TR201808026T4 - Kapsüler polisakaritlerin çözünürleştirilmesi ve kombinasyon aşıları. - Google Patents
Kapsüler polisakaritlerin çözünürleştirilmesi ve kombinasyon aşıları. Download PDFInfo
- Publication number
- TR201808026T4 TR201808026T4 TR2018/08026T TR201808026T TR201808026T4 TR 201808026 T4 TR201808026 T4 TR 201808026T4 TR 2018/08026 T TR2018/08026 T TR 2018/08026T TR 201808026 T TR201808026 T TR 201808026T TR 201808026 T4 TR201808026 T4 TR 201808026T4
- Authority
- TR
- Turkey
- Prior art keywords
- polysaccharide
- saccharide
- carrier protein
- serogroup
- process according
- Prior art date
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Abstract
Bir bakteriyel kapsüler polisakkariti saflaştırmak ve bir taşıyıcı proteine konjuge etmek için bir proses olup, aşağıdaki adımları içerir: polisakkaritin saflaştırılması, (a) bir ya da daha fazla katyonik deterjan kullanılarak polisakaritin çökeltilmesi, ardından (b) çökeltilen polisakaritin bir alkol kullanılarak çözünürleştirilmesi, polisakkaridin bir taşıyıcı proteine konjugasyonu adımlarını içerir, burada taşıyıcı protein bir bakteriyel toksindir ya da toksoittir ve burada konjugasyon bir bağlayıcı ile gerçekleştirilir, burada bakteriyel kapsüler polisakkarit Neisseria meningitidis serogrup A, W135 ya da Y'den ya da Haemophiius influenzae'den ya da Streptococcus pneumoniae'den gelir. Bir yönde konjugatlı sakkarit 0.5:1 ve 5:1 arasında bir sakkarit:protein oranına (ağırlık/ağırlık) sahiptir. Başka bir yönde, işlem sakkaridin bir siyanilatlama reaktifi ile aktive edilmesi adımını içerir.
Description
TARIFNAMEKAPSULER POLISAKARITLERIN
COZUNURLESTIRILMESI VE KOMBINASYON ASILARITEKNIK SAHA
Bu bulus, özellikle meningokok enfeksiyonuna ve hastaligina karsiolmak üzere, asilar sahasina yöneliktir.GEÇMIS TEKNOLOJINeisseria meningitidis, bir Gram negatif insan patojenidir. Farenkste
koloiiize olarak inenenjite ve zaman zaman meneiijit olmadiginda
septisemiye neden olur. N.g0n0rrh0eae ile yakindan iliskili olmakla
birlikte meningokoku net bir sekilde ayirt eden 'Özellik, tüm patojenik
meningokoklarda bulunan bir polisakarit kapsülüdür.Organizmanin kapsüler polisakaritine dayanarak on iki N.meningitidis
serogrubu tanimlanmistir (A, B, C, H, I, K, L, 29E, W135, X, Y ve Z).
A Grubu, alt Sahra Afrika°sinda epideinik hastalikta en sik sekilde
gösterilen patojendir. B ve C serogruplari, ABDade ve çogu gelismis
ülkede vakalarin büyük kismindan sorumludur. W135 ve Y
serogruplari, ABD'de ve gelismis ülkelerde geri kalan vakalardan
sorumludur.N.meningitidis”ten kapsüler polisakaritler tipik olarak polisakarit
çökeltme (örn., bir katyonik deterjan kullanilarak), etanol ileparçalama, soguk fenol ile özümleme (proteini çikartmak için) veultra-santrifujleine (LPS”yi çikartmak için) adimlarini içeren bir
proses ile hazirlanir [Örn., ref. l].A, C, Y ve Wl35 serogruplarindan kapsüler polisakaritlerin bir
tetravalent asisi birçok yildir bilinmektedir [2, 3] ve insan kullaniini
için lisans almistir. Ergenlerde ve yetiskinlerde etkili olinakla birlikte
bebeklerde zayif bir immün tepkisi ve kisa süreli koruma saglar ve
kullanilamaz [örn., 4] . Bunun nedeni, polisakaritlerin boost
edilemeyen zayif bir immün tepkisi indükleyen, T hücresinden
bagimsiz antijenler olmasidir. Bu asidaki polisakaritler konjüge
edilmez ve l:'l:l:l oraninda bulunur [5]. MENCEVAX ACWYTM,
liyofilize edilmis formundan yeniden olusturuldugunda saflastirilmis
her polisakaritten 50ug ihtiva eder.Konj'ûge edilmis C serogrubu oligosakaritler de insan kullanimi için
onaylaninistir ['orn., MenjugateTM; ref. 6]. Bununla birlikte A, Wl35
ve Y serogruplarina karsi kon jügat asilarinda ve bunlarin üretiminde
gelistirme yapilmasina ihtiyaç vardir.EP 0 072 513 El, saflastirilmis bakteriyel kapsüler antijenik
polisakaritlerin hazirlanmasina yönelik bir proses, elde edilen ürünler
ve bunlariii kullaniinlarini tarif eder. Lei QP et al (2000)
(Developinents in Biologicals 103, 259-264) ineningokokkal
polisakkarit-difteri toksoit konjugat asilarinda serbest polisakkaridin
kantifikasyonunu tarif eder. WO 02/058737 A2 bir inultivalent
meningokokkal polisakkarit-proteini konjugat asisini tarif eder. WO
96/40242 Al bir polisakkarit antijen-tasiyici protein konjugatini veserbest tasiyici proteini içeren bir asiyi tarif eder.BULUSUN AÇIKLAMASIBulus, bir bakteriyel kapsüler polisakaritin saflastirilmasina ve bir
tasiyici proteine konjugatlaninasina yönelik bir proses saglar, buradaproses asagidaki adiinlari içerir:polisakkaridin saflastirilmasi, (a) bir ya da daha fazla katyonik
deterjan kullanilarak polisakaritin çökeltilniesi, ardindan (b) çökeltilen
polisakaritin %75 ve %95 arasiiidaki bir nihai konsantrasyonda etanolkullanilarak çözünürlestirilmesi,polisakkaridin bir tasiyici proteine konjugasyonu, burada tasiyici
protein bir bakteriyel toksindir ya da toksoittir ve burada koiijugatli
sakkarit, 051 ve 5:l arasinda bir sakkarit:pr0tein oranina (W/W)sahiptir.burada bakteriyel kapsüler polisakkarit Neisseria ineningitidis
serogrup A, Wl35 ya da Y°den ya da Haeinophiius influenzae°den ya
da Streptococcus pneumoniae°den gelir ve burada bir ya da daha fazlakatyonik deterjan setiltrimetilamonyuin broinürü içerir.Bulus, bir bakteriyel kapsüler polisakaritin saflastirilniasina ve bir
tasiyici proteine konjugatlaninasina yönelik bir proses saglar, buradaproses asagidaki adimlari içerir:polisakkaridin saflastirilmasi, (a) bir ya da daha fazla katyonikdeterjan kullaiiilarak polisakaritin çökeltilinesi, ardindan (b) çökeltilenpolisakaritin %75 ve %95 arasindaki bir nihai konsantrasyonda etanolkullanilarak çözünürlestirilmesi,sakkaridin bir siyanilatlama reaktifi ile aktive edilmesi, vepolisakkaridin bir tasiyici proteine konjugasyoiiu, burada tasiyiciprotein bir bakteriyel toksindir ya da toksoittir,burada bakteriyel kapsüler polisakkarit Neisseria meningitidis
serogrup A, W135 ya da Y°den ya da Haemophiius influenzae°den ya
da Streptococcus pneumoniaesden gelir ve burada bir ya da daha fazlakatyonik deterjan setiltrimetilamonyum bromürü içerir.Çökeltme ve etanol ile çözünürlestinneÇözülebileii polisakaritlerin çökeltilmesine yönelik birçok teknik bu
konuda bilinmektedir. Tercih edilen yöntemlerde bir veya daha fazla
katyonik deterjan kullanilir. Deterjanlar tercihen asagidaki genel
formüle sahiptir:RiJL
burada: R1, R2 ve R3, ayni veya farklidir ve her biri, alkili veya arili
belirtir; veya R. ve R2, bunlarin eklendigi nitro jen atomu ile birlikte, 5
veya 6 elemanli, doymus bir heterosiklik halka olusturur ve R3, alkili
veya arili belirtir; veya R1, R2 ve R3, bunlarin eklendigi nitro jen atomu
ile birlikte, nitrojen atomunda doymamis, 5 veya 6 elemanli bir
heterosiklik halka olusturur,R4, alkili veya arili belirtir ve
X', bir aiiyoiiu gösterir.Yöntemde kullanilmak üzere özellikle tercih edilen deterjanlar,
tetrabutilamonyum ve setiltrimetilamonyum tuzlaridir (örn., bromid
tuzlari). Setiltrimetilamonyum bromid ('CTAB') özellikle tercih edilir
[8]. CTAB ayrica heksadesiltrimetilamonyum bromid, setrimonyum
bromid, Cetavlon ve Centimid olarak bilinir. Diger deterjanlar
arasinda heksadimetrin bromid ve miristiltrimetilamonyum tuzlari
bulunur.Kapsüler polisakaritler, kültür sirasinda ortam içine salinir. Buna göre
çökeltme için baslangiç materyali tipik olarak santrifüjlenmis bir
bakteri kültüründen gelen süpematan olacaktir veya konsantre edilmis
bir kültür olacaktir.Çökeltme adimi, polisakaritler için seçici olabilir, ancak tipik olarak
diger bilesenleri (örn., proteinler, nükleik asit Vb.) de birlikte
çökeltecektir.Çökelen polisakarit, çözünürlestirme öncesinde santrifûj yoluyla
t0planabilir.Çökeltmeden sonra polisakarit (tipik olarak katyonik deterjan ile bir
kompleks halinde) yeniden çözünürlestirilir. Kirleticileri (örn.,
proteinler, nükleik asit Vb.) en aza indirmek için polisakarit için
nispeten seçici olan bir solventin kullanilmasi tercih edilir. Bu
baglamda etanolun avantajli oldugu kesfedilmistir ve bu, CTAB-
polisakarit kompleksi için yüksek oranda seçicidir. Baska alt alkoller
(örn., metanol, propan-l-ol, propan-Z-ol, butan-l-ol, butan-Z-ol, 2-
metil-propan-l-ol, 2-metil-propan-2-ol, dioller Vb.) kullanilabilir.
Etanol tercihen çökelen polisakarite, %50 ile %95 arasinda (örn.,
yaklasik %55, %60, %65, %70, %75, %80, %85 veya yaklasik %90)ve tercihen %75 ile %95 arasinda nihai etanol konsantrasyonu (toplam
etanol ve su içerigi bazinda) verecek sekilde ilave edilir. Optimum
nihai etanol konsantrasyonu, polisakaritin elde edildigi bakterinin
serogrubuna bagli olabilir.Etanol, çökelen polisakarite saf formda ilave edilebilir veya
karisabilen bir solvent (örn., su) ile seyreltilmis bir formda ilave
edilebilir. Tercih edilen solvent karisimlari, etanolzsu karisimlari olup
tercih edilen oran yaklasik 70:30 ile yaklasik 95:5 arasindadir Com.,
75:25, 80:20, 85:15, 90:10).Kapsüler polisakaritlerin hazirlanmasina yönelik geleneksel prosesler
ile karsilastirildiginda iki adiinli çökeltme ve ardindan etanol ile
özümleme prosesi, daha hizli ve basittir.9. referansta tarif edilen prosesin aksine bu proseste, anyonik deterjan
yerine katyonik deterjan kullanilir. 10. referansin prosesinin aksine
polisakarit, kalsiyum veya magnezyum tuzlari kullanilarak katyon
alisverisinden çok etanol kullanilarak yeniden çözünürlestirilir. 11.
referansin prosesinin aksine çökeltme, eylemsiz, gözenekli bir destek
gerektirmez. Ek olarak önceki teknige ait proseslerin aksine alkol,
polisakariti çökeltmek için degil bunu yeniden çözünürlestirmek için
kullanilir.Bakteriyel kapsüler polisakarit genellikle Neisseria'dan gelecektir.
Tercihen bu, A, B, C, Wl35 ve Y serogruplari dahil
N.n1eningitidis,ten gelir. Tercih edilen serogruplar, A, W135 ve Y”dir.
Proses ayrica Haemophilus inf1uenzae”den (özellikle tip B veya 'Hib')
ve Streptococcus pneumoniae°den (pnömokok) kapsüler polisakarithazirlanmasi için uygundur.
Çözîin'i'irlestirilmis polisakaritin ileri islemiYeniden çözünürlestirme sonrasinda polisakarit ayrica kirleticileri
çikartmak üzere isleme tabi tutulabilir. Bu, çok küçük kirlenmenin
bile kabul edilebilir olmadigi (örn, insan asisi üretimine yönelik)
durumlarda özellikle Önemlidir. Bu tipik olarak bir veya daha fazla
filtreleme adimi içerecektir.Derinlik filtrelemesi kullanilabilir. Bu, berraklastirma için 'Özellikle
faydalidir.Aktiflestirilmis karbon içinden filtreleme kullanilabilir. Bu,
pigmentlerin ve eser organik bilesiklerin çikarilmasi için faydalidir.
Bu örnegin, OD275nm<0.2 olana kadar tekrar edilebilir.Ebatli filtreleme veya ultrafiltreleme kullanilabilir.Kirleticileri çikartmak için filtre edildikten sonra polisakarit, ileri
isleme ve/Veya proses için çökeltilebilir. Bu elverisli sekilde katyon
alisverisi yoluyla (6111., kalsiyum veya sodyum tuzlari ilave edilerek)
saglanabilir.Polisakarit, kimyasal olarak modifiye edilebilir. Örnegin bir veya daha
fazla hidroksil grubunu bloklama gruplari ile degistirmek üzere
modifiye edilebilir. Bu özellikle MenA için faydalidir [12]. B
serogrubundan gelen polisakaritler, N-propiyonile edilebilir [13].
(Istege bagli olarak modifiye edilmis) polisakarit tipik olarak
oligosakaritler olusturmak üzere hidrolize edilecektir. Bu tercihen
oligosakaritte 30°un altinda (örn. 10 ile 20 arasinda, tercihen A
serogrubu için 10 civarinda; W135 ve Y serogruplari için 15 ile 25
arasinda, tercihen 15-20 civarinda; vb.) nihai ortalama polimerizasyon
derecesi (DP) vermek için yapilir. Oligosakaritler, asilardakullanilmak 'üzere polisakaritlere tercih edilir. DP, iyon alisverisli
kromatografi veya koloriinetrik deneyler ile elverisli sekilde
ölçülebilir [14].Hidroliz yapilirsa hidrolizat genel olarak kisa oligosakaritlerin
çikarilmasi amaciyla ebatlanacaktir. Bu, ultrafiltreleme, ardindan iyon
alisverisli kroinatografi gibi çesitli yollarla yapilabilir. Polimerizasyon
derecesi yaklasik 6°dan az veya buna esit olan oligosakaritler tercihen
A serogrubu için çikarilir ve yaklasik 4”ün altinda olanlar tercihen
W135 ve Y serogruplari için çikarilir.Immünojenikligi güçlendirmek için bulusa ait polisakaritler veya
oligosakaritler tercihen bir tasiyiciya konjüge edilir (Sekil 18).
Tasiyici proteinlere konjügasyon, pediatrik asilar için Özellikle
faydalidir [örn., ref. 15] ve iyi bilinen bir tekniktir [örn., ref. 16 ila 24,
Vb.de ele alinmistir.]Tercih edilen tasiyici proteinleri, bakteriyel toksinler veya toksoidler,
örnegin difteri veya tetanos toksoidleridir. CRM197 difteri toksoidi
[25,26,27] 'Özellikle tercih edilir. Diger uygun tasiyici proteinler
arasinda N.meningitidis dis membran protein kompleksi [28], sentetik
peptitler [29, 30], isi soku proteinleri [31, 32], pertussis proteinleri
[33, 34], sitokinler [35], lenfokinler [35], hormonlar [35], büyüme
faktörleri [35], patojenden türetilmis çesitli anti jenlerden gelen çoklu
insan CD4+ T hücresi epitoplari içeren suni proteinler [36],
H.influenzae'den protein D [37], C.difficile'den toksin A veya B [38]
Vb. bulunur. Tasiyici proteinlerin karisimlari da kullanilabilir.
Sakaritzprotein orani (W/W) 0.5:1 (yani fazla protein) ile 5:1 (yani
fazla sakarit) arasinda olan konjügatlar tercih edilir ve oranlari 111.25
ile 1:2.5 arasinda olanlar daha fazla tercih edilir.Tek bir tasiyici protein, birçok farkli sakariti tasiyabilir [39].
Kon jügatlar, serbest tasiyici protein ile birlikte kullanilabilir [40].
Uygun bir konjügasyon reaksiyonu, gerekli oldugunda uygun bir
baglayici ile kullanilabilir.Sakarit tipik olarak konj'ugasyondan önce aktiflestirilecek veya
fonksiyonellestirilecektir. Aktivasyon örnegin CDAP (örn., l-siyano-
4-dimetilamino piridinyum tetrafloroborat) [41, 42, Vb.]) gibi siyanile
edici reaktif maddeler içerebilir. Diger uygun tekiiiklerde
karbodiimidler, hidrazidler, aktif esterler, norboran, p-nitrobenzoik
asit, N-hidroksisukinimid, S-NHS, EDC, TSTU kullanilir (ayrica 22.
referansin girisine bakiniz).Bir baglayici grubu araciligiyla baglainalar, bilinen bir prosedür,
örnegin 43 ve 44. referanslarda tarif edilen prosedürler kullanilarak
yapilabilir. Bir tip baglama, polisakaritin indirgeyici aminasyonunu,
elde edilen amino grubu ile bir adipik asit baglayici grubun bir ucunun
birlestirilmesini ve sonra bir proteinin, adipik asit baglayici grubun
diger ucuna birlestirilmesini içerir [20, 45, 46]. Diger baglayicilar
arasinda B-propiyonamido [47], nitrofenil-etilamin [48], haloasil
halidler [49], glikosidik baglar [50], 6-aminokaproik asit [51], ADH
[52], C4 ila Ciz yarimlari [53] vb. bulunur. Bir baglayici
kullanilmasina alternatif olarak direkt baglama kullanilabilir. Proteine
direkt baglamalar, polisakaritin oksidasyonunu., ardindan 'Örnegin 54
ve 55. referanslarda tarif edildigi gibi protein ile indirgeyici
aminasyonu içerebilir.Amino gruplarinin sakarit içine (örn., terminal :0 gruplarinin -NH2 ile
degistirilmesi suretiyle) sokulmasini, ardindan bir adipik diester (öm.,
adipik asit N-hidroksisukinimido diester) ile türevlendirmeyi ve
tasiyici protein ile reaksiyonu içeren bir proses tercih edilir.
Konj'ugasyondan sonra serbest ve konjüge edilmis sakaritlerayrilabilir. Uygun birçok yöntem vardir, örnegin hidrofobik
kroinatografi, tanjant ultra-filtreleme, diya-filtreleme, Vb. [bakinizayrica 56 ve 57. referanslar, Vb.].Sakaritleri içeren karisimlar ve kompozisyonlarBulusa ait konjügatlar, baska biyolojik moleküller ile karistirilabilir.
Birden fazla N.meningitidis serogrubundan gelen sakaritlerin
karisimlari, Örn. A+C, A+W135, A+Y, C+W135, C+Y, W135+Y,
A+C+Wl 3 5, A+C+Y, C+W13 5+Y, A+C+W 1 3 5+Y, Vb.
serogruplarindan gelen sakaritler içeren kompozisyonlar tercih edilir.
Tek tek sakarit anti jenlerinin koruyucu etkinliginin bunlarin
birlestirilinesi suretiyle ortadan kaldirilmamasi tercih edilir, bununla
birlikte gerçek immünojeniklik (örn, ELISA titerleri) azalabilir.C serogrubundan gelen bir sakarit kullanildiginda bu tercihen ~12 ila
~22 tekrar ünitesine sahiptir.Farkli N.ineningitidis serogruplarindan gelen sakaritler, ayni veya
farkli tasiyici proteinlere kon jüge edilebilir.Bir karisimin, A ve C serogruplarinin her ikisinden gelen kapsüler
sakaritler içerdigi durumda MenA sakarit:MenC sakarit oraninin
(W/W) 1”den fazla (örn., 2:l, 3zl, 421, 5:1, 10:11 veya daha yüksek)
olmasi tercih edilir. Sürpriz sekilde MenA bileseni, MenC bileseiiine
göre fazla (kütle/doz) bulundugunda bunun immünojenikliginin
gelistigi gözlendi.Bir karisim, W 135 serogrubundan ve A, C ve Y serogruplarinin en az
birinden kapsüler sakaritler (örn., oligosakaritler) içerdiginde sürpriz
sekilde MenWl35 sakaritinin immünojenikliginin, diger
serogrup(lar)dan sakarit(ler) ile kombinasyon halinde uygulandiginda,
bunun tek basina (ayni dozajda, Vb.) uygulanmasina göre daha yüksek
oldugu kesfedildi [bakiniz ref. 58]. Böylelikle MenW135 antijenininbir iminün tepkisi uyandirma kapasitesi, diger serogruplardan gelen
anti jenler ile birlestirilmeden verildiginde ayni anti jenin denk miktari
ile uyandirilan immün tepkisinden daha yüksektir. Bu güçlendirilmis
immünojeniklik, MenW135 antijeninin kontrol hayvanlarina ve
karisiiiiin test hayvanlarina uygulanmasi ve bu ikisine karsi olan
antikor titerleriiiin bakterisidal titerler, radyo-immünodeney ve
ELISA71ar Vb. gibi standart deneyler kullanilarak karsilastirilmasi
suretiyle belirlenebilir. W135 serogrubundan geleii sakaritlerin diger
serogruplar ile sinerjistik kombinasyonlarini içeren asilar immünolojik
açidan avantajlidir. Bunlar, güçlendirilmis anti-W135 tepkileri
ve/Veya daha düsük W135 dozlari saglar.Bir karisimin, Y serogrubundan ve C ve W135 serogruplarindan
birinden veya her ikisinden kapsüler sakaritler içermesi durumunda
MenY sakarit2MenWl35 sakarit oraninin (W/W) 1”den yüksek (örn.,
2:1, 3:1, 421, 521, 1021 veya daha yüksek) olmasi ve/veya MenY
sakaritzMenC sakarit oraninin (W/W) 1°den az (örn., 122, 123, 1:4, 125
veya daha düsük) olmasi tercih edilir.A2C2Wl352Y serogruplarindan gelen sakaritler için tercih edilen
oranlar (W/W) söyledir: 1212121; 1212122; 2:1:1:1; 4222121; &42221;
4:2:1:2; 8:421:2; 4222221; 2:2:1:1; 4242221; 2222122; 4:4:1:2; ve 2:2:2:1.Karisimlar ayrica proteinler içerebilir. N.meningitidis B
serogrubundan [örn., referanslar 59 ila 64] veya OMV
preparasyonlarindan [örn., 65 ila 68. referanslar, Vb.] gelen
proteinlerin dahil edilmesi tercih edilir.Meningokok olmayan ve neisserial olmayan anti jenler, tercihen
meiiiiigokok bilesenlere karsi imniün tepkisini azaltmayanlar da dahil
edilebilir. Örnegin 69. Referans, N.meningitidis B ve Cserogruplarindan gelen oligosakaritlerin Hib sakariti ilekombinasyonlarini açiklar. Pnömokok, hepatit A Virüsü, hepatit BVirüsü, B.pertussis, difteri, tetanos, Helicobacter pylori, polio ve/veyaH.influenzae”dan alinan anti jenler tercih edilir. Ozellikle tercih edilenneisserial olmayan anti jenler arasinda sunlar bulunur:-Helicobacter pylori”den anti jenler örnegin CagA [70 ila 73], VacA
[74, 75], NAP [76, 77, 78], HopX [örn., 79], HopY [öm., 79] ve/Veya
üreaz.-Streptococcus pneumoniae°den bir sakarit anti jeni [örn, 80, 81, 82]-hepatit A Virüsünden, örnegin eylemsizlestirilmis virüsten bir anti jen
[örn., 83, 84].-hepatit B virüsünden bir anti jen, örnegin yüzey ve/veya göbek
anti jenleri [öm., 84, 85], yüzey anti jeni tercihen bir alüminyum fosfat
`üzerine adsorbe edilir [86].-Haemophilus influenzae B7den bir sakarit anti jeni [örn., 87], tercihen
adsorbe edilmemistir veya bir alüminyum fosfat üzerine adsorbe
edilmistir [88].-hepatit C Virüsünden bir anti jen [örn., 89]-N.g0n0rrh0eae°den bir anti jen [öm., 59 ila 62]-Chlamydia pneumoniae°den bir anti jen [örn., 90 ila 96. referanslar]-Chlamydia trachomatisîen bir anti jen [öm., 97].-Porphyromonas gingivalis”ten bir anti jen [örn., 98]-polio antijen(ler)i [örn., 99, 100] örnegin IPV.-kuduz anti jen(ler)i [örn., 101] örnegin liyofilize edilmis,
eylemsizlestirilmis Virüs [örn., 102, RabAvertTM]-kizamik, kabakulak ve/Veya kizamikçik anti jenleri [öm., 103.
referansin 9, 10 ve 11. bölümleri]-influenza anti jen(ler)i [örn., 103. referansin 19. bölümü] örneginhemaglutinin ve/ veya nöraminidaz yüzey proteinleri.
-Moraxella catarrhalis”ten bir anti jeii [om, 104].-Streptococcus agalactiae”den (B grubu streptokok) bir anti jeii [örn.,
105, 106].-Streptococcus pyogenes”ten (A grubu streptokok) bir antijen [örn.,
106, 107, 108].-Staphilocoecus aureus”tan bir anti jen [öm., 109].-bir paramiksovir'ûsten, örnegin respiratuar sinsitiyal virüsten (RSV
[110, 111]) ve/veya parainfluenza Virüsünden (PIV3 [112])
anti jen(ler).-Bacillus anthracis°ten bir antijen [bin, 113, 114, 115].-flaViViridae familyasindaki (genus flavivirus) bir virüsten, örnegin
sari humma Virüsü, Japon ansefalit virüsü, Dengue virüslerinin d'ort
serotipi, kene ile tasinan ansefalit Virüsü, Bati Nil Virüsünden bir
antijen.-bir pestivirüs antijeni, örnegin klasik domuz atesi Virüsü, sigir Viral
diyare Virüsü ve/Veya border hastaligi Virüsünden.-bir parvovir'us anti jeni, örn., parvovir'ûs B19”dan.-bir tetanos toksoidi [örn., ref. 116].- B.pertussis°den pertussis holotoksin (PT) ve filament'oz
hemaglutinin (FHA), istege bagli olarak ayrica pertaktin ve/Veya
aglutinojenler 2 ve 3 i1e kombinasyon halinde [öm., 117 ve 118.
referanslar] .-hücresel pertussis anti jeiii.Karisim, gerekli durumlarda detoksifiye edilebilen bu digeranti jenlerden bir veya daha fazlasini içerebilir (öm., pertussis toksinindetoksifikasyonu kimyasal ve/veya genetik vasitalarla yapilir).Karisim içine bir difteri antijeninin dahil edildigi durumlarda ayricatetanos antijeni ve pertussis antijenlerinin de dahil edilmesi tercih
edilir. Benzer sekilde bir tetanos anti jeninin dahil edildigi durumlarda
ayrica difteri ve pertussis anti jenlerinin de dahil edilmesi tercih edilir.
Benzer sekilde bir pertussis anti jeninin dahil edildigi durumlarda
ayrica difteri ve tetanos anti jenlerinin de dahil edilmesi tercih edilir.
Karisim içindeki antijenler tipik olarak her biri en az lpg/ml
konsantrasyonda bulunacaktir. Genel olarak belirli bir anti jenin
konsantrasyonu, bu anti jene karsi bir iinmün tepkisi uyaiidirmak için
yeterli olacaktir.Karisim içinde protein anti jenlerinin kullanilmasina alternatif olarak
anti jeiii sifreleyen nükleik asit kullanilabilir. Karisimin protein
bilesenleri bu sekilde proteini sifreleyen nükleik asit (tercihen örn. birplazmid formunda DNA) ile degistirilebilir.Multivalent sakarit asilariBulus ayrica N.meningitidis A, C, W135 ve Y serogruplarindan en az
ikisinden (yani 2, 3 veya 4”ünden) gelen kapsüler sakaritler içeren
asilar ve immünojenik kompozisyonlar sunar, burada adi geçen
kapsüler sakaritler, tasiyici protein(1er)e konjüge edilir ve/Veya
oligosakaritlerdir. Asinin A, C, W135 ve Y serogruplarindan gelen,
koný'ige edilmis sadece iki oligosakarite veya polisakarite sahip
olmasi durumunda bunlar tercihen A ve C serogruplarindan degildir
(bakiniz 6, 119 ve 120. referanslar). Tercih edilen kompozisyonlar, C
ve Y serogruplarindan sakaritler içerir. Tercih edilen diger
kompozisyonlar, C, W 135 ve Y serogruplarindan sakaritler içerir.
Burada bir A serogrubu oligosakarit konjügati ve bir C serogrubu
oligosakarit konjügati içeren ve ayrica (i) bir alüminyum fosfat veya
bir alüminyum hidroksid adjuvan ve (ii) bir tampon içeren birimmünojenik kompozisyon açiklanir. Kompozisyon, bir alüminyum
fosfat adjuvan içerdiginde tampon tercihen bir fosfat tamponudur ve
bir alüminyum hidroksid adjuvan içerdiginde tampon tercihen bir
histidin tamponudur.Asi, A serogrubundan kapsüler sakarit içerdiginde A serogrubu
sakaritin, hidrolizi en aza indirmek amaciyla kullanimdan kisa bir süre
önce baska sakarit(ler) ile birlestirilmesi tercih edilir (bakiniz Hib
sakaritleri). Bu, A serogrubu bilesenin liyofilize edilmis formda ve
diger serogrup bilesen(ler)inin sivi formda olmasi ile elverisli sekilde
saglanabilir, buradaki sivi bilesen, kullanima hazir oldugunda
liyofilize edilmis bileseni yeniden olusturmak için kullanilir. Sivi
bilesen tercihen bir alüminyum tuzu adjuvan içerir, bu durumda
liyofilize edilmis A serogrubu bileseni, bir alüminyum tuzu adjuvani
içerebilir veya içernieyebilir.Bu yüzden burada sunlari içeren bir kit açiklanir: (a) liyofilize edilmis
formda, N.meningitidis A serogrubundan kapsüler sakarit; ve (b) sivi
formda bir veya daha fazla (örn., l, 2, 3) N.meningitidis C, Wl35 ve
Y serogrubundan kapsüler sakarit(ler). Sakaritler tercihen tasiyici
protein(ler)e konjüge edilir ve/Veya oligosakaritlerdir. Kit, iki sise
formunda olabilir.Ayrica burada açiklanan bir asi kompozisyonunun hazirlanmasina
yönelik, liyofilize edilmis, N.meningitidis A serogrubundan bir
kapsüler sakaridin bir veya daha fazla (örn., l, 2, 3) N.meningitidis C,
Wl35 ve Y serogrubundan kapsüler sakarit(ler) ile karistirilmasini
içeren, burada adi geçen bir veya daha fazla sakaritin sivi formda
oldugu bir yöntem açiklanir.Ayrica burada sunlari içeren bir kit açiklanir: (a) liyofilize edilmis
formda, N.meningitidis A serogrubundan konjüge edilmis kapsüleroligosakarit; ve (b) sivi formda bir veya daha fazla baska antijen.
Baska antijen, N.meningitidis C serogrubundan konjüge edilmiskapsüler oligosakarit olabilir veya olmayabilir.Imm'i'inojenik kompozisyonlar ve asilarBulusa ait kon jügatlar, immünojenik koinpozisyonlara ve asilara dahil
edilmeye özellikle uygundur. Bu nedenle bulusa ait bir proses,
polisakaritin, oligosakaritin veya konj'ûgatin bir imini'inojenik
kompozisyon veya asi halinde formüle edilinesi adimini içerebilir.
Bulus, bu sekilde elde edilebilen bir kompozisyon veya asi sunar.
Bulusa ait immünojenik kompozisyonlar ve asilar, meningokok
sakaritlerine ilaveten tipik olarak “farmasötik açidan kabul edilebilir
tasiyicilar” içerecektir, bunlar arasinda kompozisyonu alan kisi için
zararli antikorlarin üretilmesini kendi basina indüklemeyen tasiyicilar
bulunur. Uygun tasiyicilar tipik olarak büyük, yavas metabolize edilen
makromoleküller örnegin proteinler, polisakaritler, polilaktik asitler,
poliglikolik asitler, polimerik amino asitler, ainino asit kopolimerleri,
trehaloz [121], lipit agregatlaridir (örnegin yag damlalari veya
lipozomlar) ve eylemsiz virüs partikülleridir. Bu gibi tasiyicilar, bu
konuda siradan bilgiye sahip kisilerce iyi bilinir. Asilar ayrica
seyrelticiler, örnegin su., tuz, gliserol, vb. ihtiva edebilir. Ek olarak
nemlendirici veya emülsife edici ajanlar, pH tamponlama maddeleri
ve benzeri gibi yardimci maddeler de bulunabilir. Farmasötik açidan
kabul edilebilir eksipiyanlarin kapsamli bir tartismasi 122. referansta
mevcuttur.Asi olarak kullanilan immünojenik kompozisyonlar, immünolojik
açidan etkili miktarda bir sakarit anti jeninin yani sira gerektiginde
yukarida bahsedilen diger bilesenleri içerir. 'Immünolojik açidan etkilimiktarlar' ile bir kisiye tek bir dozda veya bir serinin parçasi halinde
bu miktarin uygulanmasinin, tedavi veya önleme için etkili olmasi
kast edilir. Bu miktar, tedavi edilecek kisinin sagligina ve fiziksel
durumuna, tedavi edilecek kisinin (örn., insan olmayan primat, primat,
vb.) yasina, taksonomik grubuna, kisinin immün sisteminin antikorlari
sentezleme kapasitesine, arzu edilen koruma derecesine, asinin
formülasyonuna, tedavi eden doktorun tibbi duruma dair
degerlendirmesine ve diger alakali faktörlere bagli olarak degisir.
Miktarin, rutin denemeler ile belirlenebilecek nISpeten genis bir aralik
içine girmesi beklenir. Doza j tedavisi, tek dozlu bir program veya çok
dozlu bir program (örn., booster dozlari içeren) olabilir. Asi, baska
immüno-regülatör ajanlar ile birlikte uygulanabilir.Asi, baska immüno-regülatör ajanlar ile birlikte uygulanabilir.Asi bir adjuvan içerebilir. Kompozisyonun etkinligini güçlendirmek
için tercih edilen adjuvanlar arasinda bunlarla sinirli olmamakla
birlikte asagidakiler bulunur: (1) alüminyum tuzlari (alum), örnegin
alüminyum hidroksidler (oksihidroksidler dahil), alüminyum fosfatlar
(hidroksifosfatlar dahil), alüminyum sülfat, vb. [123. referansta 8 ve 9.
Bölümler]; (2) su içinde yag emülsiyonu formülasyonlari (baska
spesifik immüno-uyarici ajanlar örnegin inuramil peptitler [Muramil
peptitler arasinda N-asetil-muramil-L-treonil-D-izoglutamin (thr-
MDP), N-asetil-normuramil-L-alanil-D-izoglutamin (nor-MDF), N-
asetilmuramil-L-alanil-D-izoglutamini1-L-a1a11in-2-( 1 '-2'-dipa1mitoi1-
sn-gliser0-3-hidroksifosforiloksi)-etilamin MTP-PE), Vb. bulunur]
veya bakteriyel hücre çeperi bilesenleri ile veya olmadan), örnegin (a)
MF59TM [123. referansta 10. Bölüm; 124, 125], %5 Skualen, %05
Tween 80 ve %05 Span 85 ihtiva eder (istege bagli olarak MTP-PE
ihtiva eder), bir mikro-akiskanlastirici kullanilarak mikron altipartiküller halinde formüle edilir, (b) SAF; %10 Skualan, %04 Tween
80, %5 pluronik bloke edilmis polimer L'121 ve thr-MDP ihtiva eder;
bir mikron alti emülsiyon haliiide mikro-akiskanlastirilmis veya daha
büyük partikül ebatli bir emülsiyon üretmek üzere vortekslenmistir ve
(c) RibTM adjuvan sistemi (RAS), (Ribi Iinmunochem, Hamilton,
MT); %2 Skualen, %02 Tween 80 ve inonofosforilipit A (MPL),
trehaloz diinikolat (TDM) ve hücre çeperi iskeletinden (CWS) olusan
gruptan seçilen bir veya daha fazla bakteriyel hücre çeperi bileseni,
tercihen MPL + CWS (DetoxTM) ihtiva eder; (3) saponin ad juvanlar
[123. referansin 22. bölümü], 'Örnegin QSZl veya StiinulonTM
(Cambridge Bioscience, Worcester, MA), ya basit formda ya da
bunlardan üretilmis partiküller formunda, Örnegin ISCOM'ler
(immüno-uyarici kompleksler; 123. referansin 23. bölümü), bu
ISCOMS, ilave deterjan içerineyebilir, öni., ref. 126; (4) Komple
Freund Adjuvani (CFA) ve Eksik Freund Adjuvani (IFA); (5)
sitokinler ömegin interlökinler (öm., IL-1, IL-2, IL-4, IL-5, IL-6, IL-
7, IL-12 [127], vb.), interferonlar (örn., gamina interferon), inakrofaj
koloni uyarma faktörü (M-CSF), tümör nekroz faktörü (TNF), vb.; (6)
monofosforil lipit A (MPL) veya 3-O-deasile edilmis MPL (3dMPL)
öm., '128 ve 129. referanslar, istege bagli olarak pnöinokok sakaritleri
ile kullanildiginda 'Önemli ölçüde alum içermez, örn., ref. 130; (7)
3dMPL”nin örnegin QS21 ve/veya su içinde yag emülsiyonlari ile
kombinasyonlari, örn. 131, 132 ve 133. referanslar; (8) CpG motifleri
içeren oligonükleotitler (Roman ve arkadaslari, Nat. Med., 1997, 3,
849-854; Weiner ve arkadaslari, PNAS USA, 1997, 94, 10833-10837;
Davis ve arkadaslari, J. Immunol., 1998, 160, 870-876; Chu ve
arkadaslari, J. Exp. Med., 1997, 186, 1623-1631; Lipford ve
arkadaslari, Eur. J. Iminuiiol, 1997, 27, 2340-2344; Moldoveanu ve
arkadaslari, Vacciiie, 1988, '16, 1216-1224, Krieg ve arkadaslari,Nature, 1995, 374, 546-549; Klinman ve arkadaslari, PNAS USA,
1996, 93, 2879-2883; Ballas ve arkadaslari, J. lmmunol., 1996, 157,
1840-1845; Cowdery ve arkadaslari, J. lmmunol., 1996, 156, 4570-
4575; Halpern ve arkadaslari, Cell.Immunol, 1996, 167, 72-78;
Yainainoto ve arkadaslari, Jpn. J. Cancer Res., 1988, 79, 866-873;
Stacey ve arkadaslari, J. lmmunol., 1996, 157, 2116-2122; Messina ve
arkadaslari, J. lmmunol., 1991, 147, 1759-1764; Yi ve arkadaslari, J.
lmmunol., 1996, 157, 4918-4925; Yi ve arkadaslari, J. lmmunol.,
1996, 157, 5394-5402; Yi ve arkadaslari, J. ImmunoL., 1998, 160,
4755-4761; ve Yi ve arkadaslari, J. lmmunol., 1998, 160, 5898-5906;
Uluslararasi patent basvurulari WO96/02555, WO98/ 16247,
WO98/18810, WO98/40100, WO98/55495, WO98/37919 ve
WO98/52581) yani en az bir CG din'ukleotiti ihtiva eder ve istege
bagli olarak sitosin yerine 5-ineti1sitosin kullanilir; (8) bir
polioksietilen eter veya bir polioksietilen ester örn., ref. 134; (9) bir
oktoksinol [135] veya bir polioksietilen alkil eter ile koinbinasyon
halinde bir polioksietilen sorbitan ester surfektan veya en az bir ilave
iyonik olmayan surfektan örnegin bir oktoksinol ile kombinasyon
halinde ester surfektan [136]; (10) bir saponin ve bir iminüno-uyarici
oligonükleotit (öm., bir CpG oligonükleotiti) [137]; (11) bir immüno-
uyarici ve bir metal tuzu partikülü, örn., ref. 138; (12) bir saponin ve
bir su içinde yag emülsiyonu, örn. ref. 139; (13) bir saponin (örn.,
QSZl) + 3dMPL + IL-12 (istege bagli olarak + bir sterol) öin., ref.
140; (14) E. coli isiya yatkin enterotoksin ("LT") veya bunun
detoksifiye mutantlari `Örnegin K63 veya R72 mutantlari ['Öm., 141.
referansin 5. Bölümü]; (15) kolera toksin ("CT") veya bunun
detoksifiye mutantlari [örn., 141. referansin 5. Bölümü]; (16)lipozomlar [123. referansin 13 ve 14. bölümleri]; (17) çitosan [örn.,
ref. 142]; (18) iki iplikçikli RNA; (19) mikropartiküller (yani ~100nm
ila ~150um çapinda, daha fazla tercihen ~200nm ila ~30um çapinda
ve en fazla tercihen ~500nm ila ~10um çapinda partiküller), biyo-
degrade olabilen ve toksik olmayan materyallerden olusturulmus
(örn., bir poli((1-hidroksi asit) örnegin poli(laktid-ko-glikolid), bir
polihidroksibutirik asit, bir poliortoester, bir polianhidrid, bir
polikaprolakton Vb.), istege bagli olarak (om, SDS ile) negatif yüklü
bir yüzeye veya (tüm, bir katyonik deterjan, 'Örnegin CTAB ile) pozitif
yüklü bir yüzeye sahip olacak sekilde isleme tabi tutulmustur; veya
(20) kompozisyonun etkinligini güçlendirmek için immüno-uyarici
ajanlar olarak görev yapan diger maddeler [örn, 123. referansin 7.
bölümü]Alüininyum tuzlari (Özellikle alüminyum fosfatlar ve/Veya
hidroksidler) ve MF59, mevcut bulusa ait sakarit anti jenleri ile birlikte
kullanilmak üzere tercih edilir. Bir alüminyum fosfat kullanildiginda
bir veya daha fazla sakaritin alüininyuin tuzu üzerine adsorbe edilmesi
mümkündür, ancak sakaritlerin tuza adsorbe edilmesi tercih edilmez
Ve, çözelti içinde serbest fosfat iyonlarinin dahil edilmesi (öm., bir
fosfat tamponu kullanilarak) yoluyla saglanir. Bir alüminyum
hidroksid kullanildiginda sakaritlerin tuza adsorbe edilmesi tercih
edilir. Adjuvan olarak alüminyum hidroksid kullanilmasi, A
serogrubundan sakarit için özellikle avantajlidir.Bulusa ait koinpozisyonlarda bazi anti jenlerin bir alüminyum
hidrokside adsorbe edilmesi, ancak diger anti jenlerin bir alüminyum
fosfat ile birlikte bulunmasi mümkündür. Tetravalent N.meningitidis
serogrubu kombinasyonlari için `Örnegin asagidaki permütasyonlarmümkündür:
Serogrup Alüminyum tuzu (H : bir hidroksid; P : bir fosfat)A P H P H H H P P P H H H P P P H
C P H H P H H P H H P P H P H P P
W135 P H H H P H H P H H P P P P H P
Y P H H H H P H H P P H P H P P P
Trivalent Nmeningitidis serogrubu kombinasyonlari için asagidakipermütasyorilar mümkündür:
Serogrup Alüminyum tuzu (H = bir hidroksid; P = bir fosfat)
C P H H H P P P H
W] 35 P H H P H P H P
Y P H P H H H P P
Formüle edildikten sonra bulusa ait kompozisyonlar süjeye direkt
olarak uygulanabilir. Tedavi edilecek süjeler, hayvanlar olabilir;
özellikle insan sü jeler tedavi edilebilir. Asilar çocuklarin ve ergenlerin
asilanmasi için özellikle faydalidir. Bunlar sistemik ve/veya mukoza]
yollarla verilebilir.Tipik olarak immünojenik kompozisyonlar, sivi çözeltiler veya
süspansiyonlar seklinde enjeksiyonluk ürünler olarak hazirlanir;
enjeksiyon öncesinde sivi araçlar içerisinde çözeltiye veya
süspansiyona uygun kati formlar da hazirlanabilir. Preparasyon ayrica
emülsife edilebilir veya ad juvan etkisini güçlendirmek içiii lipozomlar
içinde kapsül haline getirilebilir. Kompozisyonlarin dogrudan
veriliiiesi genellikle parenteral (ör-n., subkütan, intraperitonel,
intravenöz veya intramüsküler yoldan enjeksiyon yoluyla veya birdokunun interstitiyal bosluguna verilme suretiyle) yoldan olacaktir.Kompozisyonlar ayrica bir lezyon içine uygulanabilir. Diger
uygulama yollari arasinda oral ve pulmoner uygulama, fitiller ve
transdermal veya transkütan uygulamalar (örn., bakiniz ref. 143),
igneler ve hipospreyler bulunur. Doza j tedavisi, tek dozlu bir program
veya çok dozlu bir program (örn., booster dozlari içeren) olabilir.
Bulusa ait asilar tercihen sterildir. Bunlar tercihen pirojensizdir.
Bunlar tercihen öm., pH 6 ile pH 8 arasinda, genellikle pH 7'de
tainponlanir. Bir asi bir alüminyum hidroksid tuzu içerdiginde bir
histidin tamponunun kullanilmasi tercih edilir [144].Bulusa ait asilar, düsük düzeylerde (örn.,
Claims (16)
- . Bir bakteriyel kapsüler polisakaritin saflastirilmasina ve bir tasiyici proteine konjugatlanmasina yönelik bir proses olup, asagidaki adimlari içerir: polisakkaridin saflastirilmasi, (a) bir ya da daha fazla katyonik deterjan kullanilarak polisakaritin çökeltilmesi, ardindan (b) çökeltilen polisakaritin %75 ve %95 arasindaki bir nihai konsantrasyonda etanol kullanilarak çözünürlestirilmesi, polisakkaridin bir tasiyici proteine konjugasyonu, burada tasiyici protein bir bakteriyel toksindir ya da toksoittir ve burada konjugatli sakkarit, 05:] ve 5:] arasinda bir sakkarit:pr0tein oranina (W/W) sahiptir. burada bakteriyel kapsüler polisakkarit Neisseria meningitidis serogrup A, W135 ya da Y”den ya da Haemophiius influenzae°den ya da Streptococcus pneurnoniae°den gelir ve burada bir ya da daha fazla katyonik deterjan setiltrimetilamonyum bromi'ir'û. içerir.
- . Bir bakteriyel kapsüler polisakaritin saflastirilmasina ve bir tasiyici proteine konjugatlanmasina yönelik bir proses olup, asagidaki adimlari içerir: polisakkaridin saflastirilmasi, (a) bir ya da daha fazla katyonik deterjan kullanilarak polisakaritin çökeltilmesi, ardindan (b) çökeltilen polisakaritin %75 ve %95 arasindaki bir nihai konsantrasyonda etanol kullanilarak çözünürlestirilmesi, sakkaridin bir siyanilatlama reaktifi ile aktive edilmesi, ve polisakkaridin bir tasiyici proteine konjugasyonu, burada tasiyici protein bir bakteriyel toksindir ya da toksoittir, burada bakteriyel kapsüler polisakkarit Neisseria meningitidis serogrup A, W135 ya da Ysden ya da HaemOphiius influenzae°den ya da Streptococcus pneuinoniae”den gelir ve burada bir ya da daha fazla katyonik deterjan setiltrimetilamonyum brom'ûr'ü içerir.
- . Isteni l”e ya da istem 2°ye göre proses olup, burada saflastirma ayrica kontaminantlari ekarte etmek için adim (b)”de elde edilen polisakkariti muamele etme adimi (e)”yi içerir.
- . Istem 3°e göre proses olup, burada adim (o) bir ya da daha fazla filtrasyon adimini içerir.
- . Istem 4°e göre proses olup, burada adim (c) derinlik filtrasyonunu, aktive edilmis karbon yoluyla filtrasyonu, ebat filtrasyonunu ve/Veya ultrafiltrasyonu içerir.
- . Onceki istemlerden herhangi birine göre proses olup, burada adim (b)”de ya da adim (c)°de elde edilen polisakkarit ardindan çökeltilir.
- 7. Istem 6°ya göre proses olup, burada çökelme kalsiyum ya da sodyum tuzlarinin eklenmesiyle gerçeklesir.
- 8. Önceki istemlerden herhangi birine göre proses olup, burada tasiyici protein difteri toksoit ya da tetanoz toksoittir.
- 9. Önceki istemlerden herhangi birine göre proses olup, burada konjugasyonu sonrasinda serbest ve konjugatli sakkaritler
- 10.Istem 9°a göre proses olup, burada ayrisma hidrofobik kromatografiyi, tegetsel ultrafiltrasyonu ya da diyafiltrasyonu kullanilir.
- 11.N.Meningitidis”in birden fazla serogrubundan sakkaritlerin bir karisimini yapma islemi olup, önceki istemlerden herhangi birinin prosesini içerir ve ayrica konjugatiri karisimi saglamak için baska biyolojik moleküllerle karistirilmasi adimini içerir.
- 12.Istem ll”e göre proses olup, burada N.Meningitidis suslari A, C, W] 35 ve/Veya Y”den alinan sakkarit anti jenleri karistirilir.
- 13.Istem 12”ye göre proses olup, burada karistirma islemi A ve C olmak üzere her iki serogruptan gelen kapsüler sakkaritleri içerir ve MenA sakkaritrMenC sakkarit orani (w/W) 2: 1 ”dir,
- 14.Istem 12°ye göre proses olup, burada karistirma islemi, Y serogrubundan ve serogrup C ve W135”in birinden ya da her ikisinden gelen kapsüler sakkaritleri içeren bir bilesim saglar ve burada MenY sakkaridizMenWl35 sakkaridi orani (W/W) l”den daha fazladir ve/Veya MenY sakkaridi:MenC sakkaridi orani (W/W) 1°den daha düsüktür.
- 15.Istem 12°ye göre proses olup, burada karistirma islemi serogrup 5 A, C, Wl35 ve Y”den elde edilen kapsüler sakkaritleri içeren bir bilesimi verir ve burada A:C:Wl35:Y serogruplari l:l :l:1; sahiptir.
- 16.Bir asiyi formüle etmek için bir proses olup, 'Önceki istemlerden herhangi birinin prosesini içerir ve ayrica bir alüminyum fosfat ve/Veya bir alüminyum hidroksit olan bir adjuvanla sakkarit antijen(ler)inin karistirilmasini ihtiva eden asi formülasyonu 15 adim(lar)1n1 içerir.
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