except 6B in an amount of approximately 4.0 μg; about 10 µg to about 15 µg TT carrier protein (for serotypes 1 and 3 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride and sodium succinate buffer as excipients.

In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid formulation wherein each of the pneumococcal capsular polysaccharides of serotypes 1 and 3 is conjugated to TT and the capsular polysaccharides of serotypes 4, 5, 6A, 6B, 7F , 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated with CRM ₁₉₇ . In one embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.2 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.4 μg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 10 µg to about 15 µg TT carrier protein (serotypes 1 and 3 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.0 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.0 µg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 10 µg to about 15 µg TT carrier protein (serotypes 1 and 3 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients.

In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid formulation wherein each of the pneumococcal capsular polysaccharides of serotypes 1 and 5 is conjugated to TT and the capsular polysaccharides of serotypes 3, 4, 6A, 6B , 7F, 8, 9B, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM ₁₉₇ . In one embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.2 μg of each saccharide except 6B in an amount of approximately 4.4 μg; about 5 µg to about 10 µg of TT carrier protein (for serotypes 1 and 5 only) and about 50 µg to about 60 µg of CRM197 carrier protein; about 0.125 mg elemental aluminum adjuvant (0.5 mg aluminum phosphate); and sodium chloride buffer and sodium succinate as excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.0 μg of each saccharide except 6B in an amount of approximately 4.0 μg; about 5 µg to about 10 µg TT carrier protein (for serotypes 1 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients.

In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid composition wherein each of the pneumococcal capsular polysaccharides of serotypes 1 and 5 is conjugated to TT and the capsular polysaccharides of serotypes 3, 4, 6A, 6B, 7F , 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated with CRM197. In one embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.2 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.4 μg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 5 µg to about 10 µg TT carrier protein (for serotypes 1 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum adjuvant (0.5 mg aluminum phosphate); and sodium chloride buffer and sodium succinate as excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.0 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.0 µg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 5 µg to about 10 µg TT carrier protein (for serotypes 1 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients.

In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid composition wherein each of the pneumococcal capsular polysaccharides of serotypes 3 and 5 is conjugated to TT and the capsular polysaccharides of serotypes 1, 4. 6A, 6B, 7F , 8, 9B, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated with

- 10 042219

CRM ₁₉₇ . In one embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.2 μg of each saccharide except 6B at approximately 4.4 μg; about 10 µg to about 15 µg TT carrier protein (serotypes 3 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum adjuvant (0.5 mg aluminum phosphate); and sodium chloride buffer and sodium succinate as excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.0 μg of each saccharide except 6B at approximately 4.0 μg; about 10 µg to about 15 µg TT carrier protein (serotypes 3 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be formulated as a liquid composition wherein each of the pneumococcal capsular polysaccharides of serotypes 3 and 5 is conjugated to TT and the capsular polysaccharides of serotypes 1, 4, 6A, 6B, 7F , 8, 9B, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated with CRM ₁₉₇ . In one embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.2 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.4 μg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 10 µg to about 15 µg of TT carrier protein (for serotypes 3 and 5 only) and about 50 µg to about 60 µg of CRM197 carrier protein; about 0.125 mg elemental aluminum adjuvant (0.5 mg aluminum phosphate); and sodium chloride and sodium succinate buffer as excipients. In another embodiment, each 0.5 ml dose may be formulated as a liquid formulation containing approximately 2.0 μg of capsular polysaccharides serotypes 4, 5, 6A, 7F, 8, 9B, 10A, 11A, 14, 15B, 18C, 22F , 23F and 33F; approximately 4.0 µg capsular polysaccharides serotypes 1, 3, 6B, 12F, 19A and 19F; about 10 µg to about 15 µg TT carrier protein (serotypes 3 and 5 only) and about 50 µg to about 60 µg CRM ₁₉₇ carrier protein; about 0.125 mg elemental aluminum (0.5 mg aluminum phosphate) as an adjuvant; and sodium chloride buffer and sodium succinate as excipients. In some embodiments, such a liquid formulation may be filled into a single dose syringe without preservative. After shaking, said liquid composition becomes a vaccine, which is a homogeneous white suspension, ready for intramuscular injection. This 20-valent mixed carrier pneumococcal conjugate composition may be administered as a single injection or as part of an immunization series. For example, a mixed carrier 20-valent pneumococcal conjugate composition may be administered 2, 3, 4 or more times at suitable intervals, eg 1, 2, 3, 4, 5 or 6 months, or a combination thereof. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition is administered to an infant 4 times during the first 15 months after birth, including, for example, administration at about 2, 3, 4, and 12-15 months of age; at the age of 3, 4, 5 and 12-15 months; or at approximately 2, 4, 6 and 12-15 months of age. This first dose can be administered as early as 6 weeks of age. In another embodiment, the mixed carrier 20-valent pneumococcal conjugate composition is administered to an infant 3 times during the first 15 months after birth, including, for example, administration at 2, 4, and 11-12 months of age.

The mixed carrier polyvalent pneumococcal conjugate composition may also include one or more Streptococcus pneumoniae proteins. Examples of Streptococcus pneumoniae proteins suitable for inclusion include those defined in International Patent Application WO 02/083855 as well as those described in International Patent Application WO 02/053761.

This mixed carrier 20-valent pneumococcal conjugate composition may be administered to a subject by one or more routes of administration known to those skilled in the art, such as parenteral, transdermal or transmucosal, intranasal, intramuscular, intraperitoneal, intradermal, intravenous, or subcutaneous, and is formulated accordingly. way. This 20-valent mixed carrier pneumococcal conjugate composition can be formulated to suit the intended route of administration.

In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition may be administered as a liquid formulation by intramuscular, intraperitoneal, subcutaneous, intravenous, intra-arterial, or transdermal injection, or by injection into the respiratory mucosa. The mixed carrier 20-valent pneumococcal conjugate composition may be formulated in liquid form or in lyophilized form. In some embodiments, injectable compositions are prepared in conventional forms, either as liquid solutions or suspensions, solid forms suitable for solution or suspension in liquid prior to injection, or as emulsions. In some embodiments, injectable solutions and suspensions are prepared from sterile powders or granules. General considerations for the compilation and production

- 11 042219 guidelines for pharmaceutical agents for administration by such routes can be found, for example, in Remington's Pharmaceutical Sciences, 19th ed., Mack Publishing Co., Easton, PA, 1995; included in this application by reference. At present, oral or aerosol or nasal spray (eg, by inhalation) is most commonly used to deliver therapeutic agents directly to the lungs and respiratory system. In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition is administered via a device delivering a metered dose of the composition. Suitable devices for use in delivering the intradermal pharmaceutical compositions described herein include short needle devices such as those described in US Pat. No. 4,886,499; US Pat. No. 5,190,521; 4,270,537, US Patent No. 5,015,235, US Patent No. 5,141,496, US Patent No. 5,417,662 (all of which are incorporated herein by reference). Compositions for intradermal administration can also be administered using devices that limit the effective length of needle penetration into the skin, such as those described in WO 1999/34850, incorporated herein by reference, and their functional equivalents. Also suitable are jet injection devices that deliver liquid vaccines into the dermis via a liquid jet injector or through a needle that pierces the stratum corneum and creates a jet that reaches the dermis. Jet injection devices are described, for example, in US Pat. No. 5,480,381, US Pat. No. 5,599,302, US Pat. No. 5,344,444, US Pat. 5,893,397, US Patent No. 5,466,220, US Patent No. 5,339,163, US Patent No. 5,312,335, US Patent No. 5,503,627, US Patent No. 5,064,413, US Patent No. 5,520,639, US Patent No. 4,595,556, US Patent No. 4,790,824, US Patent No. 4,944,880 No. 4940460, WO 1997/37705 and WO 1997/13537 (all of which are incorporated into this application by reference). Also suitable are ballistic powder/particle delivery devices that use pressurized gas to accelerate the delivery of the vaccine in powder form through the outer layers of the skin and into the dermis. In addition, conventional syringes can be used in the classic Mantoux method of intradermal administration.

Preparations for parenteral administration include sterile aqueous or non-aqueous solutions, suspensions and emulsions. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, oils such as olive oil, and injectable organic esters such as ethyl oleate. Examples of oil include vegetable or animal oil, peanut oil, soybean oil, olive oil, sunflower oil, liver oil, synthetic oil such as fish oil, and lipids derived from milk or eggs. Aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media. Parenteral vehicles include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, Ringer's lactate, or fixed oils. Intravenous vehicles include fluid and nutrient replenishers, electrolyte replenishers (eg, those based on Ringer's dextrose), and the like. Preservatives and other additives may also be present, such as, for example, antimicrobials, antioxidants, chelating agents, inert gases, and the like.

This 20-valent mixed carrier pneumococcal conjugate composition can be formulated as a single dose vial, multiple dose vial, or pre-filled syringe. Pharmaceutically acceptable carriers for the liquid formulation include an aqueous or non-aqueous solvent, suspension, emulsion, or oil. The composition may be isotonic, hypertonic or hypotonic. However, it is desirable that the composition for infusion or injection be substantially isotonic. Thus, isotonicity or hypertonicity may be advantageous for the storage of the composition. When the composition is hypertonic, the composition may be diluted to isotonicity prior to administration. The tonic agent can be an ionic tonicity agent, such as a salt, or a non-ionic tonicity agent, such as a carbohydrate. Ionic tonicity regulators include sodium chloride, calcium chloride, potassium chloride, and magnesium chloride, among others. Non-ionic tonicity regulators include sorbitol and glycerol, among others. Preferably, at least one pharmaceutically acceptable buffer is included. For example, when the composition is an infusion or injection, it is preferred to formulate it in a buffer with a buffering capacity of pH 4 to 10, such as pH 5 to 9 or pH 6 to 8. The buffer may be selected from those suitable according to the US Pharmacopeia (USP). For example, the buffer may be selected from the group consisting of a monobasic acid such as acetic acid, benzoic acid, gluconic acid, glyceric acid, and lactic acid; a dibasic acid such as aconitic acid, adipic acid, ascorbic acid, carbonic acid, glutamic acid, malic acid, succinic acid and tartaric acid; a polybasic acid such as citric acid and phosphoric acid; and a base such as ammonia, diethanolamine, glycine, triethanolamine and TRIS.

This mixed carrier 20-valent pneumococcal conjugate composition may contain a surfactant. Examples of the surfactant include, among others, polyoxyethylene sorbitan ester (commonly referred to as Tween), in particular polysorbate 20 and polysorbate 80; copolymers (such as DOWFAX) of ethylene oxide (EO), propylene oxide (PO),

- 12 042219 butylene oxide (BO); octoxynols with different repeats of the ethoxy(oxy-1,2-ethandiyl) group, in particular octoxynol-9 (triton-100); ethylphenoxypolyethoxyethanol (IGEPAL CA-630/NP-40); a phospholipid such as lecithin; nonylphenol ethoxylate such as the TERGITOL NP series; polyoxyethylene ethers of fatty alcohols - lauryl, cetyl, stearyl, oleyl (surfactant Brij), in particular triethylene glycol monolauryl ether (Brij 30); ester of sorbitol, known as SPAN, in particular sorbitol trioleate (Span 85) and sorbitol monolaurate.

Mixtures of surfactants such as Tween 80/Span 85 can be used. A combination of a polyoxyethylene sorbitan ester such as Tween 80 and an octoxynol such as Triton X-100 is also suitable. A combination of Laureth 9 and Tween and/or Octoxynol is also preferred. Preferably, the amount of polyoxyethylene sorbitan ester (such as Tween 80) incorporated may be 0.01 to 1% (w/v), 0.01 to 0.1% (w/v), 0.01 to 0.05 % (w/v) or approximately 0.02%; the amount of octylphenoxypolyoxyethanol or nonylphenoxypolyoxyethanol (such as Triton X-100) included may be from 0.001 to 0.1% (w/v), in particular from 0.005 to 0.02%; and the amount of polyoxyethylene ether included (such as laureth 9) can be from 0.1 to 20% (w/v), possibly from 0.1 to 10%, in particular from 0.1 to 1% or about 0.5% . In some embodiments, the mixed carrier 20-valent pneumococcal conjugate composition can be delivered using a controlled release system. For example, intravenous infusion, transdermal patch, liposome, or other methods may be used for administration. In one aspect, macromolecules such as a microsphere or implant can be used.

The above description characterizes the present invention as a whole. A more complete understanding can be obtained with reference to the following specific examples. These examples are described solely for the purpose of illustration and are not intended to limit the scope of the invention.

Examples

Example 1 Preparation of S. Pneumoniae Capsular Polysaccharides.

Cultivation of S. pneumoniae and purification of capsular polysaccharides were performed by methods known to the person skilled in the art. S. pneumoniae serotypes were obtained from the American Type Culture Collection (ATCC) (serotype 1: ATCC #6301; serotype 3: ATCC #6303; serotype 4: ATCC #6304; serotype 5: ATCC #6305; serotype 6A: ATCC #6306; serotype 6B: ATCC #6326 serotype 7F: ATCC #10351 serotype 9V: ATCC #10368 serotype 12F: ATCC #6312 serotype 14: ATCC #6314 serotype 18C: ATCC #10356 serotype 19A: ATCC #10357 19F: ATCC #6319; serotype 22F: ATCC #6322; serotype 23F: ATCC #6323; serotype 33F: ATCC #10370). Internal strains for serotypes 8, 10A, 11A and 15B were used. S. pneumoniae were characterized by the presence of capsules and immobility, Gram-positive lancet-shaped diplococcus, and alpha hemolysis in blood agar medium. Serotypes were identified using the Kelling test using specific anti-sera (US Patent No. 5847112).

Preparation of cell banks.

Several generations of inoculum were created to develop strains and remove animal components (generations F1, F2 and F3). Two additional generations of seed were produced. The first additional generation was cultured from the F3 flask and the next generation was cultured from the first additional generation flask. The inoculum vials were stored frozen (below -70°C) with synthetic glycerol as a cryopreservative. To prepare the cell bank, all cultures were grown in soy-based medium. Prior to freezing, the cells were concentrated by centrifugation, the spent medium was removed, and the cell pellets were resuspended in fresh medium containing a cryopreservative (such as synthetic glycerol).

Cultivation and collection.

Cultures from the working cell bank were inoculated into inoculum flasks containing soy-based medium and cultured. Once the target optical density (light absorbance) was reached, the inoculum vial was used to inoculate a fermenter containing soy-based media. Cultivation was stopped when the value of optical density became constant. After cessation of cultivation, sodium deoxycholate was added to the culture for cell lysis. The resulting content of the fermenter was cooled and protein precipitation was induced. The mixture was then centrifuged to remove precipitated proteins and cell debris.

Cleaning.

The solution resulting from centrifugation was filtered through a depth filter to remove proteins and cellular debris that did not precipitate during centrifugation. The filtrate was concentrated onto a 100 kDa membrane and the concentrate was diafiltered with 10 volumes of 25 mM sodium phosphate buffer (pH 7.2) to obtain a sample. The sample was filtered to collect the supernatant from which the polysaccharides were precipitated and filtered. The filtrate was concentrated on a 30 kDa membrane and the concentrate was diafiltered using approximately 10 volumes of triple distilled water. After diafiltration, the remaining solution was filtered through a 0.2 µm filter. During the process, the filtrate was subjected to control testing (appearance, remaining proteins, remaining nucleic acids, endotoxins, molecular weights and total polysaccharides). The concentrate was sterile filtered and stored at -20°C.

Example 2 Preparation of a S.pneumoniae capsular polysaccharide conjugate with a carrier protein.

Polysaccharides of different serotypes were activated in different ways and then conjugated to a carrier protein, CRM ₁₉₇ or TT. In particular, conjugates were prepared by conjugating each of the capsular polysaccharides of all serotypes with CRM ₁₉₇ and by conjugating each of the capsular polysaccharides of serotypes 1, 3 and 5 with TT. The activation process includes reducing the size of each capsular polysaccharide to the target molecular weight, chemical activation, and buffer exchange via ultrafiltration. The conjugates were purified using ultrafiltration and finally filtered through a 0.2 µm filter. Process parameters such as pH, temperature, concentration and time are listed below.

1. The activation process.

Stage 1: hydrolysis.

Reductive amination is a known polymer conjugation process in which an amide bond is formed between the primary amino group (-NH2) of a protein and the saccharide aldehyde. However, since S. pneumoniae polysaccharides do not have aldehyde groups, an aldehyde group is added to the pneumococcal capsular polysaccharide. The diol structure of a monosaccharide can be oxidized with sodium periodate (NalO ₄ ) to form an aldehyde group. Capsular polysaccharides from serotypes 1, 3, 4, 6A, 8, 11A, 12F, 14, 15B, 18C, 22F and 33F were pretreated as follows.

In the case of serotype 1, sodium hydroxide was added to the capsular polysaccharide solution (at a final base concentration of 0.05 M) and the solution was incubated at 50±2°C. The solution was then cooled to a temperature in the range from about 21° C. to about 25° C. and hydrochloric acid was added thereto to a final pH of 6.0 ± 0.1, thereby stopping the hydrolysis. In the case of serotypes 3, 8, 11A and 15B, hydrochloric acid was added to the capsular polysaccharide solution (at a final acid concentration of 0.01 M) and the solution was incubated at 60±2°C. The solution was then cooled to a temperature in the range of about 21° C. to about 25° C. and 0.1 M sodium phosphate was added thereto to a final pH of 6.0 ± 0.1, thereby stopping the hydrolysis.

In the case of serotype 4, hydrochloric acid was added to the capsular polysaccharide solution (at a final acid concentration of 0.1 M) and the solution was incubated at 45±2°C. The solution was then cooled to a temperature in the range of about 21°C to about 25°C and 1 M sodium phosphate was added thereto to a final pH of 6.0±0.1, thereby stopping the hydrolysis.

In the case of serotype 6A, glacial acetic acid (at a final acid concentration of 0.1 M) was added to the capsular polysaccharide solution and the solution was incubated at 60±2°C. The solution was then cooled to a temperature in the range of about 21°C to about 25°C and 1M sodium hydroxide was added thereto to a final pH of 6.0±0.1. In the case of serotype 12F, hydrochloric acid was added to the capsular polysaccharide solution (at a final acid concentration of 0.01 M) and the solution was incubated at 70±2°C. The solution was then cooled to a temperature in the range of about 21°C to about 25°C, and 0.1 M sodium phosphate was added thereto until the final pH of the solution was 6.0±0.1, thereby stopping the hydrolysis.

For serotypes 14 and 18C, glacial acetic acid (at a final acid concentration of 0.2M) was added to the capsular polysaccharide solution and the solution was incubated at approximately 91-96°C. The solution was then cooled to a temperature ranging from about 21°C to about 25°C and 1 M sodium phosphate was added thereto so that the final pH of the solution was 6.0±0.1. In the case of serotypes 22F and 33F, hydrochloric acid was added to the capsular polysaccharide solution (at a final acid concentration of 0.01 M) and the solution was incubated at 60±2°C. The solution was then cooled to a temperature in the range of about 21°C to about 25°C and 0.1 M sodium phosphate was added thereto to a final pH of 6.0±0.1, thereby stopping the hydrolysis.

Each of the resulting capsular polysaccharides was diluted in water for injection (WFI) with sodium acetate and sodium phosphate to a final concentration of about 1.0 mg/mL to about 2.0 mg/mL.

Stage 2: reaction with periodate.

The molar equivalent of sodium periodate for each pneumococcal saccharide activation was determined using the total saccharide content. With thorough mixing, the oxidation reactions were allowed to proceed for 16-20 hours at 21-25°C for all serotypes except 1, 7F and 19F, for which the temperature was 10°C or less. During the conjugation process, maintaining the aldehyde concentration at an appropriate level ensures consistent and stable production of conjugates. The degree of aldehyde formation is determined by the ratio between the concentration of aldehyde formed and the concentration of saccharide, and this degree is related to the oxidation state (Do), which is set for

- 14 042219 of each serotype, as shown in the table. 2 and 3.

table 2

Do range for all serotypes to be conjugated to CRM ₁₉₇

Serotype Do Range Serotype Do range Serotype 1 4-10 Serotype 11A 1-15 Serotype 3 2-8 Serotype 12F 1-9 Serotype 4 1-5 Serotype 14 6-13 Serotype 5 2-6 Serotype 15B 1-17 Serotype 6A 5-15 Serotype 18C 6-14 Serotype 6B 7-13 Serotype 19A 7-13 Serotype 7F 2-8 Serotype 19F 6-12 Serotype 8 1-17 Serotype 22F 1-16 Serotype 9V 4-9 Serotype 23F 6-14 Serotype 10A 1-12 Serotype 33F 1-15

Table 3

Do range for serotypes 1, 3 and 5 to be conjugated to TT

Serotype Do Range Serotype 1 1-15 Serotype 3 2-14 Serotype 5 1-15

Stage 3: ultrafiltration.

The oxidized saccharide was concentrated and diafiltered with WFI on a 100 kDa MWCO ultrafilter (30 kDa ultrafilter for serotype 1 and a 5 kDa ultrafilter for serotype 18C). Diafiltration was performed using 0.9% sodium chloride solution for serotype 1, 0.01 M sodium acetate buffer (pH 4.5) for serotypes 7F and 23F, and 0.01 M sodium phosphate buffer (pH 6.0) for serotype 19F . The permeate was discarded and the retentate was filtered through a 0.2 µm filter.

Stage 4: lyophilization.

For capsular polysaccharides of serotypes 3, 4, 5, 8, 9V, 10A, 14, 15B, 22F and 33F, which must be conjugated with a carrier protein using an aqueous solvent, a mixed solution of polysaccharides and carrier protein was prepared without the addition of sucrose, lyophilized and then stored at -25±5°C.

For serotype 1 and 18C capsular polysaccharides to be conjugated to a carrier protein using an aqueous solvent, the polysaccharides and carrier protein were prepared independently without the addition of sucrose, lyophilized, and then stored at -25±5°C. For capsular polysaccharides of serotypes 6A, 6B, 7F, 19A, 19F, and 23F to be conjugated to a carrier protein using DMSO solvent, a predetermined amount of sucrose was added to the activated saccharides until a final sucrose concentration of 5±3% was reached, then samples were independently prepared, lyophilized and then stored at -25±5°C.

For serotype 11A capsular polysaccharide, a predetermined amount of sucrose was added to the activated saccharide to achieve a final sucrose concentration of 20±5%, then the polysaccharides and carrier protein were independently prepared, lyophilized, and then stored at -25±5°C.

For serotype 12F capsular polysaccharide, a predetermined amount of sucrose was added to the activated saccharide to achieve a final sucrose concentration of 10±5%, then the polysaccharides and carrier protein were independently prepared, lyophilized, and then stored at -25±5°C.

2. The process of conjugation.

Conjugation in an aqueous medium was performed for serotypes 1, 3, 4, 5, 8, 9V, 10A, 14, 15B, 18C, 22F and 33F, and conjugation in DMSO was performed for serotypes 6A, 6B, 7F, 11A, 12F, 19A, 19F and 23F. Each of the capsular polysaccharides was conjugated to a carrier protein in a ratio of 0.2 to 2:1.

Stage 1: dissolution.

Conjugation in the aquatic environment.

For serotypes 1, 3, 4, 5, 8, 9V, 10A, 14, 15B, 18C, 22F and 33F, the lyophilized sample was thawed and equilibrated at room temperature. The lyophilized sample was reconstituted to reactive concentration using sodium phosphate buffer at 23±2°C in the ratio set for each serotype.

Conjugation in dimethyl sulfoxide (DMSO).

For serotypes 6A, 6B, 7F, 11A, 12F, 19A, 19F, and 23F, the lyophilized sample was thawed, equilibrated at room temperature, and reconstituted in DMSO.

Step 2: conjugation reaction.

Conjugation in the aquatic environment.

For serotypes 1, 3, 4, 5, 8, 9V, 10A, 14, 15B, 18C, 22F and 33F, the conjugation reaction was initiated by adding a solution of sodium cyanoborohydride (100 mg/ml) to 1.0-1.4 mol of sodium cyanoborohydride per mole of saccharide. However, for serotypes 1 and 3, the reaction was initiated by adding a solution of sodium cyanoborohydride to 0.5 mole of sodium cyanoborohydride per mole of saccharide.

For serotypes 1, 3 and 5 to be conjugated to TT, the conjugation reaction was initiated by adding a solution of sodium cyanoborohydride (100 mg/ml) to 1.0-1.4 mol of sodium cyanoborohydride per mol of saccharide, except for serotype 1 - adding 0.5 mol sodium cyanoborohydride per mole of saccharide.

The reaction mixture was incubated at 23 to 37° C. for 44 to 106 hours. The reaction temperature and time were adjusted according to serotype. Then the temperature was lowered to 23±2°C and 0.9% sodium chloride was added to the reactor. A solution of sodium borohydride (100 mg/ml) was added to give 1.8-2.2 molar equivalents of sodium borohydride per mole of saccharide. The mixture was incubated at 23±2°C for 3-6 hours. This procedure reduced the amount of unreacted aldehydes present on the saccharides. The mixture was then diluted with sodium chloride 0.9% and the diluted conjugation mixture was filtered using a 0.8 or 0.45 µm pre-filter.

Conjugation in DMSO.

For capsular polysaccharides of serotypes 6A, 6B, 7F, 12F, 19A, 19F and 23F, the conjugation reaction was initiated by adding a solution of sodium cyanoborohydride (100 mg/ml) to a ratio of 0.8-1.2 molar equivalents of sodium cyanoborohydride per mole of activated saccharide. WFI was added to the reaction mixture to a target concentration of 1% (v/v) and the mixture was incubated for 12-26 h at 23±2°C. 100 mg/ml sodium borohydride solution (typically 1.8-2.2 molar equivalents of sodium borohydride per mole of activated saccharide) and WFI (target 5% (v/v)) were added to the reaction mixture and the mixture was incubated for 3- 6 hours at 23±2°C. This procedure made it possible to reduce the amount of unreacted aldehydes present on the saccharides. The reaction mixture was then diluted with sodium chloride 0.9% and the diluted conjugation mixture was filtered using a 0.8 or 0.45 µm pre-filter.

Stage 3: ultrafiltration.

The diluted conjugate mixture was concentrated and diafiltered on a 100 kDa MWCO ultrafiltration filter or a 300 kDa MWCO ultrafiltration filter with a minimum of 15 volumes of 0.9% sodium chloride or buffer. In addition, the type and pH of the buffer used in the process varied depending on each of the serotypes.

Stage 4: sterile filtration.

The retentate after ultrafiltration was subjected to sterile filtration (0.2 μm) and during the process the filtered conjugates were subjected to control testing (for appearance, free protein, free saccharide, molecular size distribution, sterility, saccharide content, protein content, pH, endotoxin, residual cyanide, residual DMSO, saccharide identity, TT identity, and CRM identity ₁₉₇ ). The final concentrate was cooled and stored at 2 to 8°C.

Example 3 Composition of a polyvalent pneumococcal conjugate vaccine.

The required volumes of the final volumetric concentrates obtained from Example 2 were calculated based on the batch volume and bulk saccharide concentrations. After adding 0.85% sodium chloride (saline), polysorbate 80 and succinate buffer to a pre-labeled formulation vessel, the bulk concentrates were added. Then the drug was thoroughly mixed and sterile filtered through a 0.2 μm membrane. The formulated mass was gently stirred during and after the addition of the bulk aluminum phosphate. The pH was checked and adjusted if necessary. The mixed bulk product was stored at 2 to 8°C. The following three types of polyvalent pneumococcal conjugate vaccine formulations were prepared and named PCV20-13TT, PCV2O-15TT and PCV20-35TT, respectively.

PCV20-13TT included polysaccharide conjugates prepared by conjugating each polysaccharide serotypes 1 and 3 with TT and each polysaccharide serotypes 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F , 22F, 23F and 33F with CRM197.

PCV20-15TT included polysaccharide conjugates prepared by conjugating each polysaccharide of serotypes 1 and 5 with TT and each polysaccharide of serotypes 3, 4, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F , 22F, 23F and 33F with CRM ₁₉₇ .

- 16 042219

PCV20-35TT included polysaccharide conjugates obtained by conjugating each polysaccharide of serotypes 3 and 5 with TT and each polysaccharide of serotypes 1, 4, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14,

15B, 18C, 19A, 19F, 22F, 23F and 33F with CRM ₁₉₇ .

The resulting vaccine composition of PCV20-13TT and PCV20-35TT included 2.2 μg of each saccharide, except for serotype 6B p in the amount of 4.4 μg; 10-15 µg TT (for serotypes 1 and 3) and 40-50 µg CRM ₁₉₇ ; 0.125 mg elemental aluminum adjuvant (0.5 mg aluminum phosphate); 4.25 mg sodium chloride; approximately 295 µg succinate buffer solution; and approximately 100 μg of polysorbate 80 in a total dose of 0.5 ml. The composition of PCV20-15TT in a total dose of 0.5 ml included from 5 to 10 μg of TT (for serotypes 1 and 5) and from 50 to 60 μg of CRM ₁₉₇ , respectively, with other components and their content identical to those in PCV20-13TT.

Example 4 Immunogenicity of monoconjugates (serotypes 8, 10A, 11A and 15).

As noted above, the mixed carrier 20-valent pneumococcal conjugate compositions described herein include pneumococcal serotypes not covered by the three pneumococcal conjugate vaccines currently available on the world market. Such pneumococcal serotypes that are not part of currently available vaccines include serotypes 8, 10A, 11A and 15B. Serotype 8, 10A, 11A and 15B monoconjugates were prepared as described in Example 2. The immunogenicity of these monoconjugates was tested in vivo. More specifically, rabbits (New Zealand White, female, 2-3 kg) were immunized with the monoconjugates at time points 0 and 2 weeks. Antibody titers measured after 4 weeks (28 days) are shown in FIG. A-D. As shown in FIG. A-D, each monoconjugate of serotypes 8, 10, 11A and 15B showed a dose-dependent in vivo antibody response as measured by geometric mean titer (GMT).

Example 5 Immunogenicity of 16-valent pneumococcal conjugate vaccine.

Mixed-carrier 16-valent pneumococcal conjugate compositions, including PCV16-13TT, PCV16-15TT and PCV16-35TT, were prepared using the general method described in Example 3. A mixed-carrier 16-valent pneumococcal control composition containing CRM ₁₉₇ conjugated with capsular polysaccharides from Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 12F, 14, 18C, 19A, 19F, 22F, 23F and 33F (PCV16-CRM ₁₉₇ ). These 16-valent pneumococcal conjugate compositions were tested for their ability to induce an immunogenic response in rabbits. These immunogenic effects were characterized by antigen-specific ELISA for serum IgG concentrations and opsonophagocytic assay (OPA) for antibody function. New Zealand White rabbits were immunized intramuscularly at weeks 0 and 3 with a dose 5% higher than the planned human clinical dose of each polysaccharide (2.31 µg of each polysaccharide except 6B at 4.62 µg) in the formulation, or the human dose (2.2 micrograms of each polysaccharide except for 6B at 4.4 micrograms). Serum samples were taken every 3 weeks after immunization. Both concentrations showed the same results.

Serotype-specific immune response against PCV16-CRM ₁₉₇ , PCV16-13TT, PCV16-15TT and PCV16-35TT compositions was assessed by IgG ELISA and complement-mediated MOPA assay, which measures the amount of functional antibody.

4-1. PCV16-CRM ₁₉₇ .

Measurement of the concentration of serotype-specific IgG.

Capsular polysaccharides (PnP) for each serotype were applied to a 96-well plate at a concentration of 0.5 to 1 μg/well. An equivalent amount of serum was collected from each subject and pooled into groups. The serum pool was serially diluted 2.5-fold with antibody dilution buffer containing Tween 20 and CWPS 5 μg/ml and then reacted at room temperature for 30 minutes. The plate was washed 5 times with wash buffer, and then 50 μl of pre-adsorbed and diluted serum was added to the plate with coated wells, followed by incubation at room temperature for 2 to 18 hours. The plate was washed in the same way, and then added to each well goat anti-rabbit IgG alkaline phosphatase conjugates followed by incubation at room temperature for 2 h. 2 hours. The reaction was quenched by adding 50 μl of 3 M NaOH and the optical density was measured at 405 and 690 nm. As a comparative example, a commercially available 13-valent vaccine (PREVNAR13) was subjected to the same procedure. The results are shown in table. 4.

- 17 042219

Table 4 IgG concentration (u/ml) for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV16- CRM197 Serotype PREVNAR13 PCV16- CRM197 1 320.99 379.99 12F - 120.44 3 436.85 653.84 14 482.05 502.6 4 1820.49 1948.29 18С 1731.07 2915.55 5 466.09 380.18 19A 993.68 672.2 6A 1064.69 1643.6 19F 863.32 1054.3 6V 326.94 552.58 22F 1.33 678.45 7F 1010.79 833.11 23F 329.11 185.97 9V 715.40 433.33 33F 4.58 499.3

PCV16-CRM ₁₉₇ was found to result in good serotype-specific IgG levels for all 16 serotypes. For PCV16-CRM ₁₉₇ , serotypes shared by PCV16-CRM ₁₉₇ and PREVNAR13 showed concentrations of serotype-specific IgG equivalent to or higher than for PREVNAR13, and each of the newly added serotypes 12F, 22F, and 33F also showed good levels of specific IgG.

Functional immunogenicity test (MORA).

Antibody functions were assessed by testing serum in the MOPA assay. The S. pneumoniae MOPA strain stored at -70° C. or below was diluted to the appropriate final dilution so that the concentration of each strain was approximately 50,000 CFU/mL. An equivalent amount of serum was taken from each subject, pooled into groups, and serially diluted 2-fold so that 20 μl of serum remained in the U-bottomed plate. After the sample was diluted, 10 μl of the strain prepared for each serotype was mixed with the diluted sample and the mixture was allowed to react at room temperature for 30 minutes so that the S. pneumoniae and the antibody were well mixed. A mixture of pre-differentiated HL-60 cells and complement was added and reacted in a CO ₂ incubator (37° C.) for 45 min. The temperature was lowered to stop phagocytosis and 10 μl of the reaction solution was applied to the agar plate pre-dried for 30-60 min and then allowed to absorb onto the plate for 20 min until dry. A stock solution of TTC 25 mg/ml was added to the top layer of the prepared agar and an antibody suitable for the respective strain was added thereto. The mixture was thoroughly mixed and then approximately 25 ml of the mixture was added to the plate and allowed to solidify for approximately 30 minutes. The fully cured plate was incubated in a CO ₂ incubator (37° C.) for 12-18 hours and then colonies were counted. The MOPA titer was expressed as the degree of dilution at which 50% death was observed. As a comparative example, a commercially available 13-valent vaccine (PREVNAR13) was subjected to the same procedure. The results are shown in table. 5.

Table 5

MOPA titers for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV16-CRM197 Serotype PREVNAR13 PCV16-CRM197 1 128 128 12F 4 1024 3 512 1024 14 2048 1024 4 2048 2048 18C 1024 2048 5 512 256 19A 4096 2048 6A 4096 4096 19F 2048 2048 6B 4096 4096 22F 16 4096 7F 2048 1024 23F 2048 1024 9V 1024 512 33F 32 1024

All serotypes showed an excellent level of functional immunogenicity in PCV16-CRM ₁₉₇ . For PCV16-CRM ₁₉₇ , serotypes shared by PCV16-CRM ₁₉₇ and PREVNAR13 showed functional immunogenicity equivalent to or better than PREVNAR13, and each of the newly added serotypes 12F, 22F, and 33F also showed a high level of functional immunogenicity.

- 18 042219

4-2. PCV16-13TT.

Serotype-specific IgG concentration and functional immunogenicity titer were measured in the same manner as in 4-1, except that PCV16-13TT was used instead of PCV16-CRM ₁₉₇ , and the results are shown below.

Measurement of the concentration of serotype-specific IgG.

Table 6

IgG concentration (U/ml) for 16 serotypes weeks after booster

Serotype PREVNAR13 PCV1613TT Serotype PREVNAR13 PCV1613TT 1 276.92 844.48 12F 0.37 354.00 3 539.40 2980.73 14 254.59 582.61 4 1000.76 1698.00 18С 3266.87 5553.58 5 303.20 184.49 19A 681.62 1702.05 6A 533.35 532.02 19F 528.77 1998.83 6B 172.75 451.18 22F 0.74 1583.58 7F 726.27 3449.73 23F 576.63 367.71 9V 647.71 725.14 33F 0.25 977.02

When serotypes 1 and 3 capsular polysaccharides were conjugated to TT, they showed significantly elevated levels of serotype-specific IgG compared to the level obtained when the serotypes were conjugated to CRM ₁₉₇ . In addition, each of the capsular polysaccharides of serotypes 12F, 22F and 33F conjugated to CRM ₁₉₇ showed a satisfactory level of serotype-specific IgG, and serotypes 4, 6B, 7F, 14, 18C, 19A and 19F showed higher levels of serotype-specific IgG. than in PREVNAR13.

Functional immunogenicity test (MORA).

Table 7

MOPA titers for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV16-13TT Serotype PREVNAR13 PCV16-13TT 1 102 645 12F 4 1625 3 813 3251 14 2048 4096 4 2580 3251 18C 4096 4096 5 813 406 19A 2580 5161 6A 4096 4096 19F 2048 5161 6B 4096 6502 22F 8 5161 7F 2580 6502 23F 4096 3251 9V 2048 3251 33F 4 3251

When serotypes 1 and 3 capsular polysaccharides were conjugated to TT, functional immunogenicity was improved compared to that obtained when they were conjugated to CRM ₁₉₇ . In addition, each of the capsular polysaccharides of serotypes 12F, 22F, and 33F conjugated to CRM ₁₉₇ showed excellent functional immunogenicity, and each of the capsular polysaccharides of serotypes 4, 6B, 7F, 9V, 14, 19A, and 19F showed better functional immunogenicity compared to PREVNAR13.

4-3. PCV16-15TT.

Serotype-specific IgG concentration and functional immunogenicity titer were measured in the same manner as in 4-1, except that PCV16-15TT was used instead of PCV16-CRM197, and the results are shown below.

- 19 042219

Measurement of the concentration of serotype-specific IgG.

Table 8

IgG concentration (U/ml) for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV1615TT Serotype PREVNAR13 PCV1615TT 1 276.92 1083.23 12F 0.37 303.99 3 539.40 901.37 14 254.59 493.06 4 1000.76 2655.28 18C 3266.87 4075.62 5 303.20 2645.56 19A 681.62 937.41 6A 533.35 1460.65 19F 528.77 1355.08 6B 172.75 603.87 22F 0.74 1874.55 7F 726.27 2285.92 23F 576.63 607.40 9V 647.71 663.37 33F 0.25 880.54

When capsular polysaccharides of serotypes 1 and 5 were conjugated to TT, the concentration of serotype-specific IgG was significantly increased compared to the concentration obtained when they were conjugated to CRM ₁₉₇ . In addition, each of the capsular polysaccharides of serotypes 12F, 22F, and 33F conjugated to CRM ₁₉₇ showed a high level of serotype-specific IgG, and each of the capsular polysaccharides of serotypes 3, 4, 6A, 6B, 7F, 14, 18C, 19A, and 19F showed a higher level of serotype-specific IgG than in PREVNAR13.

Functional immunogenicity test (MORA).

Table 9

MOPA titers for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV16-15TT Serotype PREVNAR13 PCV16-15TT 1 102 645 12F 4 1290 3 813 1290 14 2048 2580 4 2580 4096 18C 4096 3251 5 813 4096 19A 2580 2580 6A 4096 6502 19F 2048 4096 6B 4096 6502 22F 8 6502 7F 2580 4096 23F 4096 3251 9V 2048 1290 33F 4 2580

When serotypes 1 and 5 capsular polysaccharides were conjugated to TT, functional immunogenicity was improved compared to that obtained when they were conjugated to CRM197.

In addition, each of the capsular polysaccharides of serotypes 12F, 22F and 33F conjugated with CRM ₁₉₇ showed excellent functional immunogenicity, and each of the capsular polysaccharides of serotypes 3, 4, 6A, 6B, 7F and 19F showed a higher level of functional immunogenicity than in PREVNAR13.

4-4. PCV16-35TT.

Serotype-specific IgG concentration and functional immunogenicity titer were measured in the same manner as in 4-1, except that PCV16-35TT was used instead of PCV16-CRM ₁₉₇ , and the results are shown below.

- 20 042219

Measurement of the concentration of serotype-specific IgG.

Table 10

IgG concentration (U/ml) for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV16-35TT PREVNAR13 PCV16-35TT 1 242.33 367.13 12F 0.25 334.45 3 656.91 1837.36 14 320.12 1055.422 4 1305.61 1786.84 18C 2920.75 3665.59 5 408.78 1316.12 19A 652.67 409.17 6A 737.55 957.85 19F 411.07 534.19 6B 167.41 322.61 22F 1.15 1176.6 7F 808.75 1357.46 23F 742.55 408.88 9V 775.28 966.22 33F 0.25 855.55

When capsular polysaccharides of serotypes 3 and 5 were conjugated with TT, the concentration of serotype-specific IgG was significantly increased compared to the concentration obtained when they were conjugated with CRM ₁₉₇ . In addition, each of the capsular polysaccharides of serotypes 12F, 22F, and 33F conjugated to CRM ₁₉₇ had a good concentration of serotype-specific IgG, and each of the capsular polysaccharides of serotypes 1, 4, 6A, 6B, 7F, 9V, 14, 18C, and 19F showed a higher level of serotype-specific IgG than in PREVNAR13.

Functional immunogenicity test (MORA).

Table 11

MOPA titers for 16 serotypes 3 weeks after booster

Serotype PREVNAR13 PCV1635TT Serotype PREVNAR13 PCV1635TT 1 128 256 12F 4 512 3 512 2048 14 2048 4096 4 2048 4096 18C 1024 4096 5 512 2048 19A 4096 4096 6A 4096 4096 19F 2048 4096 6B 4096 4096 22F 16 4096 7F 2048 2048 23F 2048 2048 9V 1024 2048 33F 32 2048

When serotypes 3 and 5 were conjugated to TT, functional immunogenicity improved compared to that obtained when they were conjugated to CRM ₁₉₇ . In addition, each of the capsular polysaccharides of serotypes 12F, 22F and 33F conjugated with CRM ₁₉₇ showed excellent functional immunogenicity, and each of the capsular polysaccharides of serotypes 1, 4, 9 V, 12F, 14, 18C and 19F showed a higher level of functional immunogenicity. than in PREVNAR13. These results demonstrate that mixed-vehicle polyvalent pneumococcal capsular polysaccharide conjugate formulations induce immunogenicity equivalent to or better than the single-vehicle pneumococcal capsular polysaccharide conjugate vaccine, PREVNAR13. They also surprisingly show that antibody responses to serotypes 1, 3 and/or 5 conjugated to tetanus toxoid in mixed vehicle formulations were significantly enhanced compared to antibody responses against the same serotypes conjugated to CRM ₁₉₇ in the PREVNAR 13 vaccine. with one carrier. In addition, they show that mixed carrier polyvalent pneumococcal capsular polysaccharide conjugate formulations successfully induce antibody responses against the added serotypes, 12F, 22F and 33F, providing protection against a wider range of serotypes than the pneumococcal capsular polysaccharide conjugate vaccines currently available. On the market.

Example 6 Immunogenicity of a 20-valent pneumococcal conjugate vaccine.

Mixed carrier 20-valent pneumococcal conjugate formulations, including PCV20-13TT, PCV20-15TT, and PCV20-35TT, were prepared using the general method

- 21 042219 ba described in example 3. These 20-valent pneumococcal conjugate compositions were tested for the ability to induce an immunogenic response in rabbits. These immunogenic effects were characterized by antigen-specific ELISA for serum IgG concentrations and opsonophagocytic assay (OPA) for antibody function. New Zealand White rabbits were immunized intramuscularly at weeks 0 and 3 with a dose 5% higher than the planned human clinical dose of each polysaccharide (2.31 µg of each polysaccharide except 6B at 4.62 µg) in the formulation, or the human dose (2.2 micrograms of each polysaccharide except for 6B at 4.4 micrograms). Serum samples were taken every 3 weeks after immunization. Both concentrations showed the same results. Both concentrations showed the same results.

Serotype-specific immune response against compositions PCV20-13TT, PCV20-15TT and PCV20-35TT was assessed using IgG ELISA and complement-mediated MOPA assay, which measures the amount of functional antibody.

6-1. PCV20-35TT.

Measurement of the concentration of serotype-specific IgG.

Capsular polysaccharides (PnP) for each serotype were applied to a 96-well plate at a concentration of 0.5 to 1 μg/well. An equivalent amount of serum was taken from each subject and pooled into groups. The serum pool was serially diluted 2.5-fold with antibody dilution buffer containing Tween 20 and CWPS 5 μg/ml and then reacted at room temperature for 30 minutes. The plate was washed 5 times with wash buffer, and then 50 μl of pre-adsorbed and diluted serum was added to the plate with coated wells, followed by incubation at room temperature for 2 to 18 hours. The plate was washed in the same way, and then added to each well goat anti-rabbit IgG alkaline phosphatase conjugates followed by incubation at room temperature for 2 h. 2 hours. The reaction was quenched by adding 50 μl of 3 M NaOH and the optical density was measured at 405 and 690 nm. As an example for comparison, a commercially available 13-valent vaccine (PREVNAR13) was subjected to the same procedure. The results are shown in table. 12.

Table 12

IgG concentration (u/ml) for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV20-35TT Serotype PREVNAR13 PCV20-35TT 1 8856.5 53170.2 11A 547.7 30690.8 3 5310.1 39965.2 12F 343.9 14071.5 4 8831.8 93626.2 14 15202.0 39933.6 5 3890.0 4241.1 15V 905.6 26347.9 6A 24412.1 13284.2 18C 104985.9 106523.3 6B 7528.5 4120.1 19A 13799.6 8035.9 7F 61054.8 46334.1 19F 19124.3 39824.7 8 591.4 47418.7 22F 201.2 57170.0 9V 20912.3 50598.3 23F 8109.6 9615.9 10A 477.9 39935.5 33F 191.0 35957.0

Serotypes in PCV20-35TT, which are common to PCV2O-35TT and PREVNAR13, showed serotype-specific IgG concentrations equivalent to or higher than those in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed a good level of serotype-specific IgG.

Functional immunogenicity test (MORA).

Antibody functions were assessed by testing serum in the MOPA assay. The S. pneumoniae MOPA strain stored at -70° C. or below was diluted to the appropriate final dilution so that the concentration of each strain was approximately 50,000 CFU/mL. An equivalent amount of serum was taken from each subject, pooled into groups, and serially diluted 2-fold so that 20 μl of serum remained in the U-bottomed plate. After the sample was diluted, 10 μl of the strain prepared for each serotype was mixed with the diluted sample and the mixture was allowed to react at room temperature for 30 minutes so that the S. pneumoniae and the antibody were well mixed. A mixture of pre-differentiated HL-60 cells and complement was added and reacted in a CO ₂ incubator (37° C.) for 45 min. The temperature was lowered to stop phagocytosis and 10 μl of the reaction solution was applied to the agar plate pre-dried for 30-60 min and then allowed to absorb onto the plate for 20 min until dry. A stock solution of TTC 25 mg/ml was added to the top layer of the prepared agar and an antibody suitable for the respective strain was added thereto. The mixture was thoroughly mixed, then approximately 25 ml of the mixture was added to the plate and allowed to solidify for approximately 30 minutes. The fully cured plate was incubated in a CO ₂ incubator (37° C.) for 12-18 hours and then colonies were counted. The MOPA titer was expressed as the degree of dilution, with

- 22 042219 which was observed 50% cell death. As an example for comparison, a commercially available 13-valent vaccine (PREVNAR13) was subjected to the same procedure. The results are shown in table. 13.

Table 13

MOPA titers for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV20-35TT Serotype PREVNAR13 PCV20-35TT 1 78 236 11A - 2055 3 758 3360 12F - 598 4 2389 2725 14 1855 1398 5 372 757 15V - 956 6A 6375 3099 18С 6549 3904 6V 6798 5000 19A 5131 664 7F 2872 2434 19F 5197 2848 8 - 1705 22F 55 11337 9V 2026 928 23F 2064 1568 10A - 1472 33F - 1531

All serotypes showed an excellent level of functional immunogenicity. Serotypes in PCV20-35TT, which are common to PCV20-35TT and PREVNAR13, showed functional immunogenicity equivalent to or better than in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed a high level of functional immunogenicity.

6-2. PCV20-13TT.

Serotype-specific IgG concentration and functional immunogenicity titer were measured in the same manner as in 6-1, except that PCV20-13TT was used instead of PCV20-35TT, and the results are shown below.

Measurement of the concentration of serotype-specific IgG.

Table 14

IgG concentration (U/ml) for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV2013TT Serotype PREVNAR13 PCV2013TT 1 8856.5 43835.7 11A 547.7 26830.0 3 5310.1 5251.4 12F 343.9 8849.8 4 8831.8 56988.7 14 15202.0 25402.0 5 3890.0 12600.1 15V 905.6 12057.3 6A 24412.1 19211.1 18C 104985.9 70935.6 6V 7528.5 11142.8 19A 13799.6 12017.3 7F 61054.8 37449.3 19F 19124.3 39708.2 8 591.4 39845.1 22F 201.2 35974.6 9V 20912.3 23632.9 23F 8109.6 9397.4 10A 477.9 21153.0 33F 191.0 33665.6

Serotypes in PCV20-13TT that are common to PCV2O-13TT and PREVNAR13 showed serotype-specific IgG concentrations equivalent to or higher than those in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed good levels of serotype-specific IgG.

Functional immunogenicity test (MORA).

Table 15

MOPA titers for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV20-13TT Serotype PREVNAR13 PCV20-13TT 1 78 1519 11A - 1882 3 758 5989 12F - 845 4 2389 7520 14 1855 3819 5 372 672 15V - 879 6A 6375 6154 18C 6549 8139 6B 6798 6112 19A 5131 2072 7F 2872 2358 19F 5197 6146 8 - 2785 22F 55 13123 9V 2026 5282 23F 2064 2131 10A - 2173 33F - 1254

All serotypes showed an excellent level of functional immunogenicity. Serotypes in PCV20-13TT, shared by PCV20-13TT and PREVNAR13, showed functional immunogenicity equivalent to or better than in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed a high level of functional immunogenicity.

6-3. PCV20-15TT.

Serotype-specific IgG concentration and functional immunogenicity titer were measured in the same manner as in 6-1, except that PCV20-15TT was used instead of PCV20-35TT, and the results are shown below.

- 23 042219

Measurement of the concentration of serotype-specific IgG.

Table 16

IgG concentration (u/ml) for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV2015TT Serotype PREVNAR13 PCV2015TT 1 8856.5 15443.5 11A 547.7 23066.5 3 5310.1 26383.7 12F 343.9 9830.6 4 8831.8 15534.5 14 15202.0 11218.9 5 3890.0 9591.5 15V 905.6 6268.9 6A 24412.1 35326.2 18C 104985.9 56224.9 6B 7528.5 10561.9 19A 13799.6 4660.7 7F 61054.8 54145.8 19F 19124.3 25815.4 8 591.4 38313.5 22F 201.2 31025.9 9V 20912.3 34801.5 23F 8109.6 11888.4 10A 477.9 47071.9 33F 191.0 24332.6

Serotypes in PCV20-15TT that are common to PCV2O-15TT and PREVNAR13 showed serotype-specific IgG concentrations equivalent to or higher than those in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed a good level of serotype-specific IgG.

Functional immunogenicity test (MORA).

Table 17

MOPA titers for 20 serotypes 4 weeks after booster

Serotype PREVNAR13 PCV2015TT Serotype PREVNAR13 PCV20-15TT 1 78 700 11A - 1854 3 758 1677 12F - 889 4 2389 6170 14 1855 1983 5 372 1371 15V - 948 6A 6375 2750 18C 6549 4810 6B 6798 7229 19A 5131 1879 7F 2872 2508 19F 5197 5089 8 - 2016 22F 55 6676 9V 2026 2081 23F 2064 1347 10A - 1049 33F - 2606

All serotypes showed an excellent level of functional immunogenicity. Serotypes in PCV20-15TT shared by PCV20-15TT and PREVNAR13 showed functional immunogenicity equivalent to or better than in PREVNAR13, and each of the newly added serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F also showed a high level of functional immunogenicity.

Although one or more illustrative embodiments have been given in the description, those skilled in the art will appreciate that various changes in form and detail may be made therein without departing from the spirit and scope of the inventive concept defined by the following claims.

Links.

The following sources are cited in the application and contain general information relating to the technical field, as well as analyzes and other details discussed in the application. The following sources are incorporated into the application by reference in their entirety.

1. Prymula et al., Lancet, 367:740-48 (2006).

2. Vesikari et al., PIDJ, 28(4):S66-76 (2009).

3. Dagan et al., Infection & Immunity, 5383-91 (2004).

4. Juergens et al., Clinical and Vaccine Immunology, 21(9):1277-1281 (2014).

5. Andrews et al., Lancet, 14:839-846 (2014).

6. Nurkka et al., Vaccine, 20:194-201 (2001).

7. Levin and Stone, J. Immunology, 67:235-242 (1951).

8.W.H.O. Manual for the Production and Control of Vaccines: Tetanus Toxoid, 1977 (BLG/UNDP/77.2 Rev.I.).

9. Didierlaurent et al., J. Immunol., 183:6186-6197 (2009).

Claims (18)

CLAIM 1. A mixed carrier polyvalent pneumococcal conjugate composition comprising 20 different pneumococcal capsular polysaccharide-protein conjugates, wherein each pneumococcal capsular polysaccharide-protein conjugate contains a carrier protein conjugated to a capsular polysaccharide from different serotypes of Streptococcus pneumoniae, wherein the serotypes of Streptococcus pneumoniae are selected from 1, 3, 4, 5, 6A, 6V, 7F, 8, 9V, 10A, 11A, 12F, - 24 042219 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F, wherein the carrier protein is CRM197 or tetanus toxoid, wherein two of said capsular polysaccharides are conjugated to tetanus toxoid and the remaining capsular polysaccharides are conjugated to CRM197, and two capsular polysaccharides which are conjugated with tetanus toxoid are selected from the group consisting of serotypes 1, 3 and 5. 2. A polyvalent pneumococcal conjugate composition with a mixed carrier according to claim 1, characterized in that capsular polysaccharides from serotypes 1 and 5 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 3, 4, 6A, 6B, 7F, 8, 9V, 10A , 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM197. 3. A polyvalent pneumococcal conjugate composition with a mixed carrier according to claim 1, characterized in that capsular polysaccharides from serotypes 1 and 3 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 4, 5, 6A, 6B, 7F, 8, 9V, 10A , 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM197. 4. A polyvalent pneumococcal conjugate composition with a mixed carrier according to claim 1, characterized in that capsular polysaccharides from serotypes 3 and 5 are conjugated with tetanus toxoid, and capsular polysaccharides from serotypes 1, 4, 6A, 6B, 7F, 8, 9V, 10A , 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F are conjugated to CRM197. 5. A mixed carrier polyvalent pneumococcal conjugate composition according to any one of the preceding claims, further comprising an adjuvant. 6. A mixed carrier polyvalent pneumococcal conjugate composition according to claim 5, characterized in that the adjuvant is an aluminum-based adjuvant. 7. A mixed carrier polyvalent pneumococcal conjugate composition according to claim 6, characterized in that the adjuvant is selected from the group consisting of aluminum phosphate, aluminum sulfate and aluminum hydroxide. 8. A mixed carrier polyvalent pneumococcal conjugate composition according to claim 7, characterized in that the adjuvant is aluminum phosphate. 9. The use of a mixed carrier polyvalent pneumococcal conjugate composition according to any one of the preceding claims for prophylaxis against Streptococcus pneumoniae infection or disease caused by it in a subject. 10. A vaccine comprising a mixed carrier polyvalent pneumococcal conjugate composition according to any one of claims 1 to 8 and a pharmaceutically acceptable excipient. 11. A method for preventing Streptococcus pneumoniae infection or a disease caused by it in a subject, comprising administering a prophylactically effective amount of a mixed carrier polyvalent pneumococcal conjugate composition according to any one of claims 1 to 8 or a vaccine according to claim 10 to said subject. 12. The method of claim 11 wherein the subject is a human at least 50 years of age and the disease is pneumonia or invasive pneumococcal disease (IPD). 13. The method of claim 11 wherein the subject is a human at least 6 weeks of age and the disease is pneumonia, invasive pneumococcal disease (IPD) or acute otitis media (AOM). 14. The method of claim 13, wherein the subject is 6 weeks to 5 years old, 2 to 15 months old, or 6 to 17 years old. 15. The method of claim 11, wherein the subject is a human. 16. The method according to any one of claims 11 to 15, characterized in that the multivalent mixed carrier pneumococcal conjugate composition or vaccine is administered by intramuscular injection. 17. The method according to any one of claims 11-16, characterized in that the polyvalent mixed carrier pneumococcal conjugate composition or vaccine is administered as part of an immunization series. 18. Use according to claim 9, characterized in that the subject is a human.