US20120328659A1 - Treatment of streptococcal infections - Google Patents

Treatment of streptococcal infections Download PDF

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US20120328659A1
US20120328659A1 US13/581,940 US201113581940A US2012328659A1 US 20120328659 A1 US20120328659 A1 US 20120328659A1 US 201113581940 A US201113581940 A US 201113581940A US 2012328659 A1 US2012328659 A1 US 2012328659A1
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phtd
pht
protein
streptococcus pneumoniae
proteins
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Philippe Denoel
Philippe Vincent Hermand
Steve Labbe
Jan Poolman
Stephane Rioux
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GlaxoSmithKline Biologicals SA
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    • 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
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00—Drugs for disorders of the senses
    • A61P27/16—Otologicals
    • 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
    • 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
    • A61K2039/555—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
    • A61K2039/55566—Emulsions, e.g. Freund's adjuvant, MF59
    • 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
    • A61K2039/55572—Lipopolysaccharides; Lipid A; Monophosphoryl lipid A

Definitions

  • the present application relates to the field of vaccines and immunogenic compositions that protect against Streptococcal disease and particularly to methods of treating Streptococcus pneumoniae disease using vaccines containing proteins from the polyhistidine triad family of proteins, and in particular, to methods of treatment using these vaccines and immunogenic compositions
  • Streptococcus pneumoniae is one of the leading causes of infectious morbidity and mortality in the world, responsible for a large spectrum of infections such as otitis media, pneumonia, bacteremia and meningitis ⁇ Hausdorff 2005, McCullers 2001 ⁇ .
  • infections such as otitis media, pneumonia, bacteremia and meningitis ⁇ Hausdorff 2005, McCullers 2001 ⁇ .
  • the emergence of antibiotic-resistant strains of this micro-organism has further underlined the need for providing effective prophylactic vaccination ⁇ Lynch, III 2005, Bridy-Pappas 2005 ⁇ .
  • Pht protein family restricted to the genus Streptococcus , comprises promising ones, being well-conserved across the pneumococcal species ⁇ Hamel 2004, Zhang 2001 ⁇ , and being antibody targets in infected individuals and protective upon challenge in immunized mice ⁇ Beghetto 2006 ⁇ .
  • this protein family was independently reported by three groups, and three separate denominations were used: Pht (for pneumococcal histidine triad) ⁇ Adamou 2001 ⁇ , Php (for pneumococcal histidine protein) ⁇ Zhang 2001 ⁇ , and BVH ⁇ Hamel 2004 ⁇ .
  • PhtA (BVH-11-3), PhtB (PhpA/BVH-11) and PhtD (BVH-11-2) that share up to 81% sequence identity
  • PhtE (BVH-3) that diverges from the three other proteins, showing only up to 35% identity with them. It is a longer protein, the only one with six repeats of the histidine triad motif.
  • Streptococcus pneumoniae elicits different disease states exhibiting different pathologies depending on the site at which the pneumococcal population expands. Septicaemia occurs where the S. pneumoniae enters to blood steam, whereas pneumonia occurs where S. pneumoniae multiplies in the lung. S. pneumoniae is also an important pathogen in otitis media infections. S. pneumoniae can also enter the cerebrospinal fluid to cause meningitis.
  • a method of treating or preventing Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in an environment where the concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae ; comprising the step of administering a pharmaceutically effective amount of the PhtX protein to a human patient.
  • an immunogenic composition comprising a pharmaceutically effective amount of an isolated PhtX protein for use in the treatment or prevention of a Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in a human patient in an environment where the concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae.
  • a pharmaceutically effective amount of an isolated PhtX protein in the manufacture of a medicament for the treatment or prevention of a Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in a human patient in an environment where the concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae.
  • FIG. 1 Organization of the pht genes in Streptococcus pneumoniae serotype 4 strain TIGR4.
  • FIG. 2 Promoter-containing upstream regions of the pht genes.
  • the ⁇ 35 and ⁇ 10 regions are double-underlined, transcription start sites are indicated by a boldface letter and the symbol (+1), putative ribosome binding sites (rbs) are underlined, and open reading frames are represented by arrows indicating the direction of transcription over a series of boldface letters.
  • the numbers on the left correspond to sequence positions in GenBank accession numbers AY569979 (a, d and e) and AY569980 (b and c).
  • FIG. 3 Rho-independent transcription terminator sequences of the pht and ptsl genes.
  • the region in italics phtF gene; putative start codon doubly underlined
  • underlined stop codons prevent significant gene translation.
  • the numbers correspond to sequence positions in GenBank accession numbers AY569979 (a and c) and AY569980 (b, d and e).
  • FIG. 4 RT-PCR analyses of the pht transcripts.
  • FIG. 5 SDS-PAGE immunoblotting of bacterial extracts.
  • Anti-PhtD antibody was used to probe extracts from the PhtABDE ⁇ quadruple mutant (A), the PhtE ⁇ mutant (B), PhtD ⁇ mutant (C), PhtB ⁇ mutant (D), PhtA ⁇ mutant (E), and the wild-type (F) strains.
  • the position of the different Pht bands is indicated on the right, and a molecular mass mark is on the left side of the picture.
  • FIG. 6 Growth curves of 4/CDC wild-type strain and Pht-deficient mutants in MS medium (a). The growth curves of the wild-type, PhtD-deficient and Pht quadruple mutant were also determined in MS with or without Zn 2+ 200 ⁇ M (b), Mn 2+ 200 ⁇ M (c), or Fe 2+ 200 ⁇ M (d). Each figure depicts the results of one experiment representative of three.
  • FIG. 7 WU2 bacterial cells were cultured with or without TPEN 30 ⁇ M, a zinc chelator. Next, cells were probed with anti-PhtB/D (a), anti-PhtE (b), anti-PhtD/E (c), or anti-type 3 polysaccharide (d) antibodies followed by AlexaFluor-conjugated goat anti-mouse secondary antibody before they were analyzed by flow cytometry. As controls, cells were incubated with the secondary conjugate antibody. Representative FACS plots of the different conditions are shown.
  • FIG. 8 Western blot analysis. Whole-cell extracts were submitted to SDS-PAGE followed by immunoblotting. Nine different strains were probed with a polyclonal anti-PhtD (a), and 8 with a polyclonal anti-PhtE (b). Molecular mass marker is shown.
  • FIG. 9 Signal sequences comparison of PhtX family members. The shaded areas identify amino acids which are conserved in at least 2 ⁇ 3 PhtX family members.
  • FIG. 11 Antibody levels after immunization.
  • FIG. 13 Vaccine efficacy in a S. pneumoniae naso-pharyngeal colonization model.
  • Balb/c mice were immunized with PhtD, PhtA, PhtB, PhtE, or LT alone (Ctrl), before they were intranasally challenged with the 2/D39 pneumococcal strain.
  • Bacterial colonies were counted in nasal washings at day 2 and at day 6 post-challenge, and expressed as log 10 mean cfu. Each dot represents a mouse. Black horizontal bars are geometric means. Dashed line indicates limit of detection (at 0.84).
  • Statistical analyses were carried out per day with ANOVA. All significant differences, compared with control, are shown. * p ⁇ 0.05; ns: not significant.
  • FIG. 14 Vaccine efficacy in a S. pneumoniae naso-pharyngeal colonization model.
  • Balb/c mice were immunized with either CbpA, PspA, PhtD, PsaA, or LT alone (Control), before they were intranasally challenged with either the 2/D39 (A), the 4/CDC (B), or the 6B/CDC (C) pneumococcal strain.
  • Bacterial colonies were counted in nasal washings at day 2 and at day 6 post-challenge, and expressed as log 10 mean cfu. Each dot represents a mouse. Dashed lines indicate limit of detection (at 0.84). Black horizontal bars are geometric means.
  • Statistical analyses were carried out per day with ANOVA. All significant differences, compared with control, are shown. * p ⁇ 0.05; ** p ⁇ 0.01; ***p ⁇ 0.001, ns: not significant.
  • FIG. 15 Vaccine efficacy in a S. pneumoniae lung colonization model.
  • CBA/J mice were immunized with AS02-adjuvanted PhtD or with AS02 only (Ctrl), before they were challenged with the moderately virulent 19F/2737 pneumococcal strain.
  • Lungs were taken at day 3, 4 or 5 post-challenge, and bacterial load was evaluated by colony counting (cfu). Each dot represents a mouse. Dashed line indicates limit of detection (at 2). Black horizontal bars are geometric means.
  • the groups were compared with ANOVA2 over the three days, followed by Tuckey-HSD: p ⁇ 0.0001.
  • the invention provides a method of treating or preventing Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in an environment where the concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae ; comprising the step of administering a pharmaceutically effective amount of the PhtX protein to a human patient.
  • Zn2+ and Mn2+ are present in a human body in both free and bound forms. Bound Zn2+ or Mn2+ is bound to proteins such as albumin and makes up the majority of these ions. On the other hand, a small amount of free Zn2+ or Mn2+ is present in body fluids such as blood, lymph, interstitial fluid or cerebrospinal fluid.
  • bound relates to ions which are tightly associated with proteins such as albumin.
  • free relates to ions which are not tightly associated with proteins such as albumin. Such free ions are more available for uptake by S. pneumoniae .
  • the method of the invention provides a method of treating or preventing Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in an environment where the free concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae .
  • the method of the invention provides a method of treating or preventing Streptococcus pneumoniae infection wherein the Streptococcus pneumoniae infection occurs in an environment where the bound and/or free concentration of Zn 2+ and/or Mn 2+ is sufficiently low to upregulate the expression of at least one PhtX protein in the Streptococcus pneumoniae.
  • Bt the term “sufficiently low to upregulate the expression of at least one PhtX protein” for the purposes of the invention, it is meant that the level of Zn2+ and/or Mn2+ (bound and/or free) is:
  • the level of bound Zn2+ is reduced. In an embodiment, the level of free Zn2+ is reduced.
  • Situation a) may be achieved through a decrease in the overall levels of Zn2+ and/or Mn2+ whereas situation b) may be achieved by the S. pneumoniae infection occurring at a site which has comparatively low levels of Zn2+ and/or Mn2+.
  • a PhtX protein is a member of the histidine triad family of proteins.
  • the PhtX protein is optionally the full length protein but may be a fragment of the protein or a fragment or fusion protein comprising at least one fragment or full length PhtX protein.
  • the PhtX protein expressed in S. pneumoniae will be a full length protein, however the PhtX protein administered to a human patient is optionally a full length PhtX protein, a fragment of a PhtX protein or a fusion protein comprising at least one PhtX protein or fragment thereof.
  • the PhtX protein is selected from the group consisting of PhtA, PhtB, PhtD and PhtE. In an embodiment, the PhtX protein is PhtD.
  • the present invention relates to members of the polyhistidine triad family (Pht) proteins, fragments or fusion proteins thereof.
  • the PhtA, PhtB, PhtD or PhtE proteins may have an amino acid sequence sharing 80%, 85%, 90%, 95%, 98%, 99% or 100% identity with a sequence disclosed in WO 00/37105 or WO 00/39299 (e.g. with amino acid sequence 1-838 or 21-838 of SEQ ID NO: 4 of WO 00/37105 for PhtD).
  • the Pht (Poly Histidine Triad) family comprises proteins PhtA, PhtB, PhtD, and PhtE.
  • the family is characterized by a lipidation sequence, two domains separated by a proline-rich region and several histidine triads, possibly involved in metal or nucleoside binding or enzymatic activity, (3-5) coiled-coil regions, a conserved N-terminus and a heterogeneous C terminus. It is present in all strains of pneumococci tested. Homologous proteins have also been found in other Streptococci and Neisseria .
  • phrases Pht A, B, D, and E refer to proteins having sequences disclosed in the citations above or below as well as naturally-occurring (and man-made) variants thereof that have a sequence homology that is at least 90% identical to the referenced proteins. Optionally it is at least 95% identical or at least 97% identical.
  • This protein also is from the polyhistidine triad family and has the type II LXXC signal motif.
  • an immunologically functional equivalent is the protein Sp42 disclosed in WO 98/18930.
  • a PhtB truncate (approximately 79 kD) is disclosed in WO99/15675 which is also considered a member of the PhtX family.
  • PhtE is disclosed in WO00/30299 and is referred to as BVH-3.
  • any Pht protein is referred to herein, it is meant that immunogenic fragments or fusions thereof of the Pht protein can be used.
  • a reference to PhtX includes immunogenic fragments or fusions thereof from any Pht protein.
  • a reference to PhtD or PhtB is also a reference to PhtDE or PhtBE fusions as found, for example, in WO0198334.
  • the method of treatment or use of the invention may involve the administration of the full length PhtX protein, a fragment of the PhtX protein or a fusion protein containing at least 1 or 2 fragment(s) of PhtX proteins.
  • each fragment optionally contains one or more histidine triad motif(s) and/or coiled coil regions of such polypeptides.
  • a histidine triad motif is the portion of polypeptide that has the sequence HxxHxH where H is histidine and x is an amino acid other than histidine.
  • a coiled coil region is a region predicted by “Coils” algorithm Lupus, A et al (1991) Science 252; 1162-1164.
  • the or each fragment includes one or more histidine triad motif as well as at least one coiled coil region.
  • the or each fragment contains exactly or at least 2, 3, 4 or 5 histidine triad motifs (optionally, with native Pht sequence between the 2 or more triads, or intra-triad sequence that is more than 50, 60, 70, 80, 90 or 100% identical to a native pneumococcal intra-triad Pht sequence—e.g. the intra-triad sequence shown in SEQ ID NO: 4 of WO 00/37105 for PhtD).
  • the or each fragment contains exactly or at least 2, 3 or 4 coiled coil regions.
  • a Pht protein disclosed herein includes the full length protein with the signal sequence attached, the mature full length protein with the signal peptide (for example 20 amino acids at N-terminus) removed, naturally occurring variants of Pht protein and immunogenic fragments of Pht protein (e.g.
  • the PhtX protein is a fragment described in WO 09/12588, for example those comprising or consisting of the sequences of SEQ ID NO: 2, 3 or 4.
  • PhtD includes the full length protein with the signal sequence attached, the mature full length protein with the signal peptide (for example 20 amino acids at N-terminus) removed, naturally occurring variants of PhtD and immunogenic fragments of PhtD (e.g. fragments as described above or polypeptides comprising at least 15 or 20 contiguous amino acids from a PhtD amino acid sequence in WO00/37105 or WO00/39299 wherein said polypeptide is capable of eliciting an immune response specific for said PhtD amino acid sequence in WO00/37105 or WO00/39299 (e.g. SEQ ID NO: 4 of WO 00/37105 or SEQ ID NO: 14 of WO 00/39299 for PhtD). All forms of PhtD mentioned above can be used in the present invention.
  • the method of treatment or prevention is aimed at S. pneumoniae growing in the blood of the patient, for example for treatment or prevention of septicemia or bacteraemia.
  • the level of the free concentration of Zn2+ in the blood is less than 10 nM, 7 nM, 5 nM, 3 nM, 2 nM, 1 nM, 700 pM, 500 pM, 300 pM, 200 pM 100 pM, 70 pM, 50 pM, 30 pM, 20 pM or 10 pM as measured from blood serum.
  • the level of Zn2+ may be measured by preparing a serum sample from a blood sample using standard procedures and analysing the sample using graphite furnace absorbance spectrophotometer (GF-AAS) or by using atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • GF-AAS graphite furnace absorbance spectrophotometer
  • atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • the bound and free concentration of Zn2+ in the blood is less than 5, 3, 2, 1, 0.5, 0.3, 0.2 or 0.1 mg/l or less than 20, 18, 15, 12, 10, 8, 5, 3, 2, 1, 0.5 or 0.1 ⁇ M as measured from blood serum.
  • the level of Zn2+ may be measured by preparing a serum sample from a blood sample using standard procedures and analysing the sample using graphite furnace absorbance spectrophotometer (GF-AAS) or by using atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • the free concentration of Mn2+ in the blood is less than 10 nM, 7 nM, 5 nM, 3 nM, 2 nM, 1 nM, 700 pM, 500 pM, 300 pM, 200 pM 100 pM, 70 pM, 50 pM, 30 pM, 20 pM or 10 pM as measured from blood serum.
  • the level of Mn2+ may be measured by preparing a serum sample from a blood sample using standard procedures and analysing the sample using atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • the bound and free concentration of Mn2+ in the blood is less than 5, 3, 2, 1, 0.5, 0.3, 0.2 or 0.1 mg/l or less than 20, 18, 15, 12, 10, 8, 5, 3, 2, 1, 0.5, 0.2 or 0.1 ⁇ M as measured from blood serum.
  • the level of Mn2+ may be measured by preparing a serum sample from a blood sample using standard procedures and analysing the sample using atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • the method of treatment or prevention is aimed at S. pneumoniae growing in the lung of the patient, for example the treatment or prevention of pneumonia.
  • the free concentration of Zn2+ in the lung is less than 300, 200, 100, 80, 50, 20, 10, 5, 3 or 1 ⁇ g/kg as measured from a bronchial lavage.
  • the free concentration of Mn2+ in the lung is less than 300, 200, 100, 80, 50, 20, 10, 5, 3 or 1 ⁇ g/kg as measured from a bronchial lavage.
  • the level of Zn2+ or Mn2+ is measured from a tissue sample in which case the concentration of Zn2+ (or Mn2+) in the lung tissue is less than 20, 15, 10, 5, 2 or 1 ⁇ g/g or 300, 200, 150, 100, 50, 20, 10, 5, 2, 1, 0.5 or 0.1 ⁇ M as measured from lung tissue.
  • the level of ions in the tissue sample can be measured by atomic absorption spectroscopy for example by using a Vista AX-CCD simultaneous ICP-AES spectrometer.
  • the S. pneumoniae infection occurs in the a compartment of the ear, for example the middle ear, for example as an otitis media infection.
  • the level of Zn2+ and/or Mn2+ in the middle ear is less than 300, 200, 150, 100, 50, 20, 10, 5, 2, 1, 0.5, 0.2 or 0.1 ⁇ M.
  • the Streptococcus pneumoniae infection occurs in the meninges, for example as a meningitis infection.
  • concentration of Zn2+ in the cerebrospinal fluid is less than 1.5, 1, 0.75, 0.5, 0.25 or 0.1 ⁇ M or less than 100, 75, 50, 40, 25, or 10 ⁇ g/L.
  • concentration of Mn2+ in the cerebrospinal fluid is less than 2.5, 2, 1.5, 1 or 0.5 ⁇ g/L or less than 50, 25, 10 or 5 nM.
  • the human patient has decreased level(s) of Zn2+ and/or Mn2+ as measured by broncheal lavage and/or blood test.
  • decreased level(s) it is meant that the level of Zn2+ and/or Mn2+ as measured by broncheal lavage or blood test is less than that of an average human.
  • the human patient to be treated with PhtX is Zn2+ and/or Mn2+ deficient. That is, the level of Zn2+ and/or Mn2+ is less than 90, 80, 70, 60, 50, 40, 30, 20, 10, 5 or 1% of the usual level for that body fluid, for example, blood serum, cerebrospinal fluid, interstitial fluid, bronchial lavage.
  • the human patient is stressed.
  • the stressed patient has lower levels of Zn2+ and/or Mn2+ in the body, for example in the blood, interstitial fluid, cerebrospinal fluid and/or lymph.
  • the human patient has lower Zn2+ and/or Mn2+ levels in the body due to previous infection with a bacterial strain, for example a S. pneumoniae, N. meningitidis, H. influenzae, S. aureus, S. epidermidis, C. difficile , Group A streptococcus , Group B streptococcus and/or M. catarrhalis strain.
  • a bacterial strain for example a S. pneumoniae, N. meningitidis, H. influenzae, S. aureus, S. epidermidis, C. difficile , Group A streptococcus , Group B streptococcus and/or M. catarrhalis strain.
  • the previous infection is optionally a chronic bacterial infection.
  • the administration of PhtX is for the treatment or prevention of Streptococcus pneumoniae infection in the form of scepticaemia, bacteraemia, meningitis, otitis media or pneumonia.
  • the PhtX protein may also be beneficially combined with further antigens in the method or use of the invention.
  • the immunogenic composition comprises all of the proteins from within the following combinations, either as carrier proteins or as free proteins or a mixture of the two.
  • both proteins may be used as carrier proteins, or both proteins may be present as free proteins, or both may be present as carrier and as free protein, or one may be present as a carrier protein and a free protein whilst the other is present only as a carrier protein or only as a free protein, or one may be present as a carrier protein and the other as a free protein.
  • Combinations include, but are not limited to, PhtD+NR1xR2, PhtD+NR1xR2-Sp91Cterm chimeric or fusion proteins, PhtD+Ply, PhtD+Sp128, PhtD+PsaA, PhtD+PspA, PhtA+NR1xR2, PhtA+NR1xR2-Sp91Cterm chimeric or fusion proteins, PhtA+Ply, PhtA+Sp128, PhtA+PsaA, PhtA+PspA, R1xR2+ PhtD, R1xR2+ PhtA.
  • NR1xR2 is from CbpA or PspC.
  • the vaccine composition comprises detoxified pneumolysin and PhtD or PhtDE as carrier proteins.
  • the vaccine composition comprises detoxified pneumolysin and PhtD or PhtDE as free proteins.
  • the combination of proteins comprises PhtD and pneumolysin or PhtD and detoxified pneumolysin.
  • the method or use of the invention uses a combination of PhtD, detoxified pneumolysin and at least one S. pneumoniae capsulat saccharide, preferably conjugated to a carrier protein.
  • the immunogenic composition of the invention comprises pneumolysin.
  • the pneumolysin is preferably detoxified, for example by chemical treatment or by mutation of at least one amino acid.
  • the present invention further provides an immunogenic composition containing a pharmaceutically acceptable excipient and/or an adjuvant.
  • the immunogenic compositions of the present invention may be adjuvanted, particularly when intended for use in an elderly population but also for use in infant populations.
  • Suitable adjuvants include an aluminum salt such as aluminum hydroxide gel or aluminum phosphate or alum, but may also be other metal salts such as those of calcium, magnesium, iron or zinc.
  • the adjuvant is optionally selected to be a preferential inducer of a TH1 type of response.
  • Th1-type cytokines tend to favour the induction of cell mediated immune responses to a given antigen, whilst high levels of Th2-type cytokines tend to favour the induction of humoral immune responses to the antigen.
  • Th1 and Th2-type immune response are not absolute. In reality an individual will support an immune response which is described as being predominantly Th1 or predominantly Th2.
  • Th1 and Th2-type immune response are often convenient to consider the families of cytokines in terms of that described in murine CD4 +ve T cell clones by Mosmann and Coffman (Mosmann, T. R. and Coffman, R. L. (1989) TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. (Annual Review of Immunology, 7, p 145-173).
  • Th1-type responses are associated with the production of the INF- ⁇ and IL-2 cytokines by T-lymphocytes.
  • Th1-type immune responses are not produced by T-cells, such as IL-12.
  • Th2-type responses are associated with the secretion of 11-4, IL-5, IL-6, IL-10.
  • Suitable adjuvant systems which promote a predominantly Th1 response include: Monophosphoryl lipid A or a derivative thereof (or detoxified lipid A in general—see for instance WO2005107798), particularly 3-de-O-acylated monophosphoryl lipid A (3D-MPL) (for its preparation see GB 2220211 A); and a combination of monophosphoryl lipid A, optionally 3-de-O-acylated monophosphoryl lipid A, together with either an aluminum salt (for instance aluminum phosphate or aluminum hydroxide) or an oil-in-water emulsion.
  • an aluminum salt for instance aluminum phosphate or aluminum hydroxide
  • antigen and 3D-MPL are contained in the same particulate structures, allowing for more efficient delivery of antigenic and immunostimulatory signals. Studies have shown that 3D-MPL is able to further enhance the immunogenicity of an alum-adsorbed antigen [Thoelen et al. Vaccine (1998) 16:708-14; EP 689454-B1].
  • An enhanced system involves the combination of a monophosphoryl lipid A and a saponin derivative, particularly the combination of QS21 and 3D-MPL as disclosed in WO 94/00153, or a less reactogenic composition where the QS21 is quenched with cholesterol as disclosed in WO 96/33739.
  • a particularly potent adjuvant formulation involving QS21, 3D-MPL and tocopherol in an oil in water emulsion is described in WO 95/17210.
  • the immunogenic composition additionally comprises a saponin, which may be QS21.
  • the formulation may also comprise an oil in water emulsion and tocopherol (WO 95/17210).
  • Unmethylated CpG containing oligonucleotides (WO 96/02555) and other immunomodulatory oligonucleotides (WO0226757 and WO03507822) are also preferential inducers of a TH1 response and are suitable for use in the present invention.
  • Oil in water emulsion adjuvants per se have been suggested to be useful as adjuvant compositions (EP 0 399 843B), also combinations of oil in water emulsions and other active agents have been described as adjuvants for vaccines (WO 95/17210; WO 98/56414; WO 99/12565; WO 99/11241).
  • Other oil emulsion adjuvants have been described, such as water in oil emulsions (U.S. Pat. No. 5,422,109; EP 0 480 982 B2) and water in oil in water emulsions (U.S. Pat. No. 5,424,067; EP 0 480 981 B). All of which form oil emulsion systems (in particular when incorporating tocols) to form adjuvants and compositions of the present invention.
  • the oil emulsion (for instance oil in water emulsions) further comprises an emulsifier such as TWEEN 80 and/or a sterol such as cholesterol.
  • the oil emulsion (optionally oil-in-water emulsion) comprises a metabolisible, non-toxic oil, such as squalane, squalene or a tocopherol such as alpha tocopherol (and optionally both squalene and alpha tocopherol) and optionally an emulsifier (or surfactant) such as Tween 80.
  • a sterol e.g. cholesterol
  • the method of producing oil in water emulsions is well known to the man skilled in the art.
  • the method comprises mixing the tocol-containing oil phase with a surfactant such as a PBS/TWEEN80TM solution, followed by homogenisation using a homogenizer, it would be clear to a man skilled in the art that a method comprising passing the mixture twice through a syringe needle would be suitable for homogenising small volumes of liquid.
  • the emulsification process in microfluidiser M110S Microfluidics machine, maximum of 50 passes, for a period of 2 minutes at maximum pressure input of 6 bar (output pressure of about 850 bar)
  • the adaptation could be achieved by routine experimentation comprising the measurement of the resultant emulsion until a preparation was achieved with oil droplets of the required diameter.
  • the oil and emulsifier should be in an aqueous carrier.
  • the aqueous carrier may be, for example, phosphate buffered saline.
  • the size of the oil droplets found within the stable oil in water emulsion are optionally less than 1 micron, may be in the range of substantially 30-600 nm, optionally substantially around 30-500 nm in diameter, and optionally substantially 150-500 nm in diameter, and in particular about 150 nm in diameter as measured by photon correlation spectroscopy.
  • 80% of the oil droplets by number should be within the ranges, optionally more than 90% and optionally more than 95% of the oil droplets by number are within the defined size ranges.
  • the amounts of the components present in the oil emulsions of the present invention are conventionally in the range of from 0.5-20% or 2 to 10% oil (of the total dose volume), such as squalene; and when present, from 2 to 10% alpha tocopherol; and from 0.3 to 3% surfactant, such as polyoxyethylene sorbitan monooleate.
  • oil e.g. squalene
  • tocol e.g. ⁇ -tocopherol
  • An emulsifier, such as Tween80 or Span 85 may also be present at a level of about 1%. In some cases it may be advantageous that the vaccines of the present invention will further contain a stabiliser.
  • emulsion systems are described in WO 95/17210, WO 99/11241 and WO 99/12565 which disclose emulsion adjuvants based on squalene, ⁇ -tocopherol, and TWEEN 80, optionally formulated with the immunostimulants QS21 and/or 3D-MPL.
  • the adjuvant of the invention may additionally comprise further immunostimulants, such as LPS or derivatives thereof, and/or saponins.
  • further immunostimulants are described herein and in “Vaccine Design—The Subunit and Adjuvant Approach” 1995, Pharmaceutical Biotechnology, Volume 6, Eds. Powell, M. F., and Newman, M. J., Plenum Press, New York and London, ISBN 0-306-44867-X.
  • the vaccine preparations containing immunogenic compositions of the present invention may be used to protect or treat a mammal susceptible to infection, by means of administering said vaccine via systemic or mucosal route.
  • administrations may include injection via the intramuscular (IM), intraperitoneal (IP), intradermal (ID) or subcutaneous (SC) routes; or via mucosal administration to the oral/alimentary, respiratory, genitourinary tracts.
  • IM intramuscular
  • IP intraperitoneal
  • ID intradermal
  • SC subcutaneous
  • mucosal administration to the oral/alimentary, respiratory, genitourinary tracts or via mucosal administration to the oral/alimentary, respiratory, genitourinary tracts.
  • Intranasal (IN) administration of vaccines for the treatment of pneumonia or otitis media is possible (as nasopharyngeal carriage of pneumococci can be more effectively prevented, thus attenuating infection at its earliest stage).
  • the vaccine of the invention may be administered as a single dose, components thereof may also be co-administered together at the same time or at different times (for instance pneumococcal saccharide conjugates could be administered separately, at the same time or 1-2 weeks after the administration of the any bacterial protein component of the vaccine for optimal coordination of the immune responses with respect to each other).
  • the optional Th1 adjuvant may be present in any or all of the different administrations.
  • 2 different routes of administration may be used.
  • saccharides or saccharide conjugates may be administered IM (or ID) and bacterial proteins may be administered IN (or ID).
  • the vaccines of the invention may be administered IM for priming doses and IN for booster doses.
  • Vaccine preparation is generally described in Vaccine Design (“The subunit and adjuvant approach” (eds Powell M. F. & Newman M. J.) (1995) Plenum Press New York). Encapsulation within liposomes is described by Fullerton, U.S. Pat. No. 4,235,877.
  • the vaccines or immunogenic compositions of the present invention may be stored in solution or lyophilized.
  • the solution is lyophilized in the presence of a sugar acting as an amorphous lyoprotectant, such as sucrose, trehalose, glucose, mannose, maltose or lactose.
  • a sugar acting as an amorphous lyoprotectant such as sucrose, trehalose, glucose, mannose, maltose or lactose.
  • the solution is lyophilized in the presence of a sugar acting as an amorphous lyoprotectant, and a bulking agent providing improved cake structure such as glycine or mannitol.
  • a crystalline bulking agent allows for shortening freeze-drying cycles, in the presence of high salt concentration.
  • Examples of such mixtures for use in lyophilisation of the immunogenic compositions or vaccines of the invention include sucrose/glycine, trehalose/glycine, glucose/glycine, mannose/glycine, maltose/glycine, sucrose/mannitol/trehalose/mannitol, glucose/mannitol, mannose/mannitol and maltose/mannitol.
  • sucrose/glycine trehalose/glycine
  • glucose/glycine mannose/glycine
  • maltose/glycine sucrose/mannitol/trehalose/mannitol
  • glucose/mannitol mannose/mannitol and maltose/mannitol
  • the molar ratio of the two constituents is optionally 1:1, 1:2, 1:3, 1:4, 1:5 or 1:6.
  • Immunogenic compositions of the invention optionally comprise the lyophilisation reagents described above.
  • the above stabilising agents and mixtures of stabilising agents can further include a polymer capable of increasing the glass transition temperature (Tg′) of the formulation, such as poly(vinyl-pyrrolidone) (PVP), hydroxyethyl starch or dextran, or a polymer acting as a crystalline bulking agent such as polyethylene glycol (PEG) for example having a molecular weight between 1500 and 6000 and dextran.
  • a polymer capable of increasing the glass transition temperature (Tg′) of the formulation such as poly(vinyl-pyrrolidone) (PVP), hydroxyethyl starch or dextran, or a polymer acting as a crystalline bulking agent such as polyethylene glycol (PEG) for example having a molecular weight between 1500 and 6000 and dextran.
  • PVP poly(vinyl-pyrrolidone)
  • PEG polyethylene glycol
  • the immunogenic compositions of the present invention may be administered by any route, administration of the described vaccines into the skin (ID) forms one embodiment of the present invention.
  • Human skin comprises an outer “horny” cuticle, called the stratum corneum, which overlays the epidermis. Underneath this epidermis is a layer called the dermis, which in turn overlays the subcutaneous tissue.
  • the dermis which in turn overlays the subcutaneous tissue.
  • Intradermal vaccination with the vaccines described herein forms an optional feature of the present invention.
  • the conventional technique of intradermal injection comprises steps of cleaning the skin, and then stretching with one hand, and with the bevel of a narrow gauge needle (26-31 gauge) facing upwards the needle is inserted at an angle of between 10-15°.
  • the barrel of the needle is lowered and further advanced whilst providing a slight pressure to elevate it under the skin.
  • the liquid is then injected very slowly thereby forming a bleb or bump on the skin surface, followed by slow withdrawal of the needle.
  • Alternative methods of intradermal administration of the vaccine preparations may include conventional syringes and needles, or devices designed for ballistic delivery of solid vaccines (WO 99/27961), or transdermal patches (WO 97/48440; WO 98/28037); or applied to the surface of the skin (transdermal or transcutaneous delivery WO 98/20734; WO 98/28037).
  • Embodiments herein relating to “vaccine compositions” of the invention are also applicable to embodiments relating to “immunogenic compositions” of the invention, and vice versa.
  • OF1 and CBA/J female mice used in this study were purchased from Charles River laboratories (Lyon, France). Balb/c mice were from Harlan (Horst, The Netherlands). All experiments and assays were performed at GlaxoSmithKline Biologicals (GSK, Rixensart, Belgium) in accordance with the Belgian national guidelines for animal experimentation.
  • the strain 2/D39 was kindly provided by JC Paton (University of Sydney, Australia).
  • the strains 4/CDC and 6B/CDC were obtained from the Center for Disease Control and Prevention (CDC), and the 19F/2737 strain from the American type culture collection (ATCC).
  • the strain 3/43 was provided by E Yourassowski (Brugmann Hospital, University of Brussel, Belgium).
  • S. pneumoniae strain TIGR4 ⁇ Tettelin 2001 ⁇ was kindly provided by Andrew Camilli (Tufts University School of Medicine, Boston, Mass., USA).
  • the WU2 strain was kindly provided by David E Briles (University of Alabama at Birmingham, Birmingham, Ala., USA).
  • the type 4 strain was obtained from the CDC (Center for Disease Control & Prevention).
  • Pneumococci were routinely grown in Todd-Hewitt broth (THB, Difco) with 0.5% (w/v) yeast extract at 37° C./8% CO 2 .
  • TLB Todd-Hewitt broth
  • yeast extract 0.5% (w/v) yeast extract
  • erythromycin and/or spectinomycin Sigma-Aldrich, Bornem, Belgium was added at a concentration of 0.2 and 250 ⁇ g/ml; respectively.
  • Escherichia coli DH5 ⁇ and JM109 strains were grown in Luria-Bertani broth (LBT, Difco) with or without 1.5% (w/v) Bacto-agar (Difco) at 37° C. for 16 h. When appropriate, erythromycin or spectinomycin was added to the growth medium at a concentration of 100 ⁇ g/ml.
  • CbpA (or PspC) was a truncated recombinant protein, as described in Brookes-Walter et al J. Infect. Dis. 67; 6533-6542 (1999), kindly provided by JC Paton.
  • the protein was constructed from the sequence of the D39 strain and belongs thus to clade A.
  • PspA (clade 2) and PsaA are recombinant proteins originating from the 2/D39 strain Ogunniyi et al Infect. Immun. 68; 3028-3033 (2000), both provided by JC Paton.
  • Escherichia coli plasmid DNA was obtained using Plasmid Midi or Mini Purification Kit (Qiagen Benelux, Venlo, The Netherlands). PCR products were purified with the QIAquick PCR Purification Kit and DNA digests were purified on 1% (w/v) agarose gel using the QIAquick Gel Extraction Kit (Qiagen). Restriction and ligation enzymes were obtained from New England BioLabs (Westburg, Leusden, Belgium). The Expand High Fidelity System (Roche, Mannheim, Germany) was used for each PCR reaction of these studies. All commercial products were used under conditions recommended by the suppliers.
  • DNA sequencing was carried out with the Big Dye Terminator Sequencing Kit on an Applied Biosystems automated DNA sequencer (model 3100) (Applied Biosystems Inc, Forster City, Calif., USA). Sequence analyzes were performed with the MacVector V6.5 software (Oxford Molecular Ltd., Madison) or the Vector NTI 7.1 software (Informax), and sequences compared to the available S. pneumoniae TIGR4 genome sequence (www.tigr.org) ⁇ Peterson 2001 ⁇ .
  • Chromosomal DNA from each strain was obtained by harvesting confluent overnight growth from one or two heavily inoculated blood agar plates into 1 ml of TE (10 mM Tris-HCl; 5 mM EDTA; pH 7.8). The bacterial suspension was centrifuged for 5 minutes at maximal speed in a microcentrifuge and the pellet was resuspended in 75 ⁇ l of TE. Cell lysates were obtained by sequential addition of 20 ⁇ l of lysozyme (100 mg/ml) and 20 ⁇ l of proteinase K (20 mg/ml) and incubation at 37° C., 45 minutes.
  • lysis buffer (10 mM Tris-HCl, pH 8.0; 0.14 M NaCl; 0.1 M sodium citrate; 1 mM EDTA, pH 8.0; 0.1% (w/v) sodium deoxycholate) was added and incubated for 10 minutes at room temperature.
  • 250 ⁇ l of ammonium acetate (7.5 mM, pH 7.7) was added to crude lysate and incubated 10 minutes on ice.
  • the viscous DNA was extracted twice with phenol/chloroform/isoamyl (25:24:1) and precipitated in isopropyl alcohol.
  • the resulting DNA was washed with 70% (v/v) ethanol and resuspended in 50 ⁇ l TE containing 0.6 ⁇ l RNaseA (10 mg/ml). DNA suspensions were stored at 4° C.
  • RNA samples Contaminating genomic DNA was eliminated by incubating RNA samples with 1 unit of DNase I per ⁇ g of RNA for 1 h at 37° C., followed by DNase inactivation with 2.5 mM EDTA for 10 min at 65° C. Total RNA was quantified using the Ribogreen® RNA Quantification Kit (Molecular Probes) following manufacturer's instructions.
  • the method used to identify transcription starts was adapted from Ranasinghe & Hobbs ⁇ Ranasinghe 1998 ⁇ . Briefly, a primer specific for the 3′ end of the phtE gene was used to synthesize the first-strand complementary DNA (cDNA) from total RNA with the Superscript II reverse transcriptase (Invitrogen), following manufacturer's instructions. RNase A was then added for 1 h at room temperature to generate blunt 3′ ends on the cDNA-RNA hybrid. The hybrid was inserted into EcoRV-digested pKS plasmid (Stratagene) using T4 DNA ligase (incubation overnight, 16° C.). A PCR reaction was set up to amplify the 5′ end using another reverse 3′ end-specific phtE primer and pKS-specific T7 promoter primer. Sequencing of the pKS-cDNA junction was performed to identify the +1 base.
  • Terminator identification was performed using the Wisconsin Sequence Analysis Package version 10.1 (Genetics Computer Group) based on the method of Brendel & Trifonov ⁇ Brendel 1984 ⁇ .
  • RNA (2 ⁇ g) was first denatured for 5 min at 65° C. in a mixture containing 10 ⁇ M of 3′-end gene-specific reverse primer and 20 units of RNaseOut in a total volume of 10 ⁇ l.
  • the reverse transcription reaction was then carried out by adding 5 mM dithiothreitol, 1 mM dNTP, 15 units of Thermoscript reverse transcriptase (Invitrogen), 1 ⁇ cDNA synthesis buffer and RNase-free sterile water to a volume of 20 ⁇ l.
  • the reverse transcription mixture was incubated at 56-58° C. for 1 hour, followed by reverse transcriptase denaturation for 5 min at 85° C.
  • RNA strand on the RNA-cDNA hybrids was degraded by incubating the reverse transcription solution at 37° C. for 20 min with 1 unit of RNase H.
  • the PCR reaction was carried with 2 ⁇ l cDNA using different 5′ gene-specific forward primers and the 3′ gene-specific reverse primers used for the reverse transcription reaction (0.5 ⁇ M final concentrations), 0.2 mM dNTP, Taq DNA polymerase reaction buffer, 2.5 units of Taq DNA polymerase (Amersham Biosciences) and sterile water to a volume of 50 ⁇ l.
  • the PCR cycle consisted of initial denaturation at 94° C. for 5 min, followed by 25-30 cycles of denaturation at 94° C. for 15-30 sec, annealing at 55° C.
  • RNA preparation was also conducted to exclude DNA contamination in the RNA preparation.
  • PCR products were separated by 1% (w/v) agarose gel electrophoresis and visualized by ethidium bromide staining.
  • Mutator vectors were constructed from the pGEM-T vector (Promega Benelux, Leiden, the Netherlands) that replicates in E. coli but not in S. pneumoniae . They contain recombinant zones that correspond to the upstream and downstream regions of the pht genes to be deleted, amplified by PCR, surrounding an antibiotic-resistance gene (primers and restriction sites used to contruct the mutator vectors can be given on request). To prepare the quadruple Pht-deficient mutant, two different antibiotic resistance genes had to be used in order to combine deletion in the two different loci (locus phtD/phtE, and locus phtA/phtB).
  • erythromycin resistance gene amplified from a derivative of the pJDC9 vector, was selected for the phtD/phtE locus.
  • aad(9) gene purified from the pR350 plasmid (kindly provided by J Paton) was used.
  • the 4/CDC S. pneumoniae strain was prepared for transformation by two successive growing steps, before resuspension in CTM medium (10 g/l Casamino acids; 5 g/l tryptone; 5 g/l NaCL; 10 g/l yeast extract; 0.4 M K 2 HPO 4 ; 20% glucose; 30 mg/ml glutamine; 1% BSA, 0.1 M CaCL 2 ; pH 7.8) aliquoting, and freezing in 15% glycerol. Those aliquots were used for transformation. After thawing, CSP-1 or CSP-2 (100 ng/ml in CTM medium) was added to induce competence, and the bacteria were incubated at 37° C. Different time points were taken (5, 10, 15, and 20 min) to optimise competence.
  • CTM medium 10 g/l Casamino acids; 5 g/l tryptone; 5 g/l NaCL; 10 g/l yeast extract; 0.4 M K 2 HPO 4 ; 20% glucose; 30 mg/ml glutamine; 1% BSA,
  • mutator vector After addition of 1 ⁇ g of mutator vector, cells were incubated at 32° C. for 30 min, with shaking, followed by 2-4 h at 37° C., under 5% CO 2 . At last, bacteria were plated on blood agar with the appropriate antibiotics.
  • the PhtD,E-KO strain was transformed with the plasmid that brings PhtA,B deficiency by using the same protocol as described above.
  • Heat-killed bacterial suspensions were obtained by harvesting the confluent overnight growth from 5 heavily inoculated blood agar plates into 1 ml of sterile PBS (0.14 M NaCl, 2.7 mM KCl, 10 mM Na 2 HPO 4 , 1.8 mM KH 2 PO 4 , pH 7.2), and an incubation step at 56° C. for 45 minutes. Then, sample buffer (60 mM Trizma base, 1% (w/v) SDS, 10% (v/v) glycerol, 0.01% (w/v) bromophenol blue, 2% (v/v) ⁇ -mercaptoethanol) was added to the heat-killed suspensions.
  • sample buffer 60 mM Trizma base, 1% (w/v) SDS, 10% (v/v) glycerol, 0.01% (w/v) bromophenol blue, 2% (v/v) ⁇ -mercaptoethanol
  • Preparations were boiled for 5 minutes, centrifuged at maximum speed in a microcentrifuge for 2 minutes and separated by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) as described by Laemmli ⁇ Laemmli 1970 ⁇ . Proteins were electrophoretically transferred from acrylamide gels onto nitrocellulose membranes (Bio-Rad, Richmond, Calif.), as described ⁇ Towbin 1979 ⁇ . Membranes were probed with a mouse polyclonal antibody raised against PhtD, followed by goat anti-mouse IgG conjugated to alkaline phosphatase (Promega Benelux.). Enzyme-labelled bands were visualized with a NBT/BCIP substrate system.
  • Wild-type 4/CDC strain, and corresponding PhtD- and Pht quadruple-deficient mutants were cultured under different conditions of ion depletion or supplementation in a chemically defined synthetic medium (MS) ⁇ SICARD 1964 ⁇ .
  • MS medium was supplemented by increasing concentrations of, alternatively, Mn 2+ , Fe 2+ , Fe 3+ , Cu 2+ , or Zn 2+ .
  • Optical density at 600 nm was monitored during log-phase and at stationary phase. Results were compared with those of wild-type.
  • Wild-type WU2 strain was cultured with or without the Zn-specific chelator N,N,N′,N′,-tetrakis(2-pyridylmethyl)ethylenediamine (TPEN) to observe the effect of zinc depletion on Pht expression at the RNA (by RT-PCR) and protein (by flow cytometry) levels.
  • TPEN Zn-specific chelator N,N,N′,N′,-tetrakis(2-pyridylmethyl)ethylenediamine
  • WU2 bacteria were grown in THB+0.5% yeast extract at 37° C., 8% CO 2 , up to log-phase.
  • TPEN 30 ⁇ M a zinc chelator, was added to the medium. After centrifugation, bacterial pellets were resuspended in a solution containing anti-PhtE, anti-PhtB/D, anti PhtD/E or anti-type 3 polysaccharide monoclonal antibodies as control.
  • DNA of 107 MLST-selected strains was PCR-amplified using PhtD-specific oligonucleotide primers.
  • the 107 sequences were aligned by ClustaIX program and the identity was calculated by the Superneedle program (percentage of identity is 100 ⁇ (number of identities/length of shortest sequence).
  • a 1392-bp ORF located 142 bp upstream of the lmb gene homolog, codes for a protein presenting 64% sequence similarity with the Bacillus subtilis metabolite transporter YfnA protein (accession # D69814) and 81% similarity with a putative amino acid permease of S. pyogenes (accession # AAK33157) ⁇ Ferretti 2001, Kunststoff 1997 ⁇ .
  • a sequence presenting 79% identity with the first 481 bp of phtE (proposed phtF) was found 226 bp after the phtE stop codon ( FIG. 1 ). This sequence also shows 72% identity with the phtA, B and D genes.
  • the genomic organization of pht genes suggested that the tandem genes might be coordinately transcribed. Further studies were thus performed to examine this hypothesis.
  • putative promoters and ribosome binding sites of pht genes were identified.
  • the 5′-RACE on the phtE gene allowed the identification of its transcription start, from which the promoter region was deduced.
  • the transcription start site (+1) was found to be located 96 bases upstream of the PhtE translation start site, downstream of typical S. pneumoniae ⁇ 10 and ⁇ 35 RNA polymerase binding sites ⁇ Morrison 1990 ⁇ and upstream of a ribosome binding site ( FIG. 2 a ).
  • the terminator identified for the phtD gene was identical to the one reported by the TIGR web site for ORF SP1003, which corresponds to the phtD gene homolog (www.tigr.org).
  • No transcription terminators were identified by the TIGR group for the other pht or surrounding genes, probably reflecting differences in algorithms used by both studies.
  • Most hairpins ended with a stretch of T residues as typically found in prokaryotic transcription terminators ⁇ Rosenberg 1979 ⁇ and were located within 70 bp downstream of stop codons ( FIG. 3 ).
  • the phtE terminator sequence ( ⁇ G of ⁇ 4.7 kcal mol) ⁇ 1 was located 1867 bp downstream of its stop codon and of the phtF gene, the latter ORF containing in-frame stop codons preventing its translation ( FIG. 3 a ).
  • No terminator sequences were identified downstream of yfnA and lmb genes.
  • phtE could be part of an operon composed of the yfnA, lmb, phtD, phtE and phtF genes.
  • the 5′-RACE ( FIG. 2 a ) and terminator identification ( FIG. 3 a ) indicated that phtE was the first gene transcribed on a bicistronic message, composed of phtE and phtF genes, which was confirmed by RT-PCR.
  • the regions phtE to phtF were amplified by RT-PCR ( FIG.
  • RT-PCR amplified the regions yfnA to phtD.
  • Loisel et al. ⁇ Loisel 2008 ⁇ have demonstrated that this phtD transcript also encodes, in addition to yfnA, lmb and phtD, the two genes upstream yfnA (ccdA that is involved in the biogenesis of cytochrome c and spr0904 that displays similarity with thioredoxine).
  • the identification of a putative promoter upstream of the lmb gene ( FIG. 2 d ) suggested transcriptional coupling of the phtD and lmb genes.
  • Results obtained for phtB and phtA genes showed that they were transcribed as monocistronic mRNAs, as was suggested by promoter ( FIGS. 2 b and c ) and terminator sites identification ( FIGS. 3 b and d ).
  • Analysis of the transcriptional organization of phtA and phtB by RT-PCR revealed a phtB-specific amplicon with phtB-specific primers ( FIG. 4 a , lane 7).
  • No amplification product was obtained by RT-PCR with primers amplifying the region between phtA and phtB ( FIG.
  • Terminator site identification ( FIG. 3 e ) indicated that ptsl is transcribed as a monocistronic message, which also confirmed that phtA is not part of a polycistronic transcript.
  • mutants PhtA ⁇ , PhtB ⁇ , PhtD ⁇ , PhtE ⁇ , and the quadruple mutant PhtABDE ⁇ were constructed.
  • genomic DNA of the mutant strains was purified and the recombinant regions were sequenced (data not shown).
  • mutants were phenotypically characterized by immunoblotting, using a mouse polyclonal anti-PhtD antibody ( FIG. 5 ). All four Pht isotypes were recognized by this antibody. However, PhtE bands were fainter, confirming the greatest divergence of this Pht from the three others.
  • the growth of the Pht quadruple mutant was dramatically decreased in MS medium, compared to that of the wild-type strain and of the different Pht single mutants ( FIG. 6 a ).
  • the medium was supplemented with up to 200 ⁇ M of Fe 2+ , Zn 2+ , or Mn 2+
  • the growth of the wild-type and of the PhtD-deficient mutant was slightly ameliorated (growth rate vs MS alone: 96-130%).
  • growth rate vs MS alone 96-130%
  • the behavior of the quadruple mutant was striking. While the addition of 200 ⁇ M of Fe 2+ to MS only induced a 25.3% increase of growth ( FIG. 6 d ), the same concentration of Zn 2+ or Mn 2+ restored the growth capacity of the quadruple mutant ( FIG.
  • strains including 23 PMEN and in-house strains
  • 18 clonal lineages were represented, 46 strains (61%) with 27 different ST belonged to the 3 major clonal groups (1, 11 and 23), 56 different ST were present, among which the more represented were 81, 90, 124, 156, 162 and 199 (22 strains), and 27 different serotypes were present among which the more represented were 19F, 6B, 3, and 23F (47% of all strains).
  • PhtD By PCR on genomic DNA, we found the genes for PhtD, PhtE, PhtB and PhtA in 100%, 97%, 81%, and 62% of the strains, respectively. Fifty-four percent of the strains were found to carry the four pht genes in their genome. On immunoblots with polyclonal antibodies raised against PhtD, we could detect PhtD in all strains. Likewise, the other Phts were found by immunoblotting in all strains that carry their respective genes. Notably, due to the highest genetic divergence, PhtE was better detected with a polyclonal antibody specifically raised against it ( FIG. 8 ).
  • PhtE of a lower size (10-kDa smaller) in 6 isolates, and of an even smaller size (20-kDa less) in 8 strains.
  • 4 strains were found to produce a truncated PhtA ( FIG. 8 ), which gene was not detected by PCR.
  • these 4 strains also expressed the 20-kDa-truncated PhtE.
  • sequencing of the phtA/B locus of phtB negative strains has revealed that the only gene present in this locus was an hybrid between either phtA and phtB or phtA and phtD genes.
  • the 10-kDa-truncated PhtE was found mainly in the genotype ST 199 group.
  • the serotypes of these strains are 19F, 19A, 15A, 1 and 6A.
  • the 20-kDa-truncated PhtE was observed in 8 isolates that all belonged to the same clonal lineage (group 1), but carrying different serotypes (9, 19A, 19F, 14).
  • strains lacking PhtA were observed in different clonal lineages. Therefore, no major link between lack of PhtA and genotype was identified.
  • PhtD was found to be present among all pneumococcal strains tested, which designates it as the best vaccine candidate among the Pht family. In this respect, it was found essential to determine the level of sequence conservation among pneumococcal strains. For that, DNA sequencing was carried out.
  • PhtD telomere length
  • Pht proteins are promising candidates to be incorporated in a vaccine against pneumococcal infectious diseases. In that respect, it appeared crucial to investigate how the expression of these proteins is regulated, in order to better define their role in pneumococcal pathogenesis.
  • Genome analysis showed that the four gene homologues are arranged in tandem.
  • the presence of a fifth member, though truncated, of the pht gene family, downstream of the phtE gene was also evidenced, confirming the finding in a previous study ⁇ Adamou 2001 ⁇ . It seems that this truncation is conserved since the same organization was found in the S. pneumoniae strain R6 genome (accession # AAK99714) ⁇ Hoskins 2001 ⁇ .
  • promoters but no transcription terminators, were identified for lmb and yfnA genes, two genes located upstream of phtD, which tended to indicate that those genes are organized in an operon system. This corroborates the recent finding that phtD may be expressed in a large operon system together with the 4 genes upstream ⁇ Loisel 2008 ⁇ . Nevertheless, the fact that a promoter was identified for yfnA and for lmb indicates that transcription may start at these locations, which means that phtD-containing transcripts of different length may be produced.
  • the phtD gene can be transcribed as a polycistronic message with those two other genes, yfnA and lmb, that may be involved in transport and specific binding activities, respectively.
  • yfnA in S. pneumoniae ⁇ Hoskins 2001 ⁇ and the homologous proteins in B. subtilis ⁇ Yamamoto 1997 ⁇
  • S. pyogenes ⁇ Ferretti 2001 ⁇ and S. mutans ⁇ Ajdic 2002 ⁇ are thought to be amino-acid transporters, members of the superfamily of permeases.
  • Lmb protein As to the Lmb protein, it has been described as an ABC transporter-like zinc-binding protein ⁇ Loisel 2008 ⁇ and a putative laminin-binding protein ⁇ Spellerberg 1999 ⁇ . Indeed, this protein demonstrates similarities with an adhesin family known as LraI, found initially in oral streptococci ⁇ Jenkinson 1994 ⁇ , but since then discovered in other streptococci and genera ⁇ Cockayne 1998 ⁇ . It was suggested that Lral-like proteins are involved in the colonization of human epithelium by streptococci and their subsequent invasion into the bloodstream ⁇ Elsner 2002 ⁇ . It is not clear why yfnA, lmb, and phtD are associated in an operon system.
  • AdcR Binding of AdcR, induced in conditions of high Zn 2+ concentrations, inhibits the transcription of the genes under its dependence. Upon direct or indirect zinc starvation conditions, hence reduction in intracellular concentration of this metal, repression by AdcR is relieved ⁇ Brenot 2007, Clayerys 2001 ⁇ . Conversely to that and to what we have observed in the present study, it was recently published that the addition of zinc in culture medium elicits Pht production ⁇ Ogunniyi 2009 ⁇ . However, the two methods used were distinct in the sense that, in the present work, zinc was removed from a zinc-rich medium while Ogunniyi et al. added zinc to a zinc-poor medium.
  • Pht production is regulated in a bell-shaped way within a given range of zinc concentration.
  • the high zinc concentration effects observed by Ogunniyi et al ⁇ Ogunniyi 2009 ⁇ , leading to increased Pht expression may have little in vivo relevance since free zinc concentrations available in the human host are very low.
  • This speculative mechanism of storage could be considered as a means for the bacterium to regulate zinc and probably manganese homeostasis.
  • Metal ions like zinc and manganese are essential trace elements. However, they are potentially harmful to the bacterium when in excess, because they may compete with other elements as co-factors for some critical enzymes. Therefore, it is essential for the bacteria to regulate metal homeostasis, and we suggest that this is the main role of the Pht family.
  • Such a regulatory system would allow S. pneumoniae to survive when facing ion-restricted environments, for example during the initial stages of the colonization process in human nasopharynx ⁇ Bunker 1984, Harlyk 1997 ⁇ .
  • polycistronic transcripts with PhtD might be explained by the requirement of Zn 2+ or Mn 2+ for Lmb, an Lral family member, and YfnA, to exert their function.
  • Mn 2+ is required for adhesion through the Lral family of proteins, a critical feature for virulence ⁇ Dintilhac 1997b, Papp-Wallace 2006 ⁇ .
  • laminin binds Zn 2+ to promote high affinity binding between laminin and laminin binding proteins ⁇ Ancsin 1996, Bandyopadhyay 2002 ⁇ .
  • PhtD was found to be the Pht protein that affords the broadest protection, while PhtA immunization was efficient against a lesser number of the strains tested. This is in line with the results of the present study, where it is shown that PhtA is expressed in 62% of pneumococcal strains, while PhtD is present in 100%. Although successfully used in two studies, the potential for PhtB to elicit cross-protection is not known since it was evaluated against a single strain only ⁇ Adamou 2001, Zhang 2001 ⁇ .
  • PhtE this protein is found in 97% of the strains, which might be indicative of a broad cross-protection.
  • this Pht shares only 32% of identity with the three other Phts, and its C-terminal part, the most immunogenic and conserved one, is PhtE-specific.
  • the region of PhtE common with the other Phts is not accessible to antibodies ⁇ Adamou 2001, Hamel 2004 ⁇ . Therefore, PhtD, present in all strains tested, with an amino-acid sequence highly conserved among pneumococci and also demonstrating cross-reactivity with PhtA and PhtB, represents a better option.
  • nasopharyngeal colonisation assay was used to assess the ability of immunization against PhtD to prevent otitis media.
  • Several studies have shown a link between nasopharylgeal colonisation and otitis media.
  • Bogaert et al Lancet Infect. Dis. 4(3); 144-154 (2004) showed that colonisation rates tend to be higher during respiratory tract infection and otitis media. Indeed pneumococcal disease will not occur without proceeding and/or concurrent nasopharyngeal colonisation with the homologous strain (Grey et al J. Infect. Dis. 142; 923-933 (1980), Syrjanea et al Paediatr. Infect. Dis. J. 24; 801-806 (2005)).
  • LT E. coli labile toxin
  • Another experiment with the same protocol (schedule and dosages) consisted in comparing PhtD with CbpA, PsaA, and PspA.
  • Control mice were injected with LT alone.
  • mice were challenged intranasally with 7 ⁇ 10 4 cfu of type 6B/CDC strain, type 4/CDC, or type 2/D39.
  • the challenges were performed using a small bacterial inoculum volume (10 ⁇ l). Bacterial colonies were counted in nasal washings collected 2 and 6 days after the challenge. Nasal washings were obtained by flushing 500 ⁇ l of PBS inside the nasal cavity of anaesthetized mice. Next, to count the bacterial colonies, 100 ⁇ l of nasal washing was diluted ten times in Todd Hewitt Broth. From this, 10 ⁇ l was plated onto DifcoTM Blood Agar base supplemented with definibrated, sterile sheep blood and gentamycin (3 ⁇ g/ml). The Petri dish was tilted to spread the sample and the colonies were enumerated after incubation overnight at 37° C. All colony countings data, after normalization, were compared with ANOVA, followed by the Dunnett post-test when ANOVA was found significant.
  • mice were immunized intranasally with the different Pht proteins before they were challenged via the same route with the 2/D39 strain.
  • FIG. 4 Although only vaccination with PhtD or PhtE afforded significant protection against the challenge with the type 2 strain, all members of the Pht family were able to reduce bacterial load in the nasopharynx of the vaccinated animals. Due to the better performance of PhtD in this model, this member of the Pht family was chosen for further experiments, consisting in comparing PhtD with other pneumococcal proteins.
  • mice were immunized with different pneumococcal antigens, including PhtD, and were subsequently challenged with a type 2, a type 4 or a type 6B strain.
  • the elicited humoral responses after intra-nasal immunization were antigen-dependent ( FIG. 2B ).
  • CbpA elicited lower antibody titers than PspA and PhtD.
  • the level of protection afforded by CbpA against the clade-homologous 2/D39 strain was similar to that of PspA and PhtD ( FIG. 5A ).
  • PhtD was the only antigen able to afford some protection against the three strains in this model of naso-pharyngeal colonization.
  • mice were immunized i.m. at day 0, 14 and 28 with 3 ⁇ g of PhtD adjuvanted with AS02.
  • mice were challenged intranasally with 2 ⁇ 10 7 cfu/50 ⁇ l of S. pneumoniae 19F/2737.
  • Control mice were injected with adjuvant only.
  • Bacterial load was measured by colony counting in lungs collected 3, 4 and 5 days post-challenge. All colony countings data, after normalization, were compared with ANOVA, followed by the Dunnett post-test when ANOVA was found significant.
  • CBA/J mice a strain susceptible to pneumococcal infections
  • PhtD a strain susceptible to pneumococcal infections
  • PhtD a strain susceptible to pneumococcal infections
  • Such a protocol allows for the induction of a focal pneumonia without generalized sepsis.
  • the number of living bacteria in the lungs was evaluated at day 3, 4 and 5.

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