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  • C12N7/00—Viruses; Bacteriophages; Compositions thereof; Preparation or purification thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/0016—Combination vaccines based on diphtheria-tetanus-pertussis
  • A61K39/0018—Combination vaccines based on acellular diphtheria-tetanus-pertussis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/02—Bacterial antigens
  • A61K39/0225—Spirochetes, e.g. Treponema, Leptospira, Borrelia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/02—Bacterial antigens
  • A61K39/09—Lactobacillales, e.g. aerococcus, enterococcus, lactobacillus, lactococcus, streptococcus
  • A61K39/092—Streptococcus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/12—Viral antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/12—Viral antigens
  • A61K39/145—Orthomyxoviridae, e.g. influenza virus
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/39—Medicinal preparations containing antigens or antibodies characterised by the immunostimulating additives, e.g. chemical adjuvants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/04—Immunostimulants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
  • A61K2039/541—Mucosal route
  • A61K2039/543—Mucosal route intranasal
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55505—Inorganic adjuvants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
  • A61K2039/55555—Liposomes; Vesicles, e.g. nanoparticles; Spheres, e.g. nanospheres; Polymers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
  • A61K2039/55561—CpG containing adjuvants; Oligonucleotide containing adjuvants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/60—Medicinal preparations containing antigens or antibodies characteristics by the carrier linked to the antigen
  • A61K2039/6031—Proteins
  • A61K2039/6068—Other bacterial proteins, e.g. OMP
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N2760/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA ssRNA viruses negative-sense
  • C12N2760/00011—Details
  • C12N2760/16011—Orthomyxoviridae
  • C12N2760/16111—Influenzavirus A, i.e. influenza A virus
  • C12N2760/16134—Use of virus or viral component as vaccine, e.g. live-attenuated or inactivated virus, VLP, viral protein
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• the present invention relates to an adjuvant composition comprising a polyoxyethylene ether or polyoxyethylene ester, in combination with a pharmaceutically acceptable excipient, and to a vaccine comprising such adjuvant compositions and antigen.
• the present invention relates to the use of polyoxyethylene ethers or esters in the manufacture of an adjuvant formulations, and vaccine formulations, and their use as medicaments.
• Mucosal vaccination for example intranasal and oral, may represent an easy and more convenient way of vaccination than traditional vaccination through systemic injection.
• the use of an injection to administer a vaccine dose is associated with a number of disadvantages, namely pain and irritation at the injection site following injection. These factors may lead to "needle-fear" which has been known to result in poor patient compliance for vaccination regimes.
• conventional systemic injections can be a source of infection in the region of the skin puncture.
• mucosal vaccination is attractive since it has been shown in animals that mucosal administration of antigens has a greater efficiency of inducing protective responses at mucosal surfaces, which is the route of entry of many pathogens.
• mucosal vaccination such as intranasal vaccination, may induce mucosal immunity not only in the nasal mucosa, but also in distant mucosal sites such as the genital mucosa (Mestecky, 1987, Journal of Clinical Immunology, 7, 265-276; McGhee and Kiyono, Infectious Agents and Disease, 1993, 2, 55-73).
• this vaccination route will have to be able to induce systemic immunological responses at least as efficiently as those induced by injection. While it has been reported that certain antigens when administered via this route are able to induce systemic responses (Cahill et ⁇ /.,1993, FEMS Microbiology Letters, 107, 211-216), most soluble antigens given intranasally by themselves induce little or no immune response.
• a number of authors have investigated potential mucosal adjuvants to overcome this problem, which exert their adjuvant activity through various mechanisms including: encapsulation of the antigen (e.g. liposomes and microparticles); or via direct interaction with, and subsequent release of immunostimulatory cytokines from, target cells (e.g. cholera toxin and E.coli heat-labile toxin); or by enhancing the uptake of antigen across the epithelium (e.g. cholera toxin).
• target cells e.g. cholera toxin and E.coli heat-labile toxin
• enhancing the uptake of antigen across the epithelium e.g. cholera toxin
• the applicant presents here the surprising finding that polyoxyethylene ethers and polyoxyethylene esters act as a potent adjuvants for vaccines.
• the adjuvants of the present invention are safe, easily sterilisable, and simple to administer.
• Such compositions are sufficient to induce systemic immune responses when administered mucosally, which are at least as high as those observed after conventional systemic injection of the vaccine.
• Polyoxyethylene ethers such as polyoxyethylene lauryl ether are described in the Merck index (12 th ed: entry 7717), where therapeutic uses are stated to include: topical anesthetic; anti-pruritic; and sclerosing agent activities.
• polyoxyethylene ethers, or esters are non-ionic surfactants.
• non-ionic surfactants have been utilised in vaccine formulations. It has been reported that vaccine preparations comprising an admixture of either polyoxyethylene castor oil or caprylic/capric acid glycerides, with polyoxyethylene sorbitan monoesters, and an antigen, are capable of inducing systemic immune responses after topical administration to a mucosal membrane (WO 9417827).
• This patent application discloses the combination of TWEEN20TM (polyoxyethylene sorbitan monoester) and Imwitor742TM (caprylic/capric acid glycerides), or a combination of TWEEN20TM and polyoxyethylene castor oil is able to enhance the systemic immune response following intranasal immunisation.
• Novasomes (US 5, 147,725) are paucilamenar vesicular structures comprising
• Polyoxyethylene ethers and cholesterol encapsulate the antigen and are capable of adjuvanting the immune response to antigens after systemic administration.
• Surfactants have also been formulated in such a way as to form non-ionic surfactant vesicles (commonly known as neosomes, WO 95/09651).
• neosomes commonly known as neosomes, WO 95/09651.
• Such vesicles in the presence of cholesterol form lipid-bilayer vesicles which are capable of entrapping antigen within the inner aqueous phase or within the bilayer itself.
• one embodiment of the present invention provides for an adjuvant formulation comprising a surfactant of formula (I), O 99/52549
• Another embodiment of the present invention takes the form of a vaccine adjuvant comprising a surfactant of formula (I), formulated in the absence of cholesterol.
• Vaccines and adjuvant formulations of the present invention comprise molecules of general formula (I): HO(CH 2 CH 2 O) n -A-R wherein, n is 1-50, A is a bond or -C(O)-, R is C,. 50 alkyl or Phenyl C,. J0 alkyl.
• One embodiment of the present invention consists of a vaccine formulation comprising a polyoxyethylene ether of general formula (I), wherein n is between 1 and 50, preferably 4-24, most preferably 9; the R component is C ⁇ o, preferably C 4 -C 20 alkyl and most preferably C I2 alkyl, and A is a bond.
• the concentration of the polyoxyethylene ethers should be in the range 0.1-20%, preferably from 0.1-10%, and most preferably in the range 0.1-1%.
• Preferred polyoxyethylene ethers are selected from the following group: polyoxyethylene-9-lauryl ether, polyoxyethylene-9-steoryl ether, polyoxyethylene-8-steoryl ether, polyoxyethylene-4-lauryl ether, polyoxyethylene-35-lauryl ether, and polyoxyethylene-23-lauryl ether.
• a further embodiment of the present invention consists of a vaccine composition
• a polyoxyethylene ester of general formula (I) wherein n is between 1 and 50, preferably 4-24, most preferably 9; R is C,. J0 , preferably C 4 to C 20 alkyl and most preferably C 12 alkyl, and A is -C(O)-.
• concentration of the polyoxyethylene ester should be in the range 0.1-20%, preferably from 0.1-10%, and most preferably in the range 0.1-1%.
• Preferred polyoxyethylene esters are selected from the following group: polyoxyethylene-9-lauryl esters, polyoxyethylene-9-steoryl esters, polyoxyethylene-8-steoryl esters, polyoxyethylene-4-lauryl esters, polyoxyethylene- 35-lauryl esters, and polyoxyethylene-23-lauryl esters.
• vaccine compositions comprising polyoxyethylene phenyl ethers of general formula (I), wherein n is
• R is C,. 50 phenyl alkyl, preferably C 4 - C 20 phenyl alkyl, and most preferably C 12 phenyl alkyl, and A is a bond.
• concentration of the polyoxyethylene ethers should preferably be in the range 0.1-10%, and most preferably in the range 0.25-1%.
• the vaccine preparations of the present invention may be used to protect or treat a mammal susceptible to, or suffering from disease, by means of administering said vaccine via a mucosal route, such as the oral/bucal/intestinal/vaginal rectal or nasal route. Such administration may be in a droplet, spray, or dry powdered form. Nebulised or aerosolised vaccine formulations also form part of this invention. Enteric formulations such as gastro resistant capsules and granules for oral administration, suppositories for rectal or vaginal adrr ⁇ iistration also form part of this invention.
• the present invention may also be used to enhance the immunogenicity of antigens applied to the skin (transdermal or transcutaneous delivery).
• the adjuvants of the present invention may be parentally delivered, for example intramuscular, or subcutaneous administration, characterised in that the adjuvants are not in the form of a vesicle.
• an adjuvant for use in mucosal vaccine formulations.
• Such adjuvants are well tolerated in humans and are potent in their induction of systemic immune responses.
• the adjuvants of the present invention may take the form of a solution, or non- vesicular solution or suspension, and as such do not have any of the problems associated with the manufacture, stability, uniformity, and quality control of particulate adjuvant systems. These formulations are potent adjuvants and also exhibit low reactogenicity and are well tolerated by patients.
• the polyoxyethylene ethers of the present invention have haemolytic activity.
• the haemolytic activity of a polyoxyethylene ether may be measured in vitro, with reference to the following assay, and is as expressed as the highest concentration of the detergent which fails to cause lysis of the red blood cells: 1. Fresh blood from guinea pigs is washed with phosphate buffered saline (PBS)
• the polyoxyethylene ethers, or surfactants of general formula (I), of the present invention preferably have a haemolytic activity, of approximately between 0.5-0.0001 %, more preferably between 0.05-0.0001%, even more preferably between 0.005-0.0001%, and most preferably between 0.003-0.0004%.
• said polyoxyethylene ethers or esters should have a haemolytic activity similar (i.e. within a ten-fold difference) to that of either polyoxyethylene-9 lauryl ether or polyoxyethylene-8 steoryl ether.
• the ratio of the length of the polyoxyethylene section to the length of the alkyl chain in the surfactant affects the solubility of this class of detergent in an aqueous medium.
• the adjuvants of the present invention may be in solution or may form particulate structures such as micelles.
• the adjuvants of the present invention are because of their non- vesicular nature are clear and not cloudy or opaque, stable and are easily sterilisable by filtration through a 220 nm membrane, and are manufactured in a easy and controlled fashion.
• Vaccines of the present invention may take the form of a non- vesicular solution or suspension of polyoxyethylene ether or ester of general formula (I) in a pharmaceutically acceptable excipient, such as PBS or water, and an antigen or antigenic preparation.
• a vaccine formulation may then be applied to a mucosal surface of a mammal in either a priming or boosting vaccination regime; or alternatively be administered systemically, for example via the transdermal, subcutaneous or intramuscular routes.
• CT and LT are heterodimers consisting of a pentameric ring of ⁇ - subunits, cradling a toxic A subunit. Their structure and biological activity are disclosed in Clements and Finklestein, 1979, Infection and Immunity, 24:760-769; Clements et al., 1980, Infection and Immunity, 24:91-97.
• mLT(Rl 92G) is rendered insuceptible to proteolytic cleavage by a substitution of the amino acid arginine with glycine at position 192, and has been shown to have a greatly reduced toxicity whilst retairiing its potent adjuvant activity.
• mLT(R192G) is, therefore, termed a proteolytic site mutant. Methods for the manufacture of mLT(R192G) are disclosed in the patent application WO 96/06627.
• mutant forms of LT include the active site mutants such as mLT(A69G) which contain a substitution of an glycine for an alanine in position 69 of the LTA sequence.
• active site mutants such as mLT(A69G) which contain a substitution of an glycine for an alanine in position 69 of the LTA sequence.
• mLT(R192G) as a mucosal vaccine is described in patent application WO 96/06627.
• Such adjuvants may be advantageously combined with the non- ionic surfactants of the present invention.
• the polyoxyethylene ether, or ester will further be combined with other adjuvants or immunostimulants including Cholera toxin and its B subunit, Monophosphoryl Lipid A and its non-toxic derivative 3-de-O-acylated monophosphoryl lipid A (as described in UK patent no. GB 2,220,211 ), saponins such as Quil A (derived from the bark of the South American tree Quillaja Saponaria Molina), and fractions thereof, including QS21 and QS17 (US 5,057,540; Kensil, C.
• adjuvants or immunostimulants including Cholera toxin and its B subunit, Monophosphoryl Lipid A and its non-toxic derivative 3-de-O-acylated monophosphoryl lipid A (as described in UK patent no. GB 2,220,211 ), saponins such as Quil A (derived from the bark of the South American tree Quillaja Saponaria Molina), and fractions thereof, including QS21 and QS17 (US 5,057,
• oligonucleotide adjuvant system containing an unmethylated CpG dinucleotide (as described in WO 96/02555).
• a particularly preferred immunostimulant used in conjunction with POE is CpG immunostimulatory oligonucleotide, which formulations are potent in the induction and boosting of immune responses in larger animals.
• Preferred oligonucleotides have the following sequences: The sequences preferably contain all phosphorothioate modified internucleotide linkages. OLIGO 1 : TCC ATG ACG TTC CTG ACG TT
• OLIGO 2 TCT CCC AGC GTG CGC CAT OLIGO 3: ACC GAT GAC GTC GCC GGT GAC GGC ACC ACG
• the CpG oligonucleotides utilised in the present invention may be synthesized by any method known in the art (eg EP 468520). Conveniently, such oligonucleotides may be synthesized utilising an automated synthesizer.
• polyoxyethylene ethers or esters may be combined with vaccine vehicles composed of chitosan or other polycationic polymers, polylactide and polylactide-co- glycolide particles, particles composed of polysaccharides or chemically modified polysaccharides, cholesterol-free liposomes and lipid-based particles, oil in water emulsions (WO 95/17210), particles composed of glycerol monoesters, etc.
• the polyoxyethylene ethers or esters may also be admixed with powdered excipients such as lactose containing antigen which can be administered as a dry powder.
• Adjuvants of the present invention comprise the surfactants: polyoxyethylene ethers or esters wherein the polyoxyethylene ethers or esters are not present in the form of vesicles. Accordingly, the present invention includes the use of polyoxyethylene ethers and esters of general formula (I) in the manufacture of adjuvant compositions and vaccines, wherein the surfactant of general formula (I) is not present in a vesicular form.
• the vaccine formulations of the present invention contain an antigen or antigenic composition capable of eliciting an immune response against a human pathogen, which antigen or antigenic composition is derived from HIV-1, (such as tat, nef, gpl20 or gpl60), human herpes viruses, such as gD or derivatives thereof or Immediate Early protein such as ICP27 from HSVl or HSV2, cytomegalo virus ((esp Human)(such as gB or derivatives thereof), Rotavirus (including live-attenuated viruses), Epstein Barr virus (such as gp350 or derivatives thereof), Varicella Zoster Virus (such as gpl, II and IE63), or from a hepatitis virus such as hepatitis B virus (for example Hepatitis B Surface antigen or a derivative thereof), hepatitis A virus, hepatitis C virus and hepatitis E virus, or from other viral pathogens, such as paramyxo
• Influenza virus whole live or inactivated virus, split influenza virus, grown in eggs or MDCK cells, or Vero cells or whole flu virosomes (as described by R. Gluck, Vaccine, 1992, 10, 915-920) or purified or recombinant proteins thereof, such as HA, NP, NA, or M proteins, or combinations thereof), or derived from bacterial pathogens such as Neisseria spp, including N. gonorrhea and N.
• meningitidis for example capsular polysaccharides and conjugates thereof, transferrin-binding proteins, lactoferrin binding proteins, PilC, adhesins
• S. pyogenes for example M proteins or fragments thereof, C5A protease, lipoteichoic acids
• S. agalactiae S. mutans
• H. ducreyi Moraxella spp, including M catarrhalis, also known as Branhamella catarrhalis (for example high and low molecular weight adhesins and invasins ⁇ " Bordetella spp, including B.
• pertussis for example pertactin, pertussis toxin or derivatives thereof, filamenteous hemagglutinin, adenylate cyclase, fimbriae), B. parapertussis and B. bronchiseptica; Mycobacterium spp., including M. tuberculosis (for example ESAT6, Antigen 85A, -B or -C), M. bovis, M. leprae, M. avium, M. paratuberculosis, M. smegmatis; Legionella spp, including L. pneumophila; Escherichia spp, including enterotoxic E.
• M. tuberculosis for example ESAT6, Antigen 85A, -B or -C
• M. bovis for example ESAT6, Antigen 85A, -B or -C
• M. bovis for example ESAT6, Antigen 85A, -B or -C
• M. bovis for example ESAT6,
• coli for example colonization factors, heat-labile toxin or derivatives thereof, heat-stable toxin or derivatives thereof), enterohemorragic E. coli, enteropathogenic E. coli (for example shiga toxin-like toxin or derivatives thereof); Vibrio spp, including V. cholera (for example cholera toxin or derivatives thereof); Shigella spp, including S. sonnei, S. dysenteriae, S. flexnerii; Yersinia spp, including Y. enterocolitica (for example a Yop protein) , Y. pestis, Y. pseudotuberculosis; Campylobacter spp, including C.
• V. cholera for example cholera toxin or derivatives thereof
• Shigella spp including S. sonnei, S. dysenteriae, S. flexnerii
• Yersinia spp including Y. enterocolitica (for example
• jejuni for example toxins, adhesins and invasins
• C. coli Salmonella spp, including S. typhi, S. paratyphi, S. choleraesuis, S. enteritidis
• Listeria spp. including L. monocytogenes
• Helicobacter spp including H. pylori (for example urease, catalase, vacuolating toxin); Pseudomonas spp, including P. aeruginosa; Staphylococcus spp., including S. aureus, S. epidermidis; Enterococcus spp., including E. faecalis, E.
• Clostridium spp. including C. tetani (for example tetanus toxin and derivative thereof), C. botulinum (for example botulinum toxin and derivative thereof), C. difficile (for example clostridium toxins A or B and derivatives thereof); Bacillus spp., including B. anthracis (for example botulinum toxin and derivatives thereof); Corynebacterium spp., including C. diphtheriae (for example diphtheria toxin and derivatives thereof); Borrelia spp., including B. burgdorferi (for example OspA, OspC, DbpA, DbpB), B.
• garinii for example OspA, OspC, DbpA, DbpB
• B. afzelii for example OspA, OspC, DbpA, DbpB
• B. andersonii for example OspA, OspC, DbpA, DbpB
• B. hermsii for example E. equi and the agent of the Human Granulocytic Ehrlichiosis
• Rickettsia spp including R. rickettsii
• Chlamydia spp. including C. trachomatis (for example MOMP, heparin-binding proteins), C.
• pneumoniae for example MOMP, heparin-binding proteins,), C. psittaci; Leptospira spp., including L. interrogans; Treponema spp., including T. pallidum (for example the rare outer membrane proteins), T. denticola, T. hyodysenteriae; or derived from parasites such as Plasmodium spp., including P. falciparum; Toxoplasma spp., including T. gondii (for example SAG2, SAG3, Tg34); Entamoeba spp., including E. histolytica; Babesia spp., including B.
• Preferred bacterial vaccines comprise antigens derived from Streptococcus spp, including S. pneumoniae (for example capsular polysaccharides and conjugates thereof, PsaA, PspA, streptolysin, choline-binding proteins)and the protein antigen Pneumolysin (Biochem Biophys Acta, 1989, 67, 1007; Rubins et al., Microbial
• H. influenzae type B for example PRP and conjugates thereof
• non typeable H. influenzae for example OMP26
• high molecular weight adhesins for example P5, P6, protein D and lipoprotein D
• fimbrin and fimbrin derived peptides US 5,843,464
• bacterial vaccines comprise antigens derived from Morexella Catarrhalis (including outer membrane vesicles thereof, and OMP106 (WO97/41731)) and from Neisseria mengitidis B (including outer membrane vesicles thereof, and NspA (WO 96/29412).
• the vaccine formulation of the invention comprises the HIV-1 antigen, gpl20, especially when expressed in CHO cells.
• the vaccine formulation of the invention comprises gD2t as hereinabove defined.
• vaccines containing the claimed adjuvant comprise antigen derived from the Human Papilloma Virus (HPV) considered to be responsible for genital warts, ( ⁇ PV 6 or HPV 11 and others), and the HPV viruses responsible for cervical cancer (HPV 16, HPV 18 and others).
• HPV Human Papilloma Virus
• Particularly preferred forms of genital wart prophylactic, or therapeutic, vaccine comprise LI particles or capsomers, and fusion proteins comprising one or more antigens selected from the HPV 6 and HPV 1 1 proteins E6, E7, LI, and L2.
• fusion protein 1 1
• the most preferred forms of fusion protein are: L2E7 as disclosed in WO 96/26277, and proteinD(l/3)-E7 disclosed in GB 9717953.5 (PCT/EP98/05285).
• a preferred HPV cervical infection or cancer, prophylaxis or therapeutic vaccine, composition may comprise HPV 16 or 18 antigens.
• HPV 16 or 18 antigens For example, LI or L2 antigen monomers, or LI or L2 antigens presented together as a virus like particle (VLP) or the LI alone protein presented alone in a VLP or capsomer structure.
• VLP virus like particle
• antigens, virus like particles and capsomer are per se known. See for example WO94/00152, WO94/20137, WO94/05792, and WO93/02184.
• Additional early proteins may be included alone or as fusion proteins such as preferably E7, E2 or E5 for example; particularly preferred embodiments of this includes a VLP comprising L1E7 fusion proteins (WO 96/11272).
• HPV 16 antigens comprise the early proteins E6 or E7 in fusion with a protein D carrier to form Protein D - E6 or E7 fusions from HPV 16, or combinations thereof; or combinations of E6 or E7 with L2 (WO 96/26277).
• HPV 16 or 18 early proteins E6 and E7 may be presented in a single molecule, preferably a Protein D- E6/E7 fusion.
• Such vaccine may optionally contain either or both E6 and E7 proteins from HPV 18, preferably in the form of a Protein D - E6 or Protein D - E7 fusion protein or Protein D E6 E7 fusion protein.
• the vaccine of the present invention may additionally comprise antigens from other HPV strains, preferably from strains HPV 6, 11, 31, 33, or 45.
• Vaccines of the present invention further comprise antigens derived from parasites that cause Malaria.
• preferred antigens from Plasmodia falciparum include RTS,S and TRAP.
• RTS is a hybrid protein comprising substantially all the C- terminal portion of the circumsporozoite (CS) protein of P. falciparum linked via four
• a preferred embodiment of the present invention is a Malaria vaccine wherein the antigenic preparation comprises a combination of the RTS,S and TRAP antigens.
• Other plasmodia antigens that are likely candidates to be components of a multistage Malaria vaccine are P.faciparum MSP1, AMA1, MSP3, EBA, GLURP, RAP1, RAP2, Sequestrin, PfEMPl, PD32, LSA1, LSA3, STARP, SALSA, PfEXPl, Pfs25, Pfs28, PFS27/25, Pfsl6, Pfs48/45, Pfs230 and their analogues in Plasmodium spp.
• the formulations may also contain an anti-tumour antigen and be useful for the immunotherapeutic treatment cancers.
• the adjuvant formulation finds utility with tumour rejection antigens such as those for prostrate, breast, colorectal, lung, pancreatic, renal or melanoma cancers.
• exemplary antigens include MAGE 1 and MAGE 3 or other MAGE antigens for the treatment of melanoma, PRAME,
• a vaccine comprising an adjuvant composition according to the invention and a tumour rejection antigen.
• said antigen may be a self peptide hormone such as whole length Gonadotrophin hormone releasing hormone (GnRH, WO 95/20600), a short 10 amino acid long peptide, in the treatment of many cancers, or in immunocastration.
• GnRH Gonadotrophin hormone releasing hormone
• a short 10 amino acid long peptide in the treatment of many cancers, or in immunocastration.
• compositions of the present invention will be used to formulate vaccines containing antigens derived from Borrelia sp.
• antigens may include nucleic acid, pathogen derived antigen or antigenic preparations, recombinantly produced protein or peptides, and chimeric fusion proteins.
• the antigen is OspA.
• the OspA may be a full mature protein in a lipidated form virtue of the host cell (E.Coli) termed (Lipo-OspA) or a non-lipidated derivative.
• non-lipidated derivatives include the non-lipidated NSl-OspA fusion protein which has the first 81 N-terminal amino acids of the non-structural protein (NS1) of the influenza virus, and the complete OspA protein, and another, MDP-OspA is a non- lipidated form of OspA carrying 3 additional N-terminal amino acids.
• NS1 non-structural protein
• MDP-OspA is a non- lipidated form of OspA carrying 3 additional N-terminal amino acids.
• Vaccines of the present invention may be used for the prophylaxis or therapy of allergy.
• Such vaccines would comprise allergen specific (for example Der pi) and allergen non-specific antigens (for example peptides derived from human IgE, including but not restricted to the stanworth decapeptide (EP 0 477 231 Bl)).
• each vaccine dose is selected as an amount which induces an immunoprotective response without significant, adverse side effects in typical vaccinees. Such amount will vary depending upon which specific immunogen is employed and how it is presented. Generally, it is expected that each dose will comprise 1 - 1000 ⁇ g of protein, preferably 1 -500 ⁇ g, preferably 1 - 1 OO ⁇ g, most preferably 1 to 50 ⁇ g.
• An optimal amount for a particular vaccine can be ascertained by standard studies involving observation of appropriate immune responses in subjects. Following an initial vaccination, subjects may receive one or several booster immunisation adequately spaced.
• compositions of the present invention will be used to formulate vaccines containing antigens derived from a wide variety of sources.
• antigens may include human, bacterial, or viral nucleic acid, pathogen derived antigen or antigenic preparations, tumour derived antigen or antigenic preparations, host- derived antigens, including GnRH and IgE peptides, recombinantly produced protein or peptides, and chimeric fusion proteins.
• the vaccines of the present invention may also be administered via the oral route.
• the pharmaceutically acceptible excipient may also include alkaline buffers, or enteric capsules or microgranules.
• the vaccines of the present invention may also be administered by the vaginal route.
• the pharmaceutically acceptable excipients may also include emulsifiers, polymers such as CARBOPOL ® , and other known stablilisers of vaginal creams and suppositories.
• the vaccines of the present invention may also be administered by the rectal route. In such cases the excipients may also include waxes and polymers known in the art for forming rectal suppositories.
• the formulations of the present invention maybe used for both prophylactic and therapeutic purposes. Accordingly, the present invention provides for a method of treating a mammal susceptible to or suffering from an infectious disease or cancer, or allergy, or autoimmune disease. In a further aspect of the present invention there is provided a vaccine as herein described for use in medicine. Vaccine preparation is generally described in New Trends and Developments in Vaccines, edited by Voller et al., University Park Press, Baltimore, Maryland, U.S.A. 1978.
• the present invention relates to the use of polyoxyethylene ethers or esters of general formula (I) in the manufacture of an adjuvant formulation, comprising a surfactant of formula (I) and a pharmaceutically acceptable excipient.
• the present invention relates to the use of polyoxyethylene ethers or esters of general formula (I) in the manufacture of vaccine formulation, comprising a surfactant of formula (I) and a pharmaceutically acceptable excipient and an antigen.
• the present invention also
• 15 relates to the use of polyoxyethylene ethers or esters of general formula (I) in the manufacture of an adjuvant formulation or vaccine, as described above, wherein the formulation does not contain cholesterol.
• the present invention further provides the use of polyoxyethylene ethers or esters of general formula (I) in the manufacture of an adjuvant formulation or vaccine, as described above, wherein the formulation is a non-vesicular solution or suspension.
• Suitable pharmaceutically acceptable excipients include water, phosphate buffered saline, isotonic buffer solutions.
• polyoxyethylene lauryl ether Alternative terms or names for polyoxyethylene lauryl ether are disclosed in the CAS registry.
• the CAS registry number of polyoxyethylene lauryl ether is: CAS REGISTRY NUMBER: 9002-92-0
• Example 1 Techniques used to measure antigen specific antibody (Ab) responses .
• ELISA for the measurement of QspA-specific serum IgG Maxisorp Nunc immunoplates are coated overnight at 4°C with 50 ⁇ l/well of 1 ⁇ g/ml of antigen OspA diluted in PBS (in rows B to H of plate), or with 50 ⁇ l of 5 ⁇ g/ml purified goat anti-mouse Ig (Boerhinger), in PBS (row A). Free sites on the plates were blocked (1 hour, 37°C) using saturation buffer : PBS comtaining 1%BSA, 0.1% polyoxyethylene sorbitan monolaurate (TWEEN 20), and 4% Normal Bovine Serum (NBS).
• saturation buffer PBS comtaining 1%BSA, 0.1% polyoxyethylene sorbitan monolaurate (TWEEN 20), and 4% Normal Bovine Serum (NBS).
• Anti-TT, anti-FHA and anti-influenza IgG titres were measured using a similar technique, by replacing the OspA coating antigen with either TT, FHA, or whole influenza antigen.
• TT was supplied by a commercially available source (Behring).
• FHA was produced and purified by methods described in EP 0 427 462 B.
• Anti-influenza immunoglobulin titres were measured using a similar technique, by replacing the OspA coating antigen with whole influenza virus antigen, inactivated with ⁇ -propiolactone (BPL), supplied by SSD GmBH manufacturer (Dresden, Germany).
• BPL ⁇ -propiolactone
• LA2 is a murine monoclonal antibody which recognizes a conformational OspA epitope at the surface of the bacteria and has been shown to be able to kill B. burgdorferi in vitro, as well as to protect mice against a challenge with laboratory- grown spirochete (Schaible UE et al. 1990. Proc Natl Acad Sci USA 87:3768-3772).
• LA-2 mab has been shown to correlate with bactericidal antibodies, and studies on human sera showed also a good correlation between the total anti-OspA IgG titers and the LA-2 titers (as measured by ELISA).
• LA2 mAb-peroxidase conjugate (1/10,000) diluted in saturation buffer was added to each well (50 ⁇ l/well) and incubated for lhr at 37°C. After 5 washings, plates are incubated for 20 min at room temperature (in darkness) with 50 ⁇ l well of revelation buffer (OPDA 0.4 mg/ml and H 2 O 2 0.03% in 50mM pH 4.5 citrate buffer). The reaction and colour formation was stopped with H 2 SO 4 2N. Optical densities are read at 492 and 630 nm by using Biorad 3550 immunoreader. L A2-like Ab titers are calculated by the 4 parameter mathematical method using
• mice Female Balb/c mice (8 animals per group) aged 8 weeks were immunised intramuscularly with 1 ⁇ g of the antigen lipo-OspA on 50 ⁇ g alum. After 3 months the mice were boosted intranasally (under anesthesia) with 10 ⁇ l of solution (5 ⁇ l per nostril, delivered as droplets by pipette) containing either A: 5 ⁇ g lipo-OspA; B: 5 ⁇ g lipo-OspA in 36 % tween-20, 10% Imwitor 742 ; C: 5 ⁇ g lipo-OspA in 36 % tween- 20; D: 5 ⁇ g lipo-OspA in 18% polyoxyethylene-9 lauryl ether.
• A 5 ⁇ g lipo-OspA
• B 5 ⁇ g lipo-OspA in 36 % tween-20, 10% Imwitor 742
• C 5 ⁇ g lipo-OspA in 36 % twe
• mice were primed as described in example 2. The mice were then boosted (using the method described in example 2) with 5 ⁇ g lipo-OspA alone (group A and C) or in the presence of B: 1 % sodium taurocholic acid; D: 1% dodecyl-maltoside; E: 36% tween 20 or F: 18% polyoxyethylene-9 lauryl ether. Since the experiment with groups A and B was performed at a different moment to that with groups C,D,E and F they are separated on the figures below (see figure 3). It is clear that 1% sodium taurocholate does not significantly adjuvant the boost above that obtained with the antigen alone.
• Dodecyl-maltoside at 1%, or tween-20 at 36% provide a slight adjuvant effect, but only polyoxyethylene-9 lauryl ether provides a very significant enhancement of the IgG response. A similar effect is observed for the LA2 response (see figure 4).
• mice primed as in example 1 were boosted intranasally with 10 ⁇ l containing 5 ⁇ g of lipo-OspA in either A: PBS; B: 1% polyoxyethylene-9 lauryl ether; C: 2% polyoxyethylene-9 lauryl ether; D: 5% polyoxyethylene-9 lauryl ether; E: 1% polyoxyethylene-23 lauryl ether or; F: 10 % polyoxyethylene-23 lauryl ether. 14 days after the boost the sera were analysed as in example 2.
• Figures 5 and 6, below, show that concentrations of polyoxyethylene-9 lauryl ether as low as 1% show a very significant enhancement of the immune response.
• Polyoxyethylene-23 -lauryl ether also significantly enhances the intranasal boost response.
• Example 5 Combination vaccine - intranasal boosting
• mice were primed intra-muscularly with the commercial DTPa vaccine (Diptheria, Tetanus, accular Pertussis vaccine: INFANRIXTM SmithKline Beecham, Belgium). The mice were primed once intramuscularly with 2 X 50 ⁇ l injections corresponding to 20% of the human dose.
• DTPa vaccine Diptheria, Tetanus, accular Pertussis vaccine: INFANRIXTM SmithKline Beecham, Belgium.
• the mice were primed once intramuscularly with 2 X 50 ⁇ l injections corresponding to 20% of the human dose.
• mice were boosted (as in example 2) intranasally with either tetanus toxoid (TT: 5 ⁇ g) or filamentous haemagglutinin (FHA: 5 ⁇ g) in A: PBS; B: 1% polyoxyethylene-9 lauryl ether; or; C: by intramuscular injection of the DTPa vaccine (2x50 ⁇ l). 14 days after the boosting the sera were analysed for their TT and FHA specific IgG. The titres are shown in figures 7 and 8.
• Lipo-OspA alone was able to boost the systemic response when administered intranasally to monkeys, but this boost is very significantly enhanced by the addition of 1% polyoxyethylene 9 lauryl ether.
• the titres obtained following intranasal boosting in the presence of polyoxyethylene 9 lauryl ether are also greater than those obtained following an intramuscular injection (group C).
• Example 7 Intranasal priming and boosting of AGMs
• African Green Monkeys (3 animals per group) were primed and boosted intranasally with 60 ⁇ g of lipo-OspA delivered in 200 ⁇ l (100 ⁇ l per nostril delivered with a bidose spray-device from Pfeiffer GmBH, Germany) of A: PBS; B: 1% polyoxyethylene-9 lauryl ether. 14 days after the boosting the sera were assayed for their Osp-A specific immunoglobulin.
• Figure 1 shows that when Lipo-OspA is not adjuvanted, no systemic immune response can be detected following intranasal
• Example 8 Intranasal adjuvant effect of CpG on the induction of systemic and nasal humoral immune responses to lipo OspA antigen in primates
• This model was designed to investigate the priming and boosting effect of polyoxyethylene-9 lauryl ether (POE-9LE), with and without additional immunostimulants, in a primate priming and boosting model. Serum and nasal immunoglobulin responses were measured.
• the immunostimulant used in this study was the CpG 1001 as described in example 9.
• African Green monkeys were primed and boosted intranasally at days 0 (pi) and 14 (pll).
• Vaccines were given using a bi-dose spray delivery system from the Pfeiffer company (100 ⁇ l in each nostril, under anesthesia). Formulations tested were:
• Ig Ab titers to lipo OspA were measured in sera collected at day 14 post-pll.
• Antigen-specific nasal IgA were measured using a very sensitive ELISA in nasal swabs collected at the same time, animals were considered positive when their IgA titres exceeded a pre-determined level which was significantly above background levels.
• Figure 12 shows the levels of serum anti-lipo-OspA immunoglobulin responses observed at day 14 post-pll.
• Lipo-OspA given as a priming and boosting formulation alone did not induce any detectable serum immunoglobulin. This response was not improved in the presence of CpG.
• a dose of 0.25 % and 0.5 % of POE-9 LE elicited greater immune responses that those observed after vaccination with CpG alone, although the 0.5% dose is much more efficient in this respect.
• the 0.25 % dose induces an Ab response similar in magnitude to that obtained with 0.5 % dose, indicating a synergistic effect of the CpG and POE components.
• Example 9 Intranasal adjuvant effect of CpG on the boosting of systemic humoral immune responses to lipo OspA antigen
• CpG is a known immunomodulatory oligonucleotide described in PCT WO 96/02555. The immune response boosted by these vaccine formulations
• the formulations were at least as high as those induced by conventional i.m. boosting vaccinations.
• the formulations were further compared to a well known intranasal adjuvant, the heat- labile enterotoxin from E.Coli (mLT).
• the CpG sequences used in this experiment were CpG 1001 (TCC ATG AGC TTC CTG ACG TT), CpG 1002 (TCT CCC AGC GTG CGC CAT), and the negative control the non-immunostimulatory sequence CpG 1005 (TCC ATG AGC TTC CTG AGC TT).
• mice were primed at day 0 by intramuscular administration of 100 ⁇ l vaccine containing 1 ⁇ g lipo OspA adsorbed on 50 ⁇ g aluminium hydroxyde.
• intranasal booster was given in 10 ⁇ l (5 ⁇ l in each nostril), by nasal drop administration with a micropipette under anesthesia.
• Groups of 6 mice were boosted either intranasally (i.n.) or intramuscularly (i.m.) with the following vaccine formulations:
• concentrations of polyoxyethylene-9 lauryl ether as low as 1% show a very significant enhancement of the immune response.
• concentration of polyoxyethylene-9 lauryl ether required to provide the nasal adjuvanticity observed in the previous examples a dose-range assay with lower doses was performed.
• Balb/c mice primed as in example 2 were boosted intranasally with 10 ⁇ l containing 5 ⁇ g of lipo-OspA in either A: PBS; B: 1% polyoxyethylene-9 lauryl ether; C: 0.5% polyoxyethylene-9 lauryl ether; D: 0.25% polyoxyethylene-9 lauryl ether; or; E: by intramuscular injection of l ⁇ g lipo-OspA adsorbed on 50 ⁇ g Alum. 14 days after the boost the sera were analyzed as in example 1.
• the Ab response reached is similar to that elicited by the parenteral vaccine.
• mice were primed intra-muscularly with classical monovalent split influenza vaccine. The mice were primed twice intramuscularly at days 0 and 14 with 100 ⁇ l injections containing 1.5 ⁇ g equivalent hemagglutinin A (HA) of A/Singapore/6/86 split monobulk.
• HA hemagglutinin A
• mice were boosted (as in example 2) intranasally with 1.5 ⁇ g equivalent HA of inactivated whole A/Singapore/6/86 virus in A: PBS; B: 1% polyoxyethylene-9 lauryl ether; or; C: by intramuscular injection of the split A/Singapore/6/86 vaccine (1.5 ⁇ g equivalent HA). 14 days after the boosting the sera were analyzed for their A/Singapore/6/86 virus-specific IgG.
• mice primed parenterally The mice were primed once subcutaneously with 100 ⁇ l injections containing S. pneumoniae PS 14 and PS 19 polysaccharides (1 ⁇ g each one) conjugated to the protein D carrier.
• mice Two months later, the mice were boosted intranasally (under anesthesia) with 40 ⁇ l of solution (10 ⁇ l per nostril at time 0 followed 30 minutes later by 10 ⁇ l per nostril again, delivered as droplets by pipette) containing 1 ⁇ g PS 14 and 1 ⁇ g PS 19 conjugates in either A: NaCl 150 mM pH 6.1; B: 1% polyoxyethylene-9 lauryl ether. 14 days after the boost the sera were assayed for their PS 14 and PS19-specific IgG Abs.
• the administration of PS 14 or PS 19 by itself induces a boosting response which is further enhanced by addition of polyoxyethylene-9 lauryl ether as an adjuvant.
• mice primed as in example 2 were boosted intranasally with 10 ⁇ l containing 5 ⁇ g of lipo-OspA in either A: PBS; B: 1% polyoxyethylene-9 lauryl ether; C: 1%
• Figures 22 and 23 show that polyoxyethylene-8 stearyl ether is as potent as polyoxyethylene-9 lauryl ether for enhancing the boosting response to the antigen. Ab titres reached with both polyoxyethylene ethers are similar to those elicited by the parenteral vaccine.

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