Classifications

• • 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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0043—Nose
• • 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
• • 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
  • A61P31/04—Antibacterial agents
• • 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
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
  • A61P31/14—Antivirals for RNA viruses
  • A61P31/16—Antivirals for RNA viruses for influenza or rhinoviruses
• • 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
  • A61P31/14—Antivirals for RNA viruses
  • A61P31/18—Antivirals for RNA viruses for HIV
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
• • 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
  • A61P37/08—Antiallergic agents

Definitions

• the present invention relates to a novel adjuvant system comprising a polyoxyethylene sorbitan ester surfactant in combination with an octoxynol.
• the present invention provides said novel adjuvants, vaccines comprising them, and methods for their manufacture and for their formulation into vaccines.
• the use of the adjuvants or vaccines of the present invention in the prophylaxis or therapy of disease is also provided.
• the adjuvants are particularly useful as mucosal adjuvants, but are also effective systemically.
• the adjuvants are especially useful in the context of influenza vaccines.
• mucosal vaccination is attractive since it has been shown in animals that mucosal administration of antigens has a greater efficiency in 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).
• safe and effective adjuvants which are suitable for use in humans, remain to be identified.
• the present invention provides a solution to this problem.
• non-ionic surfactant formulations have been utilised.
• 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 94/17827).
• This patent application discloses the combination of the non-ionic surfactant 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.
• Non-ionic surfactants have also been formulated in such a way as to form non-ionic surfactant vesicles (commonly known as NISV; US 5,679,355).
• NISV non-ionic surfactant vesicles
• Such formulations of non-ionic surfactants often in the presence of cholesterol, form lipid-bilayer vesicles which entrap antigen within the inner aqueous phase or within the bilayer itself.
• WO 96/36352 and US 5,653,987 describe a liquid pharmaceutical agent comprising at least two absorption enhancers and water, primarily for oral insulin delivery, wherein the amount of each absorption enhancing agent is present in a concentration of from 1 to 10 % w/w of the total formulation.
• Surfactants are commonly used in the formulation of oil emulsion adjuvants for systemic administration, and function to stabilise the oil droplets.
• polyoxyethylene sorbitan esters TWEENTM
• SPANTM sorbitan fatty acid esters
• Influenza virus vaccines have been prepared in the past by the use of Triton X-100 or a mixture of Tween and ether to split influenza virus. A clinical comparison of the systemic immunogenicity of the two splits shows that they are comparable (Gross et al. 1981. J. Clin Microbiol 14, 534-8). Other surfactants have also been investigated for their effect on the immunogenicity of the resulting split vaccine. In a comparative study of parenteral administration Mukhlis et al. (1984 Vaccine 2, 199-203) showed that whole virus was more immunogenic than detergent disrupted virus, but that between different detergents Triton X-100 and cetyl trimethyl ammonium bromide (CTAB) gave marginally more immunogenic splits than the detergent empigen.
• CTAB cetyl trimethyl ammonium bromide
• compositions may be administered systemically, but are sufficient to induce systemic immune responses when administered mucosally.
• the immune responses induced by mucosal administration of vaccines of the present invention may be at least as high as or at least comparable to those observed after a systemic injection of conventional vaccine.
• the present invention provides safe and potent adjuvants which are easy to manufacture, which may be administered either through mucosal or systemic routes.
• the invention provides an adjuvant which comprises a polyoxyethylene sorbitan ester and an octoxynol.
• the invention provides a vaccine comprising an adjuvant according to the invention, together with an antigen.
• a vaccine composition comprising an adjuvant according to the invention together with influenza virus antigen for administration to a mucosal surface, in particularly to the nasal mucosa.
• influenza virus antigen for administration to a mucosal surface, in particularly to the nasal mucosa.
• routes of administration and other possible antigens for use in a vaccine according to the invention which will be described below.
• Octoxynols and polyoxyethylene sorbitan esters are described in "Surfactant systems” Eds: Attwood and Florence (1983, Chapman and Hall).
• the octoxynol series including t-octylphenoxypolyethoxyethanol (TRITON X-100TM) is also described in Merck Index Entry 6858 (Page 1162, 12 th Edition, Merck & Co. Inc., Whitehouse Station, N.J., USA; ISBN 0911910-12-3).
• the polyoxyethylene sorbitan esters, including polyoxyethylene sorbitan monooleate (TWEEN80TM) are described in Merck Index Entry 7742 (Page 1308, 12 th Edition, Merck & Co. Inc., Whitehouse Station, N.J., USA; ISBN 0911910-12-3). Both may be manufactured using methods described therein, or purchased from commercial sources such as Sigma Inc.
• Preferred octoxynols for use in the adjuvants according to the invention include other non-ionic surfactants from the Triton series, such as Triton X-45, Triton X-102, Triton X-l 14, Triton X-165, Triton X-205, Triton X-305, Triton N-57, Triton N-101 and Triton N-128, but t-octylphenoxypolyethoxyethanol (Triton X-100) is particularly preferred.
• the adjuvants of the present invention comprise a polyoxyethylene sorbitan ester and an octoxynol.
• the octoxynol is t-octylphenoxypolyethoxyethanol (TRITON -X-100TM).
• the polyoxyethylene sorbitan ester is polyoxyethylene sorbitan monooleate (TWEEN80TM).
• the adjuvant according to the invention may advantageously further comprise a bile salt or a cholic acid derivative.
• the adjuvant may comprise a polyoxyethylene sorbitan ester such as polyoxyethylene sorbitan monooleate (Tween 80), an octoxynol such as t- octylphenoxy polyethoxyethanol (Triton X-100) and a bile salt or cholic acid derivative such as sodium deoxycholate or taurodeoxycholate.
• a polyoxyethylene sorbitan ester such as polyoxyethylene sorbitan monooleate (Tween 80)
• an octoxynol such as t- octylphenoxy polyethoxyethanol (Triton X-100)
• Triton X-100 t-octylphenoxy polyethoxyethanol
• sodium deoxycholate Triton X-100
• the total concentration of non-ionic surfactants present in the adjuvant formulation is less than 40%, more preferably up to about 20%.
• a preferred range is between about 0.001% to 20%, more preferably 0.01 to 10% and most preferably up to about 2% (w/v).
• the individual non-ionic surfactants have preferred concentrations in the final vaccine composition as follows: octyl-or nonylphenoxy polyethoxyethanols such as Triton X- 100 or other detergents in the Triton series: from 0.001% to 20%, preferably 0.001% to 10%), more preferably from 0.001 to 1% and most preferably 0.005 to 0.1% (w/v); polyoxyethylene sorbitan esters such as Tween 80: 0.01 to 1%, most preferably about 0.0% (w/v).
• octyl-or nonylphenoxy polyethoxyethanols such as Triton X- 100 or other detergents in the Triton series: from 0.001% to 20%, preferably 0.001% to 10%), more preferably from 0.001 to 1% and most preferably 0.005 to 0.1% (w/v); polyoxyethylene sorbitan esters such as Tween 80: 0.01 to 1%, most preferably about 0.0% (w/v).
• Tween 80TM 0.01 to 1%, most preferably about 0.1% (v/v);
• Triton X-100TM 0.001 to 0.1, most preferably 0.005 to 0.02 % (w/v).
• One aspect of the present invention is a vaccine formulation comprising a polyoxyethylene sorbitan ester surfactant in combination with an octoxynol, wherein the antigen present in the vaccine is not entrapped within a non-ionic surfactant vesicle.
• Inflluenza virus antigens for use in the vaccine according to the invention may be any form of influenza antigens suitable for raising an immune response, including live or inactivated whole virus, split virus, or subunit antigens prepared from whole virus or by recombinant means.
• Influenza virus for production of the antigen may be grown in embryonated eggs in a conventional process or the virus may be grown in tissue culture.
• Suitable cell substrates for tissue culture of influenza include for example dog kidney cells such as MDCK cells, cells from a clone of MDCK, or MDCK-like cells, monkey kidney cells such as AGMK cells including Vero cells, or any other cell type suitable for the production of influenza virus for vaccine purposes.
• Suitable cell substrates also include human cells e.g. MRC-5 cells. Suitable cell substrates are not limited to cell lines; for example primary cells such as chicken embryo fibroblasts are also included.
• an influenza virus antigen preparation which comprises split virus which has undergone a series of purification steps.
• the antigen preparation may be produced by a number of different commercially applicable processes, for example the split flu process described in patent no. DD 300 833 and DD 21 1 444, incorporated herein by reference.
• Commercially available split influenza vaccine includes FluarixTM which is sold by SmithKline Beecham.
• a preferred vaccine formulation according to the invention comprises egg or tissue culture derived influenza antigen, preferably split influenza antigen, together with a polyoxyethylene sorbitan ester and an octoxynol, optionally further comprising a bile salt or derivative of cholic acid.
• such a formulation comprises split influenza virus antigen, polyoxyethylene sorbitan monooleate (Tween 80), t- octylphenoxypolyethoxyethanol (Triton X-100) and sodium deoxycholate.
• the influenza vaccine according to the invention is preferably a multivalent influenza vaccine comprising two or more strains of influenza. Most preferably it is a trivalent vaccine comprising three strains.
• Conventional influenza vaccines comprise three strains of influenza, two A strains and one B strain.
• monovalent vaccines which may be useful for example in a pandemic situation, are not excluded from the invention.
• a monovalent, pandemic flu vaccine will most likely contain influenza antigen from a single A strain.
• the vaccine preparations of the present invention are preferably 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.
• 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 administration 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.
• the vaccines of the present invention are preferably haemolytic in nature
• a variety of administration devices may be used.
• a spray device such as the commercially available AccusprayTM (Becton Dickinson) may be used.
• Preferred spray devices for intranasal use are devices for which the performance of the device is not dependent upon the pressure applied by the user. These devices are known as pressure threshold devices. Liquid is released from the nozzle only when a threshold pressure is attained. These devices make it easier to achieve a consistent spray with a regular droplet size.
• Pressure threshold devices suitable for use with the present invention are known in the art and are described for example in WO 91/13281, EP 311 863 B and EP 516 636 B, incorporated herein by reference. Such devices are commercially available from Pfeiffer GmbH.
• Preferred intranasal devices produce droplets (measured using water as the liquid) in the range 1 to 200 ⁇ m, preferably 10 to 120 ⁇ m. Below lO ⁇ m there is a risk of inhalation, therefore it is desirable to have no more than about 5% of droplets below lO ⁇ m. Droplets above 120 ⁇ m do not spread as well as smaller droplets, so it is desirable to have no more than about 5% of droplets exceeding 120 ⁇ m.
• Bi-dose delivery is a further preferred feature of an intranasal delivery device for use with the vaccines according to the invention.
• Bi-dose devices contain two subdoses of a single vaccine dose, one sub-dose for administration to each nostril. Generally the two sub-doses are in a single chamber and the construction of the device allows the efficient delivery of a single sub-dose at a time.
• the invention provides in a further aspect a kit comprising an intranasal administration device as described herein containing a vaccine formulation according to the invention.
• the intranasal administration device is filled with an influenza vaccine.
• the adjuvant formulations of the present invention may also comprise a bile acid or a derivative thereof, particular in the form of a salt.
• a bile acid or a derivative thereof particular in the form of a salt.
• derivatives of cholic acid and salts thereof in particular sodium salts of cholic acid or cholic acid derivatives.
• bile acids and derivatives thereof include cholic acid, deoxycholic acid, chenodeoxycholic acid, lithocholic acid, ursodeoxycholic acid, hyodeoxycholic acid and derivatives such as glyco-, tauro-, amidopropyl- 1 -propanesulfonic-, amidopropyl-2-hydroxy- 1 -propanesulfonic derivatives of the aforementioned bile acids, or N,N-bis (3Dgluconoamidopropyl) deoxycholamide.
• NaDOC sodium deoxycholate
• the adjuvant formulations of the present invention are advantageous when in the form of an aqueous solution or a suspension of non-vesicular forms.
• Such formulations are easy to manufacture reproducibly, and also to sterilise (terminal filtration through a 450 or 220 nm pore membrane) and are easy to administer to the nasal mucosa in the form of a spray without degradation of the complex physical structure of the adjuvant.
• a method of preparing a vaccine which method comprises admixing an adjuvant according to the invention with an antigen.
• a method of inducing or enhancing an immune response in a subject comprising admixing the antigen and the adjuvant according to the invention, and administering said admixture to the subject.
• the route of administration to the subject is via a mucosal surface and more preferably via the nasal mucosa.
• the vaccine is preferably administered as a spray.
• a systemic response is induced by a nasal administration of the vaccine.
• a mucosal vaccine according to the invention is preferably capable of inducing a systemic immune response when administered via a mucosal route.
• the present invention further provides the use of a polyoxyethylene sorbitan ester, and an octoxynol in the manufacture of an adjuvant formulation, in particular an adjuvant formulation for application to the mucosa of a patient.
• the present invention also relates to the use of a polyoxyethylene sorbitan ester, an octoxynol and an antigen, in the manufacture of a vaccine formulation, especially a vaccine formulation for application to the mucosa.
• the antigen is influenza virus antigen.
• adjuvants and vaccines for administration to the nasal mucosa are particularly preferred.
• the administering of a vaccine according to the invention comprises the administration of a priming or a boosting dose of the vaccine, such as a priming or a boosting dose of influenza vaccine comprising an influenza antigen preparation.
• a priming or a boosting dose of influenza vaccine comprising an influenza antigen preparation.
• 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 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, gpl 20 or gpl 60), human herpes viruses, such as gD or derivatives thereof or Immediate Early protein such as ICP27 from HSV1 or HSV2, cytomegalovirus ((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.
• HA HA
• NP NP
• NA NP
• M proteins derived from bacterial pathogens
• 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.
• 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.
• M. tuberculosis for example ESAT6, Antigen 85A, -B or -C
• paratuberculosis M. smegmatis; Legionella spp, including L. pneumophila; Escherichia spp, including enterotoxic E. 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.
• enterotoxic E. coli for example colonization factors, heat-labile toxin or derivatives thereof, heat-stable toxin or derivatives thereof
• enterohemorragic E. coli enteropathogenic E. coli
• Vibrio spp including V.
• enterocolitica for example a Yop protein
• Y. pestis for example a Yop protein
• Campylobacter spp including C. jejuni (for example toxins, adhesins and invasins) and 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.
• 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; Ehrlichia spp., including E.
• B. burgdorferi for example OspA, OspC, DbpA, DbpB
• B. garinii for example OspA, OspC, DbpA, DbpB
• B. afzelii for example OspA, OspC, DbpA, D
• Plasmodium spp. including P.falciparum
• Toxoplasma spp. including T. gondii (for example SAG2, SAG3, Tg34); Entamoeba spp., including E. histolytica
• Babesia spp. including B. microti
• Trypanosoma spp. including T. cruzi
• Giardia spp. including G. lamblia
• Leshmania spp. including E major
• Pneumocystis spp. including P. carinii
• Trichomonas spp. including T. vaginalis
• Schisostoma spp. including S. mansoni, or derived from yeast such as Candida spp., including C. albicans
• Cryptococcus spp. including C. neoformans.
• 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 Pathogenesis, 25, 337-342), and mutant detoxified derivatives thereof (WO 90/06951; WO 99/03884).
• Other preferred bacterial vaccines comprise antigens derived from Haemophilus spp., including H. in ⁇ uenzae type B (for example PRP and conjugates thereof), non typeable H.
• in ⁇ uenzae for example OMP26, high molecular weight adhesins, P5, P6, protein D and lipoprotein D, and fimbrin and fimbrin derived peptides (US 5,843,464) or multiple copy varients or fusion proteins thereof.
• Other preferred bacterial vaccines comprise antigens derived from Moraxella 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, gpl 20, 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 1 1 and others), and the HPV viruses responsible for cervical cancer (HPV16, HPV18 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 11 proteins E6, E7, LI, and L2.
• fusion protein L2E7 as disclosed in WO 96/26277, and protein D(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 may 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 amino acids of the preS2 portion of Hepatitis B surface antigen to the surface (S) antigen of hepatitis B virus. Its full structure is disclosed in the International Patent Application No.
• 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.
• the formulations may alternatively contain an anti-tumour antigen and be useful for the immunotherapeutic treatment of 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, BAGE or GAGE (Robbins and Kawakami, 1996, Current Opinions in Immunology 8, pps 628-636; Van den Eynde et al., International Journal of Clinical & Laboratory Research (submitted 1997); Correale et al. (1997), Journal of the National Cancer Institute 89, p293.
• Tumor-Specific antigens are suitable for use with adjuvant of the present invention and include, but are not restricted to Prostate specific antigen (PSA) or Her- 2/neu, KSA (GA733), MUC-1 and carcinoembryonic antigen (CEA).
• PSA Prostate specific antigen
• KSA Her- 2/neu
• CEA carcinoembryonic antigen
• 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.
• 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 l-100 ⁇ 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.
• the vaccines of the present invention may also be administered via the oral route.
• the pharmaceutically acceptable excipient may also include antacid 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.
• the excipients may also include waxes and polymers known in the art for forming rectal suppositories.
• the formulations of the present invention may be 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 auto-immune disease. In a further aspect of the present invention there is provided an adjuvant combination and 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 adjuvant of the present invention may further be combined with other adjuvants 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), immunologically active saponin fractions e.g.
• Quil A derived from the bark of the South American tree Quillaja Saponaria Molina and derivatives thereof (for example QS21, US Patent No.5,057,540), and the oligonucleotide adjuvant system CpG (as described in WO 96/02555), especially 5 TCG TCG TTT TGT CGT TTT GTC GTT 3' (SEQ ID NO. 1).
• the present invention is illustrated by, but not limited to, the following examples.
• the concentrations of the Tween-80 and Triton X- 100 are shown in the examples.
• Example 1 Methods used to measure antibody (Ab) responses in sera
• ELISA for the measurement of influenza-specific serum Ig Abs Maxisorp Nunc immunoplates are coated overnight at 4°C with 50 ⁇ l/well of 1 ⁇ g/ml HA of ⁇ -propiolactone (BPL) inactivated influenza virus (supplied by SSD GmBH manufacturer, Dresden, Germany) diluted in PBS. Free sites on the plates are blocked (1 hour, 37°C) using saturation buffer: PBS containing 1%BSA, 0.1% polyoxyethylene sorbitan monolaurate (TWEEN 20).
• BPL ⁇ -propiolactone
• serial 2-fold dilutions in saturation buffer, 50 ⁇ l per well
• a reference serum added as a standard curve (serum having a mid-point titer expressed as ELISA Unit/ml, and put in row A ) and serum samples (starting at a 1/100 dilution and put in rows B to H) are incubated for lhr 30mins at 37°C.
• the plates are then washed ( ⁇ 3) with washing buffer (PBS, 0.1% polyoxyethylene sorbitan monolaurate (TWEEN 20)).
• biotinylated goat anti- human Ig (Amersham) diluted 1/3000 in saturation buffer are incubated (50 ⁇ l/well) for lhr 30mins, at 37°C. After 3 washings, and subsequent addition of streptavidin- horseradish peroxidase conjugate (Amersham), plates are washed 5 times and incubated for 20 min at room temperature with 50 ⁇ l/well of revelation buffer (OPDA 0.4 mg/ml (Sigma) and H 2 O 2 0.03% in 50mM pH 4.5 citrate buffer). Revelation is stopped by adding 50 ⁇ l/well H SO 4 2N. Optical densities are read at 492 and 630 nm by using Biorad 3550 immunoreader. Antibody titre are calculated by the 4 parameter mathematical method using SoftMaxPro software.
• HSD activity of Flu-specific serum Abs in mice Sera 25 ⁇ l are first treated for 20 minutes at room temperature (RT) with 100 ⁇ l borate 0.5M buffer (pH 9) and 125 ⁇ l Dade Behring-purchased kaolin. After centrifugation (30 minutes, 3000 RPM or 860 g), 100 ⁇ l supernatant (corresponding to a 1/10 dilution of the serum) are taken and incubated for 1 hour at 4°C with 0.5% chicken red blood cells. Supernatant is collected after centrifugation for 10 minutes at 3200 RPM (970 g). Both operations are done for eliminating the natural hemagglutinating factors contained in the sera.
• 25 ⁇ l treated-sera are diluted in 25 ⁇ l PBS (serial 2-fold dilutions starting at 1/20) in 96 well Greiner plates.
• BPL inactivated whole virus is added (25 ⁇ l / well) at a concentration of 4 Hemagglutination Units (i.e. at a dilution which is 4-fold lower than the last one provoking an agglutination of red blood cells) for 30 minutes at RT under agitation.
• Chicken red blood cells are then added (25 ⁇ l / well) for 1 hour at RT. Plates are finally kept overnight at 4°C before to be read.
• the HAI titer corresponds to the inverse of the last serum dilution inhibiting the virus-induced hemagglutination.
• influenza vaccines e.g. adjuvanted parenteral vaccines, DNA-based vaccines or mucosally delivered vaccines
• na ⁇ ve animals In general, the promising results obtained from these studies were not confirmed in humans. This was probably due to the fact that the majority of adults have been immunologically "primed" through natural infections before vaccination, unlike the na ⁇ ve animals. Therefore, the best way to evaluate intranasal influenza vaccines in animal models would be to test their ability to boost pre-established immune responses in nasally primed animals. We assess in the present example the effect of TWEEN-80 and Triton X-100 on such responses.
• the priming was done in female Balb/c mice (8 weeks old) at day 0 by administering with a pipette (under anesthesia) in each nostril 2.5 ⁇ g HA of BPL-inactivated A/Beijing/262/95 influenza virus contained in 10 ⁇ l PBS.
• mice (6 animals/group) were boosted intranasally (under anesthesia) with 20 ⁇ l of solution (10 ⁇ l per nostril, delivered as droplets by pipette) containing 5 ⁇ g HA of BPL- inactivated A/Beijing 262/95 influenza virus in either A: PBS; B: TWEEN80 (0.11%) plus Triton X-100 (0.074%) ; or by C: intramuscular injection of 1.5 ⁇ g HA of influenza vaccine.
• Antigens were supplied by SSD GmBH manufacturer (Dresden, Germany). HAI Ab responses were measured in sera as described in Example 1.
• inactivated influenza virus delivered intranasally is capable of boosting pre-established systemic HAI Ab responses as efficiently as the classical parenteral influenza vaccine.
• the same antigen given intranasally in the absence of TWEEN80 and Triton is significantly less immunogenic.
• Example 3 A comparison of the immunogenicity of an intranasal split influenza vaccine with TWEEN 80 & TRITON X-100 compared to a licensed conventional parenteral vaccine in healthy adult subjects.
• A,B Two formulations (A,B) of egg-derived split influenza antigens have been evaluated.
• A is an intranasal formulation and B is the FluarixTM/ ⁇ -Rix® given intramuscularly.
• the formulations contain three inactivated split virion antigens prepared from the WHO recommended strains of the 1998/1999 season.
• the device used for intranasal delivery is the AccusprayTM intranasal syringes from Becton Dickinson. lOO ⁇ l of the A formulation is sprayed in each nostril.
• composition of the formulations are Composition of the formulations.
• the intranasal formulation (A) contains the following inactivated split virions:
• the volume of one dose is 200 ⁇ l (lOO ⁇ l sub-doses for each nostril).
• the comparator FluarixTM/ ⁇ -Rix® is the SmithKline Beecham Biologicals' commercial inactivated trivalent split influenza vaccine. The dose of 500 ⁇ l is administered intramuscularly.
• This dose contains;
• the intranasal formulation (200 ⁇ l) contained the following inactivated virions: 30 ⁇ g of haemagglutinin A/Beijing/262/95 (H1N1), 30 ⁇ g of haemagglutinin A/Sydney/5/97 (H3N2), 30 ⁇ g of haemagglutinin B/Harbin/7/94 with phosphate buffered saline (pH 7.4 ⁇ 0.1), Tween 80 (0.1%), Triton X-100 (0.015%), sodium deoxycholate (0.0045%) and thiomersal ( ⁇ 35 ⁇ g/ml).
• the immunogenicity of the vaccines was examined by assessing the serum haemagglutination inhibition (HI) titres to determine the seroconversion rate (defined as the percentage of vaccinees who have at least a 4- fold increase in serum HI titres on day 21 compared to day 0, for each vaccine strain), conversion factor (defined as the fold increase in serum HI Geometric Mean Titres (GMTs) on day 21 compared to day 0, for each vaccine strain) and seroprotection rate (defined as the percentage of vaccinees with a serum HI titre >40 after vaccination (for each vaccine strain) that is accepted as indicating protection).
• HI serum haemagglutination inhibition
• an influenza vaccine needs to have > or equal to 40% seroconversion rate, > or equal to 70% seroprotection rate and a conversion factor of > or equal to 2.5, for each strain, in order to meet the international regulatory requirements. This applies for adults between 18-60 years; different criteria apply for the elderly.
• HI seropositivity, serconversion and seroprotection rates twenty-one days after one dose of FluarixTM or the intranasal formulation can be seen in Table 1.
• Seroconversion (n,%) number and percentage of subjects with at least a 4-fold increase in titres from day 0 to day 21
• the conversion factor fold increase in serum HI GMTs after vaccination was greater than 2.5, the level required for a successful influenza vaccine.
• the immunogenicity results tabulated above show that the intranasal formulation produced similar levels of seropositivity, seroconversion and seroprotection to those produced by the conventional parenteral vaccine (FluarixTM) twenty-one days after one dose.
• the intranasal formulation produced a better mucosal IgA response after one dose than the conventional parenteral vaccine (FluarixTM).

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