US20140112950A1 - Combination vaccines with lower doses of antigen and/or adjuvant - Google Patents

Combination vaccines with lower doses of antigen and/or adjuvant Download PDF

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US20140112950A1
US20140112950A1 US14/002,700 US201214002700A US2014112950A1 US 20140112950 A1 US20140112950 A1 US 20140112950A1 US 201214002700 A US201214002700 A US 201214002700A US 2014112950 A1 US2014112950 A1 US 2014112950A1
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adjuvant
antigen
toxoid
aluminium
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Manmohan Singh
Barbara Baudner
David Skibinski
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GlaxoSmithKline Biologicals SA
Novartis Vaccines and Diagnostics Inc
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    • A61K39/0016—Combination vaccines based on diphtheria-tetanus-pertussis
    • A61K39/0018—Combination vaccines based on acellular diphtheria-tetanus-pertussis
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    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/4375—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having nitrogen as a ring heteroatom, e.g. quinolizines, naphthyridines, berberine, vincamine
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    • A61K39/00—Medicinal preparations containing antigens or antibodies
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    • A61K39/116—Polyvalent bacterial antigens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/12—Viral antigens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/12—Viral antigens
    • A61K39/125—Picornaviridae, e.g. calicivirus
    • A61K39/13—Poliovirus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/12—Viral antigens
    • A61K39/295—Polyvalent viral antigens; Mixtures of viral and bacterial antigens
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/39—Medicinal preparations containing antigens or antibodies characterised by the immunostimulating additives, e.g. chemical adjuvants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • A—HUMAN NECESSITIES
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    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
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    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
    • A—HUMAN NECESSITIES
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    • 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
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    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
    • A61K2039/55511—Organic adjuvants
    • A61K2039/55555—Liposomes; Vesicles, e.g. nanoparticles; Spheres, e.g. nanospheres; Polymers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
    • A61K2039/55511—Organic adjuvants
    • A61K2039/55566—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
    • A61K2039/70—Multivalent vaccine
    • C—CHEMISTRY; METALLURGY
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    • C12N2730/00—Reverse transcribing DNA viruses
    • C12N2730/00011—Details
    • C12N2730/10011—Hepadnaviridae
    • C12N2730/10111—Orthohepadnavirus, e.g. hepatitis B virus
    • C12N2730/10134—Use of virus or viral component as vaccine, e.g. live-attenuated or inactivated virus, VLP, viral protein
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2770/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA ssRNA viruses positive-sense
    • C12N2770/00011—Details
    • C12N2770/32011—Picornaviridae
    • C12N2770/32611—Poliovirus
    • C12N2770/32634—Use of virus or viral component as vaccine, e.g. live-attenuated or inactivated virus, VLP, viral protein
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • This invention is in the field of combination vaccines i.e. vaccines containing mixed immunogens from more than one pathogen, such that administration of the vaccine can simultaneously immunize a subject against more than one pathogen.
  • Vaccines containing antigens from more than one pathogenic organism within a single dose are known as “multivalent” or “combination” vaccines.
  • Various combination vaccines have been approved for human use in the EU and the USA, including trivalent vaccines for protecting against diphtheria, tetanus and pertussis (“DTP” vaccines) and trivalent vaccines for protecting against measles, mumps and rubella (“MMR” vaccines).
  • DTP diphtheria
  • MMR measles
  • Combination vaccines offer patients the advantage of receiving a reduced number of injections, which can lead to the clinical advantage of increased compliance (e.g. see chapter 29 of reference 1), particularly for pediatric vaccination.
  • combination vaccines can include relatively high amounts of aluminium salts as adjuvants which causes concern to some patient pressure groups despite empirical safety studies [2,3].
  • aluminium levels in known combination vaccines are as follows (see also Table A below):
  • a vaccine with lower levels of aluminium would be helpful for some patient groups, and it is an object of the present invention to provide such vaccines, ideally without loss of vaccine potency.
  • the invention provides a variety of combination vaccine compositions as well as methods for their manufacture.
  • the compositions have a relatively low amount of antigen and/or a relatively low amount of aluminium, but they can nevertheless have immunogenicity which is comparable to combination vaccines with a relatively high amount of antigen and/or a relatively high amount of aluminium.
  • Aluminium-free combination vaccine compositions are also provided e.g. compositions which are adjuvanted with an oil-in-water emulsion adjuvant.
  • the invention provides an immunogenic composition in a unit dose form for administration to a patient comprising (i) a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid, and (ii) an aluminium salt adjuvant, wherein the amount of Al +++ in the unit dose is less than 0.2 mg.
  • the invention also provides an immunogenic composition
  • an immunogenic composition comprising (i) a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and (ii) an aluminium salt adjuvant, wherein the concentration of Al +++ is less than 0.4 mg/ml.
  • the invention provides an immunogenic composition
  • an immunogenic composition comprising (i) an aluminium salt adjuvant and (ii) a low dose of each of a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid.
  • the invention provides an immunogenic composition in a unit dose form for administration to a patient comprising (i) a low dose of each of a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid, and (ii) an aluminium salt adjuvant, wherein the amount of Al +++ in the unit dose is less than 0.2 mg.
  • the invention also provides an immunogenic composition
  • an immunogenic composition comprising (i) a low dose of each of a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and (ii) an aluminium salt adjuvant, wherein the concentration of Al +++ is less than 0.4 mg/ml.
  • the invention provides an immunogenic composition
  • an immunogenic composition comprising (i) an oil-in-water emulsion adjuvant (ii) a diphtheria toxoid, a tetanus toxoid, a pertussis toxoid, and a Hib conjugate (iii) a hepatitis B virus surface antigen and/or an inactivated poliovirus antigen.
  • the composition is ideally aluminium-free.
  • the aluminium salt adjuvant advantageously has an adsorbed TLR agonist, as discussed below.
  • a further aspect of the invention is an immunisation schedule for an infant in which only one or two DTaP-containing compositions are administered. This aspect is explained in further detail below.
  • Diphtheria is caused by Corynebacterium diphtheriae , a Gram-positive non-sporing aerobic bacterium. This organism expresses a prophage-encoded ADP-ribosylating exotoxin (‘diphtheria toxin’), which can be treated (e.g. using formaldehyde) to give a toxoid that is no longer toxic but that remains antigenic and is able to stimulate the production of specific anti-toxin antibodies after injection. Diphtheria toxoids are disclosed in more detail in chapter 13 of reference 1. Preferred diphtheria toxoids are those prepared by formaldehyde treatment. The diphtheria toxoid can be obtained by growing C.
  • diphtheriae in growth medium e.g. Fenton medium, or Linggoud & Fenton medium
  • growth medium e.g. Fenton medium, or Linggoud & Fenton medium
  • bovine extract e.g. bovine extract
  • formaldehyde treatment e.g. formaldehyde treatment
  • ultrafiltration and precipitation e.g. formaldehyde treatment
  • the toxoided material may then be treated by a process comprising sterile filtration and/or dialysis.
  • Quantities of diphtheria toxoid can be expressed in international units (IU).
  • IU international units
  • the NIBSC [6] supplies the ‘Diphtheria Toxoid Adsorbed Third International Standard 1999’ [7,8], which contains 160 IU per ampoule.
  • the ‘Lf’ unit (“flocculating units”, the “limes flocculating dose”, or the “limit of flocculation”) is defined as the amount of toxoid which, when mixed with one International Unit of antitoxin, produces an optimally flocculating mixture [9].
  • the NIBSC supplies ‘Diphtheria Toxoid, Plain’ [10], which contains 300 Lf per ampoule and ‘The 1st International Reference Reagent For Diphtheria Toxoid For Flocculation Test’ [11] which contains 900 Lf per ampoule.
  • concentration of diphtheria toxin in a composition can readily be determined using a flocculation assay by comparison with a reference material calibrated against such reference reagents.
  • the conversion between IU and Lf systems depends on the particular toxoid preparation.
  • a composition includes a ‘low dose’ of diphtheria toxoid.
  • concentration of diphtheria toxoid in the composition is ⁇ 8 Lf/ml e.g. ⁇ 7, ⁇ 6, ⁇ 5, ⁇ 4 ⁇ 3, ⁇ 2, ⁇ 1 Lf/ml, etc.
  • the amount of diphtheria toxoid is less than 4 Lf e.g. ⁇ 3, ⁇ 2, ⁇ 1, ⁇ 1 ⁇ 2 Lf, etc.
  • composition of the invention includes an aluminium salt adjuvant
  • diphtheria toxoid in the composition is preferably adsorbed (more preferably totally adsorbed) onto that salt, preferably onto an aluminium hydroxide adjuvant.
  • Tetanus is caused by Clostridium tetani , a Gram-positive, spore-forming bacillus . This organism expresses an endopeptidase (‘tetanus toxin’), which can be treated to give a toxoid that is no longer toxic but that remains antigenic and is able to stimulate the production of specific anti-toxin antibodies after injection. Tetanus toxoids are disclosed in more detail in chapter 27 of reference 1. Preferred tetanus toxoids are those prepared by formaldehyde treatment. The tetanus toxoid can be obtained by growing C. tetani in growth medium (e.g. a Latham medium derived from bovine casein), followed by formaldehyde treatment, ultrafiltration and precipitation. The material may then be treated by a process comprising sterile filtration and/or dialysis.
  • growth medium e.g. a Latham medium derived from bovine casein
  • tetanus toxoid can be expressed in international units (IU).
  • IU international units
  • NIBSC supplies the ‘Tetanus Toxoid Adsorbed Third International Standard 2000’ [12,13], which contains 469 IU per ampoule.
  • the ‘Lf’ unit is an alternative to the IU system.
  • NIBSC supplies ‘The 1st International Reference Reagent for Tetanus Toxoid For Flocculation Test’[14] which contains 1000 LF per ampoule.
  • concentration of diphtheria toxin in a composition can readily be determined using a flocculation assay by comparison with a reference material calibrated against such reference reagents.
  • a composition includes a ‘low dose’ of tetanus toxoid.
  • concentration of tetanus toxoid in the composition is ⁇ 3.5 Lf/ml e.g. ⁇ 3, ⁇ 2.5, ⁇ 2, ⁇ 1.5 ⁇ 1, ⁇ 1 ⁇ 2 Lf/ml, etc.
  • the amount of tetanus toxoid is less than 1.75 Lf e.g. ⁇ 1.5, ⁇ 1, ⁇ 1 ⁇ 2, ⁇ 1 ⁇ 4 Lf, etc.
  • composition of the invention includes an aluminium salt adjuvant then tetanus toxoid in the composition is preferably adsorbed (sometimes totally adsorbed) onto that salt, preferably onto an aluminium hydroxide adjuvant.
  • Bordetella pertussis causes whooping cough.
  • Pertussis antigens in vaccines are either cellular (whole cell, in the form of inactivated B. pertussis cells; ‘wP’) or acellular (‘aP’).
  • Preparation of cellular pertussis antigens is well documented (e.g. see chapter 21 of reference 1) e.g. it may be obtained by heat inactivation of phase I culture of B. pertussis .
  • acellular antigens are used, one, two or (preferably) three of the following antigens are included: (1) detoxified pertussis toxin ( pertussis toxoid, or ‘PT’); (2) filamentous hemagglutinin (‘FHA’); (3) pertactin (also known as the ‘69 kiloDalton outer membrane protein’).
  • PT pertussis toxoid
  • FHA filamentous hemagglutinin
  • pertactin also known as the ‘69 kiloDalton outer membrane protein’.
  • PT and FHA can be isolated from the fermentation broth (e.g. by adsorption on hydroxyapatite gel), whereas pertactin can be extracted from the cells by heat treatment and flocculation (e.g. using barium chloride).
  • the antigens can be purified in successive chromatographic and/or precipitation steps.
  • PT and FHA can be purified by hydrophobic chromatography, affinity chromatography and size exclusion chromatography.
  • Pertactin can be purified by ion exchange chromatography, hydrophobic chromatography and size exclusion chromatography, or by IMAC.
  • FHA and pertactin may be treated with formaldehyde prior to use according to the invention.
  • PT is preferably detoxified by treatment with formaldehyde and/or glutaraldehyde.
  • the PT may be a mutant PT in which enzymatic activity has been reduced by mutagenesis [15] (e.g. the 9K/129G double mutant [16]), but detoxification by chemical treatment is preferred.
  • the invention can use a PT-containing wP antigen or, preferably, a PT-containing aP antigen.
  • a composition of the invention will typically, in addition to the PT, include FHA and, optionally, pertactin. It can also optionally include fimbriae types 2 and 3.
  • a composition includes a ‘low dose’ of pertussis toxoid. This means that the concentration of pertussis toxoid in the composition is ⁇ 5 ⁇ g/ml e.g. ⁇ 4, ⁇ 3, ⁇ 2.5, ⁇ 2, ⁇ 1 ⁇ g/ml, etc. In a typical 0.5 ml unit dose volume, therefore, the amount of pertussis toxoid is less than 2.5 ⁇ g e.g. ⁇ 2, ⁇ 1.5, ⁇ 1, ⁇ 0.5 ⁇ g, etc.
  • composition of the invention includes an aluminium salt adjuvant
  • pertussis toxoid in the composition is preferably adsorbed (sometimes totally adsorbed) onto that salt, preferably onto an aluminium hydroxide adjuvant.
  • Any FHA can also be adsorbed to an aluminium hydroxide adjuvant.
  • Any pertactin can be adsorbed to an aluminium phosphate adjuvant.
  • Hib vaccines are typically based on the capsular saccharide antigen (e.g. chapter 14 of ref. 1), the preparation of which is well documented (e.g. references 17 to 26).
  • the Hib saccharide is conjugated to a carrier protein in order to enhance its immunogenicity, especially in children.
  • Typical carrier proteins are tetanus toxoid, diphtheria toxoid, the CRM197 derivative of diphtheria toxoid, H. influenzae protein D, and an outer membrane protein complex from serogroup B. meningococcus .
  • Tetanus toxoid is a preferred carrier, as used in the product commonly referred to as ‘PRP-T’.
  • PRP-T can be made by activating a Hib capsular polysaccharide using cyanogen bromide, coupling the activated saccharide to an adipic acid linker (such as (1-ethyl-3-(3-dimethylaminopropyl) carbodiimide), typically the hydrochloride salt), and then reacting the linker-saccharide entity with a tetanus toxoid carrier protein.
  • adipic acid linker such as (1-ethyl-3-(3-dimethylaminopropyl) carbodiimide
  • the saccharide moiety of the conjugate may comprise full-length polyribosylribitol phosphate (PRP) as prepared from Hib bacteria, and/or fragments of full-length PRP.
  • Conjugates with a saccharide:protein ratio (w/w) of between 1:5 (i.e. excess protein) and 5:1 (i.e. excess saccharide) may be used e.g. ratios between 1:2 and 5:1 and ratios between 1:1.25 and 1:2.5.
  • the weight ratio of saccharide to carrier protein is between 1:2.5 and 1:3.5.
  • the weight ratio of saccharide to carrier protein in the conjugate may be between 1:0.3 and 1:2 [27].
  • Administration of the Hib conjugate preferably results in an anti-PRP antibody concentration of ⁇ 0.15 ⁇ g/ml, and more preferably ⁇ 1 ⁇ g/ml, and these are the standard response thresholds.
  • a composition includes a ‘low dose’ of a Hib conjugate. This means that the concentration of Hib saccharide in the composition is ⁇ 5 ⁇ g/ml e.g. ⁇ 4, ⁇ 3, ⁇ 2.5, ⁇ 2, ⁇ 1, etc. In a typical 0.5 ml unit dose volume, therefore, the amount of Hib is less than 2.5 ⁇ g e.g. ⁇ 2, ⁇ 1.5, ⁇ 1, ⁇ 0.5, etc.
  • Hib conjugate can be adsorbed onto that salt or can be unadsorbed.
  • Hepatitis B virus is one of the known agents which causes viral hepatitis.
  • the HBV virion consists of an inner core surrounded by an outer protein coat or capsid, and the viral core contains the viral DNA genome.
  • the major component of the capsid is a protein known as HBV surface antigen or, more commonly, ‘HBsAg’, which is typically a 226-amino acid polypeptide with a molecular weight of ⁇ 24 kDa.
  • All existing hepatitis B vaccines contain HBsAg, and when this antigen is administered to a normal vaccinee it stimulates the production of anti-HBsAg antibodies which protect against HBV infection.
  • HBsAg can be made in two ways.
  • the first method involves purifying the antigen in particulate form from the plasma of chronic hepatitis B carriers, as large quantities of HBsAg are synthesized in the liver and released into the blood stream during an HBV infection.
  • the second way involves expressing the protein by recombinant DNA methods.
  • HBsAg for use with the method of the invention is recombinantly expressed in yeast cells. Suitable yeasts include Saccharomyces (such as S. cerevisiae ) or Hanensula (such as H. polymorpha ) hosts.
  • yeast-expressed HBsAg is generally non-glycosylated, and this is the most preferred form of HBsAg for use with the invention.
  • Yeast-expressed HBsAg is highly immunogenic and can be prepared without the risk of blood product contamination.
  • the HBsAg will generally be in the form of substantially-spherical particles (average diameter of about 20 nm), including a lipid matrix comprising phospholipids.
  • Yeast-expressed HBsAg particles may include phosphatidylinositol, which is not found in natural HBV virions.
  • the particles may also include a non-toxic amount of LPS in order to stimulate the immune system [28].
  • the particles may retain non-ionic surfactant (e.g. polysorbate 20) if this was used during disruption of yeast [29].
  • a preferred method for HBsAg purification involves, after cell disruption: ultrafiltration; size exclusion chromatography; anion exchange chromatography; ultracentrifugation; desalting; and sterile filtration. Lysates may be precipitated after cell disruption (e.g. using a polyethylene glycol), leaving HBsAg in solution, ready for ultrafiltration.
  • HBsAg may be subjected to dialysis (e.g. with cysteine), which can be used to remove any mercurial preservatives such as thimerosal that may have been used during HBsAg preparation [30]. Thimerosal-free preparation is preferred.
  • the HBsAg is preferably from HBV subtype adw2.
  • a composition includes a ‘low dose’ of HBsAg.
  • concentration of HBsAg in the composition is ⁇ 5 ⁇ g/ml e.g. ⁇ 4, ⁇ 3, ⁇ 2.5, ⁇ 2, ⁇ 1, etc.
  • the amount of HBsAg is less than 2.5 ⁇ g e.g. ⁇ 2, ⁇ 1.5, ⁇ 1, ⁇ 0.5, etc.
  • composition of the invention includes an aluminium salt adjuvant then HBsAg can be adsorbed onto that salt (preferably adsorbed onto an aluminium phosphate adjuvant).
  • IPV Inactivated Poliovirus Antigen
  • Poliomyelitis can be caused by one of three types of poliovirus.
  • the three types are similar and cause identical symptoms, but they are antigenically very different and infection by one type does not protect against infection by others.
  • Sabin strains of types 1 to 3 can be used e.g. as discussed in references 31 & 32.
  • Polioviruses may be grown in cell culture.
  • a preferred culture uses a Vero cell line, which is a continuous cell line derived from monkey kidney. Vero cells can conveniently be cultured microcarriers. Culture of the Vero cells before and during viral infection may involve the use of bovine-derived material, such as calf serum, and of lactalbumin hydrolysate (e.g. obtained by enzymatic degradation of lactalbumin). Such bovine-derived material should be obtained from sources which are free from BSE or other TSEs.
  • virions may be purified using techniques such as ultrafiltration, diafiltration, and chromatography. Prior to administration to patients, polioviruses must be inactivated, and this can be achieved by treatment with formaldehyde before the viruses are used in the process of the invention.
  • viruses are preferably grown, purified and inactivated individually, and are then combined to give a bulk mixture for use with the invention.
  • a composition includes a ‘low dose’ of a poliovirus.
  • concentration of the virus in the composition is ⁇ 20 DU/ml e.g. ⁇ 18, ⁇ 16, ⁇ 14, ⁇ 12, ⁇ 10, etc.
  • concentration of the virus in the composition is ⁇ 4 DU/ml e.g. ⁇ 3, ⁇ 2, ⁇ 1, ⁇ 0.5, etc.
  • Type 3 poliovirus this means that the concentration of the virus in the composition is ⁇ 16 DU/ml e.g. ⁇ 14, ⁇ 12, ⁇ 10, ⁇ 8, ⁇ 6, etc.
  • the three antigens can be present at a DU ratio of 5:1:4 respectively, or at any other suitable ratio e.g. a ratio of 15:32:45 when using Sabin strains [31].
  • a low dose of antigen from Sabin strains is particularly useful, with ⁇ 10 DU type 1, ⁇ 20 DU type 2, and ⁇ 30 DU type 3 (per unit dose).
  • composition of the invention includes an aluminium salt adjuvant then polioviruses are preferably not adsorbed to any adjuvant before they are formulated, but after formulation they may become adsorbed onto any aluminium adjuvant(s) in the composition.
  • immunogenic compositions of the invention may include antigens from further pathogens.
  • these antigens may be from N. meningitidis (one or more of serogroups A, B, C, W135 and/or Y) or S. pneumoniae.
  • compositions include a Neisseria meningitidis capsular saccharide conjugate there may be one or more than one such conjugate.
  • Including 2, 3, or 4 of serogroups A, C, W135 and Y is typical e.g. A+C, A+W135, A+Y, C+W135, C+Y, W135+Y, A+C+W135, A+C+Y, A+W135+Y, A+C+W135+Y, etc.
  • Components including saccharides from all four of serogroups A, C, W135 and Y are useful, as in the MENACTRATM and MENVEOTM products.
  • conjugates from more than one serogroup may be present at substantially equal masses e.g. the mass of each serogroup's saccharide is within ⁇ 10% of each other.
  • a typical quantity per serogroup is between 1 ⁇ g and 20 ⁇ g e.g. between 2 and 10 ⁇ g per serogroup, or about 4 ⁇ g or about 5 ⁇ g or about 10 ⁇ g.
  • a double mass of serogroup A saccharide may be used.
  • SBA serum bactericidal assay
  • the capsular saccharide of serogroup A meningococcus is a homopolymer of ( ⁇ 1 ⁇ 6)-linked N-acetyl-D-mannosamine-1-phosphate, with partial O-acetylation in the C3 and C4 positions.
  • Acetylation at the C-3 position can be 70-95%.
  • Conditions used to purify the saccharide can result in de-O-acetylation (e.g. under basic conditions), but it is useful to retain OAc at this C-3 position.
  • at least 50% (e.g. at least 60%, 70%, 80%, 90%, 95% or more) of the mannosamine residues in a serogroup A saccharides are O-acetylated at the C-3 position.
  • Acetyl groups can be replaced with blocking groups to prevent hydrolysis [35], and such modified saccharides are still serogroup A saccharides within the meaning of the invention.
  • the serogroup C capsular saccharide is a homopolymer of ( ⁇ 2 ⁇ 9)-linked sialic acid (N-acetyl neuraminic acid, or ‘NeuNAc’).
  • the saccharide structure is written as ⁇ 9)-Neu p NAc 7/8 OAc ⁇ ( ⁇ 2 ⁇ .
  • Most serogroup C strains have O-acetyl groups at C-7 and/or C-8 of the sialic acid residues, but about 15% of clinical isolates lack these O-acetyl groups [36,37].
  • OAc ⁇ O-acetylated
  • OAc+ de-O-acetylated
  • Serogroup C saccharides used with the invention may be prepared from either OAc+ or OAc ⁇ strains.
  • Licensed MenC conjugate vaccines include both OAc ⁇ (NEISVAC-CTM) and OAc+ (MENJUGATETTM & MENINGITECTTM) saccharides.
  • strains for production of serogroup C conjugates are OAc+ strains, e.g.
  • OAc+ strains may be used.
  • OAc+ strains in serosubtype P1.1 are also useful, such as the C11 strain.
  • Preferred MenC saccharides are taken from OAc+ strains, such as strain C11.
  • the serogroup W135 saccharide is a polymer of sialic acid-galactose disaccharide units. Like the serogroup C saccharide, it has variable O-acetylation, but at sialic acid 7 and 9 positions [41].
  • the structure is written as: ⁇ 4)-D-Neup5Ac(7/9OAc)- ⁇ -(2 ⁇ 6)-D-Gal- ⁇ -(1 ⁇ .
  • the serogroup Y saccharide is similar to the serogroup W135 saccharide, except that the disaccharide repeating unit includes glucose instead of galactose. Like serogroup W135, it has variable O-acetylation at sialic acid 7 and 9 positions [41].
  • the serogroup Y structure is written as: ⁇ 4)-D-Neup5Ac(7/9OAc)- ⁇ -(2 ⁇ 6)-D-Glc- ⁇ -(1 ⁇ .
  • the saccharides used according to the invention may be O-acetylated as described above (e.g. with the same O-acetylation pattern as seen in native capsular saccharides), or they may be partially or totally de-O-acetylated at one or more positions of the saccharide rings, or they may be hyper-O-acetylated relative to the native capsular saccharides.
  • reference 42 reports the use of serogroup Y saccharides that are more than 80% de-O-acetylated.
  • the saccharide moieties in meningococcal conjugates may comprise full-length saccharides as prepared from meningococci, and/or may comprise fragments of full-length saccharides i.e. the saccharides may be shorter than the native capsular saccharides seen in bacteria.
  • the saccharides may thus be depolymerised, with depolymerisation occurring during or after saccharide purification but before conjugation. Depolymerisation reduces the chain length of the saccharides.
  • One depolymerisation method involves the use of hydrogen peroxide [43]. Hydrogen peroxide is added to a saccharide (e.g. to give a final H 2 O 2 concentration of 1%), and the mixture is then incubated (e.g.
  • saccharides used to prepare conjugates for use according to the invention may be obtainable by any of these depolymerisation methods.
  • Depolymerisation can be used in order to provide an optimum chain length for immunogenicity and/or to reduce chain length for physical manageability of the saccharides.
  • the average molecular weight for saccharides from each of meningococcal serogroups A, C, W135 and Y may be more than 50 kDa e.g. ⁇ 75 kDa, ⁇ 100 kDa, ⁇ 110 kDa, ⁇ 120 kDa, ⁇ 130 kDa, etc.
  • a MenA saccharide may be in the range 50-500 kDa e.g. 60-80 kDa; a MenC saccharide may be in the range 100-210 kDa; a MenW135 saccharide may be in the range 60-190 kDa e.g. 120-140 kDa; and/or a MenY saccharide may be in the range 60-190 kDa e.g. 150-160 kDa.
  • the mass of Hib saccharide can be substantially the same as the mass of a particular meningococcal serogroup saccharide. In some embodiments, the mass of Hib saccharide will be more than (e.g. at least 1.5 ⁇ ) the mass of a particular meningococcal serogroup saccharide. In some embodiments, the mass of Hib saccharide will be less than (e.g. at least 1.5 ⁇ less) the mass of a particular meningococcal serogroup saccharide.
  • composition includes saccharide from more than one meningococcal serogroup, there is an mean saccharide mass per serogroup. If substantially equal masses of each serogroup are used then the mean mass will be the same as each individual mass; where non-equal masses are used then the mean will differ e.g. with a 10:5:5:5 ⁇ g amount for a MenACWY mixture, the mean mass is 6.25 ⁇ g per serogroup.
  • the mass of Hib saccharide will be substantially the same as the mean mass of meningococcal saccharide per serogroup. In some embodiments, the mass of Hib saccharide will be more than (e.g.
  • the mass of Hib saccharide will be less than (e.g. at least 1.5 ⁇ ) the mean mass of meningococcal saccharide per serogroup [46].
  • the capsular saccharide of Neisseria meningitidis serogroup B is not a useful vaccine immunogen and so polypeptide antigens can be used instead.
  • the “universal vaccine for serogroup B meningococcus ” reported by Novartis Vaccines in ref. 47 can be used with the invention.
  • a composition of the invention can include a factor H binding protein (fHBP) antigen.
  • fHBP factor H binding protein
  • the fHBP antigen has been characterised in detail. It has also been known as protein ‘741’ [SEQ IDs 2535 & 2536 in ref. 48], ‘NMB1870’, ‘GNA1870’ [refs. 49-51], ‘P2086’, ‘LP2086’ or ‘ORF2086’ [52-54]. It is naturally a lipoprotein and is expressed across all meningococcal serogroups.
  • the fHBP antigen falls into three distinct variants [55] and it is preferred to include antigens for all variants.
  • a composition of the invention may include a Neisserial Heparin Binding Antigen (NHBA) [56]. This antigen was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB2132.
  • NHBA Neisserial Heparin Binding Antigen
  • a composition of the invention may include a NadA antigen.
  • the NadA antigen was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB1994.
  • a composition of the invention may include a NspA antigen.
  • the NspA antigen was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB0663.
  • a composition of the invention may include a NhhA antigen.
  • the NhhA antigen was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB0992.
  • a composition of the invention may include an App antigen.
  • the App antigen was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB1985.
  • a composition of the invention may include an Omp85 antigen.
  • Omp85 was included in the published genome sequence for meningococcal serogroup B strain MC58 [57] as gene NMB0182.
  • a composition of the invention may include a meningococcal outer membrane vesicle.
  • compositions of the invention can include at least one pneumococcal capsular saccharide conjugated to a carrier protein.
  • the invention can include capsular saccharide from one or more different pneumococcal serotypes. Where a composition includes saccharide antigens from more than one serotype, these are preferably prepared separately, conjugated separately, and then combined. Methods for purifying pneumococcal capsular saccharides are known in the art (e.g. see reference 58) and vaccines based on purified saccharides from 23 different serotypes have been known for many years. Improvements to these methods have also been described e.g. for serotype 3 as described in reference 59, or for serotypes 1, 4, 5, 6A, 6B, 7F and 19A as described in reference 60.
  • Pneumococcal capsular saccharide(s) will typically be selected from the following serotypes: 1, 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and/or 33F.
  • a composition may include a capsular saccharide from 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 or more different serotypes.
  • Compositions which include at least serotype 6B saccharide are useful.
  • a useful combination of serotypes is a 7-valent combination e.g. including capsular saccharide from each of serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F.
  • Another useful combination is a 9-valent combination e.g. including capsular saccharide from each of serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F and 23F.
  • Another useful combination is a 10-valent combination e.g. including capsular saccharide from each of serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F.
  • An 11-valent combination may further include saccharide from serotype 3.
  • a 12-valent combination may add to the 10-valent mixture: serotypes 6A and 19A; 6A and 22F; 19A and 22F; 6A and 15B; 19A and 15B; or 22F and 15B.
  • a 13-valent combination may add to the 11-valent mixture: serotypes 19A and 22F; 8 and 12F; 8 and 15B; 8 and 19A; 8 and 22F; 12F and 15B; 12F and 19A; 12F and 22F; 15B and 19A; 15B and 22F; 6A and 19A, etc.
  • a useful 13-valent combination includes capsular saccharide from serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19 (or 19A), 19F and 23F e.g. prepared as disclosed in references 61 to 64.
  • One such combination includes serotype 6B saccharide at about 8 ⁇ g/ml and the other 12 saccharides at concentrations of about 4 ⁇ g/ml each.
  • Another such combination includes serotype 6A and 6B saccharides at about 8 ⁇ g/ml each and the other 11 saccharides at about 4 ⁇ g/ml each.
  • Suitable carrier proteins for conjugates include bacterial toxins, such as diphtheria or tetanus toxins, or toxoids or mutants thereof. These are commonly used in conjugate vaccines.
  • the CRM197 diphtheria toxin mutant is useful [65].
  • Other suitable carrier proteins include synthetic peptides [66,67], heat shock proteins [68,69 ], pertussis proteins [70,71], cytokines [72], lymphokines [72], hormones [72], growth factors [72], artificial proteins comprising multiple human CD4 + T cell epitopes from various pathogen-derived antigens [73] such as N19 [74], protein D from H.
  • influenzae [ 75-77], pneumolysin [78] or its non-toxic derivatives [79], pneumococcal surface protein PspA [80], iron-uptake proteins [81], toxin A or B from C. difficile [ 82], recombinant Pseudomonas aeruginosa exoprotein A (rEPA) [83], etc.
  • CRM197 particularly useful carrier proteins for pneumococcal conjugate vaccines are CRM197, tetanus toxoid, diphtheria toxoid and H. influenzae protein D.
  • CRM197 is used in PREVNARTM.
  • a 13-valent mixture may use CRM197 as the carrier protein for each of the 13 conjugates, and CRM197 may be present at about 55-60 ⁇ g/ml.
  • composition includes conjugates from more than one pneumococcal serotype
  • a mixture of different conjugates will usually be formed by preparing each serotype conjugate separately, and then mixing them to form a mixture of separate conjugates.
  • Reference 84 describes potential advantages when using different carrier proteins in multivalent pneumococcal conjugate vaccines, but the PREVNARTM product successfully uses the same carrier for each of seven different serotypes.
  • a carrier protein may be covalently conjugated to a pneumococcal saccharide directly or via a linker.
  • Various linkers are known. For example, attachment may be via a carbonyl, which may be formed by reaction of a free hydroxyl group of a modified saccharide with CDI [85,86] followed by reaction with a protein to form a carbamate linkage. Carbodiimide condensation can be used [87].
  • An adipic acid linker can be used, which may be formed by coupling a free —NH 2 group (e.g.
  • linkers include ⁇ -propionamido [90], nitrophenyl-ethylamine [91], haloacyl halides [92], glycosidic linkages [93], 6-aminocaproic acid [94], N-succinimidyl-3-(2-pyridyldithio)-propionate (SPDP) [95], adipic acid dihydrazide ADH [96], C 4 to C 12 moieties [97], etc.
  • SPDP N-succinimidyl-3-(2-pyridyldithio)-propionate
  • Conjugation via reductive amination can be used.
  • the saccharide may first be oxidised with periodate to introduce an aldehyde group, which can then form a direct covalent linkage to a carrier protein via reductive amination e.g. to the ⁇ -amino group of a lysine. If the saccharide includes multiple aldehyde groups per molecule then this linkage technique can lead to a cross-linked product, where multiple aldehydes react with multiple carrier amines.
  • This cross-linking conjugation technique is particularly useful for at least pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F and 23F.
  • a pneumococcal saccharide may comprise a full-length intact saccharide as prepared from pneumococcus, and/or may comprise fragments of full-length saccharides i.e. the saccharides may be shorter than the native capsular saccharides seen in bacteria.
  • the saccharides may thus be depolymerised, with depolymerisation occurring during or after saccharide purification but before conjugation. Depolymerisation reduces the chain length of the saccharides. Depolymerisation can be used in order to provide an optimum chain length for immunogenicity and/or to reduce chain length for physical manageability of the saccharides. Where more than one pneumococcal serotype is used then it is possible to use intact saccharides for each serotype, fragments for each serotype, or to use intact saccharides for some serotypes and fragments for other serotypes.
  • compositions include saccharide from any of serotypes 4, 6B, 9V, 14, 19F and 23F, these saccharides are preferably intact. In contrast, where a composition includes saccharide from serotype 18C, this saccharide is preferably depolymerised.
  • a serotype 3 saccharide may also be depolymerised, For instance, a serotype 3 saccharide can be subjected to acid hydrolysis for depolymerisation [61] e.g. using acetic acid. The resulting fragments may then be oxidised for activation (e.g. periodate oxidation, may be in the presence of bivalent cations e.g. with MgCl 2 ), conjugated to a carrier (e.g. CRM197) under reducing conditions (e.g. using sodium cyanoborohydride), and then (optionally) any unreacted aldehydes in the saccharide can be capped (e.g. using sodium borohydride) [61]. Conjugation may be performed on lyophilized material e.g. after co-lyophilizing activated saccharide and carrier.
  • a serotype 1 saccharide may be at least partially de-O-acetylated e.g. achieved by alkaline pH buffer treatment [62] such as by using a bicarbonate/carbonate buffer.
  • Such (partially) de-O-acetylated saccharides can be oxidised for activation (e.g. periodate oxidation), conjugated to a carrier (e.g. CRM197) under reducing conditions (e.g. using sodium cyanoborohydride), and then (optionally) any unreacted aldehydes in the saccharide can be capped (e.g. using sodium borohydride) [62].
  • Conjugation may be performed on lyophilized material e.g. after co-lyophilizing activated saccharide and carrier.
  • a serotype 19A saccharide may be oxidised for activation (e.g. periodate oxidation), conjugated to a carrier (e.g. CRM197) in DMSO under reducing conditions, and then (optionally) any unreacted aldehydes in the saccharide can be capped (e.g. using sodium borohydride) [98]. Conjugation may be performed on lyophilized material e.g. after co-lyophilizing activated saccharide and carrier.
  • a carrier e.g. CRM197
  • any unreacted aldehydes in the saccharide can be capped (e.g. using sodium borohydride) [98].
  • Conjugation may be performed on lyophilized material e.g. after co-lyophilizing activated saccharide and carrier.
  • One or more pneumococcal capsular saccharide conjugates may be present in lyophilised form.
  • Pneumococcal conjugates can ideally elicit anticapsular antibodies that bind to the relevant saccharide e.g. elicit an anti-saccharide antibody level ⁇ 0.20 ⁇ g/mL [99].
  • the antibodies may be evaluated by enzyme immunoassay (EIA) and/or measurement of opsonophagocytic activity (OPA).
  • EIA enzyme immunoassay
  • OPA opsonophagocytic activity
  • compositions of the invention include an aluminium salt adjuvant, although other embodiments may be aluminium-free.
  • Aluminium salt adjuvants currently in use are typically referred to either as “aluminium hydroxide” or as “aluminium phosphate” adjuvants. These are names of convenience, however, as neither is a precise description of the actual chemical compound which is present (e.g. see chapter 9 of reference 100).
  • the invention can use any of the “hydroxide” or “phosphate” salts that useful as adjuvants.
  • Aluminium salts which include hydroxide ions are the preferred insoluble metal salts for use with the present invention as these hydroxide ions can readily undergo ligand exchange for adsorption of antigen and/or TLR agonists.
  • preferred salts for adsorption of TLR agonists are aluminium hydroxide and/or aluminium hydroxyphosphate. These have surface hydroxyl moieties which can readily undergo ligand exchange with phosphorus-containing groups (e.g. phosphates, phosphonates) to provide stable adsorption.
  • An aluminium hydroxide adjuvant is most
  • aluminium hydroxide typically aluminium oxyhydroxide salts, which are usually at least partially crystalline.
  • Aluminium oxyhydroxide which can be represented by the formula AlO(OH)
  • IR infrared
  • adsorption band at 1070 cm ⁇ 1 and a strong shoulder at 3090-3100 cm ⁇ 1 (chapter 9 of ref. 100).
  • the degree of crystallinity of an aluminium hydroxide adjuvant is reflected by the width of the diffraction band at half height (WHH), with poorly-crystalline particles showing greater line broadening due to smaller crystallite sizes.
  • the surface area increases as WHH increases, and adjuvants with higher WHH values have been seen to have greater capacity for antigen adsorption.
  • a fibrous morphology e.g. as seen in transmission electron micrographs
  • aluminium hydroxide adjuvants e.g. with needle-like particles with diameters about 2 nm.
  • the PZC of aluminium hydroxide adjuvants is typically about 11 i.e. the adjuvant itself has a positive surface charge at physiological pH.
  • Adsorptive capacities of between 1.8-2.6 mg protein per mg Al +++ at pH 7.4 have been reported for aluminium hydroxide adjuvants.
  • the adjuvants known as “aluminium phosphate” are typically aluminium hydroxyphosphates, often also containing a small amount of sulfate. They may be obtained by precipitation, and the reaction conditions and concentrations during precipitation influence the degree of substitution of phosphate for hydroxyl in the salt. Hydroxyphosphates generally have a PO 4 /Al molar ratio between 0.3 and 0.99. Hydroxyphosphates can be distinguished from strict AlPO 4 by the presence of hydroxyl groups. For example, an IR spectrum band at 3164 cm ⁇ 1 (e.g. when heated to 200° C.) indicates the presence of structural hydroxyls (chapter 9 of ref. 100).
  • the PO 4 /Al 3+ molar ratio of an aluminium phosphate adjuvant will generally be between 0.3 and 1.2, preferably between 0.8 and 1.2, and more preferably 0.95 ⁇ 0.1.
  • the aluminium phosphate will generally be amorphous, particularly for hydroxyphosphate salts.
  • a typical adjuvant is amorphous aluminium hydroxyphosphate with PO 4 /Al molar ratio between 0.84 and 0.92, included at 0.6 mg A1 3+ /ml.
  • the aluminium phosphate will generally be particulate. Typical diameters of the particles are in the range 0.5-20 ⁇ m (e.g. about 5-10 ⁇ m) after any antigen adsorption.
  • Adsorptive capacities of between 0.7-1.5 mg protein per mg Al +++ at pH 7.4 have been reported for aluminium phosphate adjuvants.
  • a composition can include a mixture of both an aluminium hydroxide and an aluminium phosphate, and components may be adsorbed to one or both of these salts.
  • An aluminium phosphate solution used to prepare a composition of the invention may contain a buffer (e.g. a phosphate or a histidine or a Tris buffer), but this is not always necessary.
  • the aluminium phosphate solution is preferably sterile and pyrogen-free.
  • the aluminium phosphate solution may include free aqueous phosphate ions e.g. present at a concentration between 1.0 and 20 mM, preferably between 5 and 15 mM, and more preferably about 10 mM.
  • the aluminium phosphate solution may also comprise sodium chloride.
  • the concentration of sodium chloride is preferably in the range of 0.1 to 100 mg/ml (e.g. 0.5-50 mg/ml, 1-20 mg/ml, 2-10 mg/ml) and is more preferably about 3 ⁇ 1 mg/ml.
  • the presence of NaCl facilitates the correct measurement of pH prior to adsorption of antigens.
  • a composition includes less than 0.2 mg Al +++ per unit dose.
  • the amount of Al +++ can be lower than this e.g. ⁇ 150 ⁇ g, ⁇ 100 ⁇ g, ⁇ 75 ⁇ g, ⁇ 50 ⁇ g, ⁇ 25 ⁇ g, ⁇ 10 ⁇ g, etc.
  • a composition has an Al +++ concentration below 0.4 mg/ml.
  • the concentration of Al +++ can be lower than this e.g. ⁇ 300 ⁇ g/ml, ⁇ 250 ⁇ g/ml, ⁇ 200 ⁇ g/ml, ⁇ 150 ⁇ g/ml, ⁇ 100 ⁇ g/ml, ⁇ 75 ⁇ g/ml, ⁇ 50 ⁇ g/ml, ⁇ 20 ⁇ g/ml, etc.
  • compositions of the invention include an aluminium-based adjuvant
  • settling of components may occur during storage.
  • the composition should therefore be shaken prior to administration to a patient.
  • the shaken composition will be a turbid white suspension.
  • composition of the invention includes an aluminium salt adjuvant then it is possible to adsorb a TLR agonist to that aluminium salt, thereby improving the immunopotentiating effect of the adjuvant [102]. This can lead to a better immune response and/or permits a reduction in the amount of aluminium in the composition while maintaining an equivalent adjuvant effect.
  • a composition of the invention can therefore include an aluminium salt (preferably an aluminium hydroxide) to which a TLR agonist (preferably a TLR7 agonist, and more preferably an agonist of human TLR7) is adsorbed.
  • a TLR agonist preferably a TLR7 agonist, and more preferably an agonist of human TLR7
  • the agonist and the salt can form a stable adjuvant complex which retains the salt's ability to adsorb antigens.
  • TLR agonists with adsorptive properties typically include a phosphorus-containing moiety which can undergo ligand exchange with surface groups on an aluminium salt e.g. with surface hydroxide groups.
  • a useful TLR agonist may include a phosphate, a phosphonate, a phosphinate, a phosphonite, a phosphinite, a phosphate, etc.
  • Preferred TLR agonists include at least one phosphate or phosphonate group [102].
  • TLR7 agonists Useful adsorptive TLR2 and TLR7 agonists are disclosed in references 102 to 106.
  • Specific adsorptive TLR7 agonists of interest include, but are not limited to, compounds IA to 27A in Table A on pages 79-84 of reference 107.
  • the TLR7 agonist can be one of:
  • these compounds can be adsorbed to aluminium salt adjuvants by simple mixing.
  • the compound (1 mg/mL) can be dissolved in 10 mM NaOH and added to a suspension of aluminium hydroxide adjuvant (2 mg/mL) to give a final TLR agonist concentration of 100 ⁇ g/dose.
  • 0.1 mg/mL, more preferably 0.01 mg/mL of the compound is added to 2 mg/mL aluminium hydroxide.
  • the mass ratio of aluminium salt to TLR agonist is between 2:1 and 400:1, preferably 20:1, more preferably 200:1. Incubation at room temperature for 1 hour usually suffices for >90% adsorption. Adsorption can take place across a range of pH, e.g. from 6.5 to 9.
  • an aluminium salt and a TLR agonist are prepared in histidine buffer e.g. between 5-20 mM (such as 10 mM) histidine buffer, conveniently at pH 6.5.
  • histidine buffer e.g. between 5-20 mM (such as 10 mM) histidine buffer, conveniently at pH 6.5.
  • the pH should be in the range between 6.0 and 6.5.
  • the pH is also crucial for the integrity and stability of the antigens, and in case of protein antigens, for their proper folding in the final vaccine formulation.
  • TLR7 agonist is ‘compound T’ (compound 6A on page 80 of reference 107). It has a solubility of about 4 mg/ml in water and adsorbs well to aluminium hydroxide:
  • the weight ratio of agonist to Al +++ will be less than 5:1 e.g. less than 4:1, less than 3:1, less than 2:1, or less than 1:1.
  • the maximum concentration of TLR agonist would be 2.5 mg/ml.
  • a lower mass of TLR agonist than of Al +++ is typical e.g. per dose, 100 ⁇ g of TLR agonist with 0.2 mg Al +++ , etc.
  • the amount of TLR agonist in a unit dose will fall in a relatively broad range that can be determined through routine trials.
  • An amount of between 1-1000 ⁇ g/dose can be used e.g. from 5-100 ⁇ g per dose or from 10-100 ⁇ g per dose, and ideally ⁇ 300 ⁇ g per dose e.g. about 5 ⁇ g, 10 ⁇ g, 20 ⁇ g, 25 ⁇ g, 50 ⁇ g or 100 ⁇ g per dose.
  • concentration of a TLR agonist in a composition of the invention may be from 2-2000 ⁇ g/ml e.g. from 10-200 ⁇ g/ml, or about 5, 10, 20, 40, 50, 100 or 200 ⁇ g/ml, and ideally ⁇ 600 ⁇ g/ml.
  • At least 50% (by mass) of an agonist in the composition is adsorbed to the metal salt e.g. ⁇ 60%, ⁇ 70%, ⁇ 80%, ⁇ 85%, ⁇ 90%, ⁇ 92%, ⁇ 94%, ⁇ 95%, ⁇ 96%, ⁇ 97%, ⁇ 98%, ⁇ 99%, or even 100%.
  • composition of the invention includes a TLR agonist adsorbed to a metal salt, and also includes a buffer
  • concentration of any phosphate ions in the buffer should be less than 50 mM (e.g. between 1-15 mM) as a high concentration of phosphate ions can cause desorption.
  • Use of a histidine buffer is preferred.
  • Oil-in-water emulsions are known to be useful adjuvants e.g. MF59 and AS03 are both present in authorised vaccines in Europe.
  • Various useful emulsion adjuvants are known, and they typically include at least one oil and at least one surfactant, with the oil(s) and surfactant(s) being biodegradable (metabolisable) and biocompatible.
  • the oil droplets in the emulsion generally have a sub-micron diameter, with these small sizes being achieved with a microfluidiser to provide stable emulsions. Droplets with a size less than 220 nm are preferred as they can be subjected to filter sterilization.
  • the invention can be used with oils such as those from an animal (such as fish) or vegetable source.
  • Sources for vegetable oils include nuts, seeds and grains. Peanut oil, soybean oil, coconut oil, and olive oil, the most commonly available, exemplify the nut oils.
  • Jojoba oil can be used e.g. obtained from the jojoba bean. Seed oils include safflower oil, cottonseed oil, sunflower seed oil, sesame seed oil and the like. In the grain group, corn oil is the most readily available, but the oil of other cereal grains such as wheat, oats, rye, rice, teff, triticale and the like may also be used.
  • 6-10 carbon fatty acid esters of glycerol and 1,2-propanediol may be prepared by hydrolysis, separation and esterification of the appropriate materials starting from the nut and seed oils.
  • Fats and oils from mammalian milk are metabolizable and may therefore be used in the practice of this invention.
  • the procedures for separation, purification, saponification and other means necessary for obtaining pure oils from animal sources are well known in the art.
  • Most fish contain metabolizable oils which may be readily recovered. For example, cod liver oil, shark liver oils, and whale oil such as spermaceti exemplify several of the fish oils which may be used herein.
  • a number of branched chain oils are synthesized biochemically in 5-carbon isoprene units and are generally referred to as terpenoids.
  • Shark liver oil contains a branched, unsaturated terpenoids known as squalene, 2,6,10,15,19,23-hexamethyl-2,6,10,14,18,22-tetracosahexaene, which is particularly preferred herein.
  • Squalane the saturated analog to squalene
  • Fish oils, including squalene and squalane are readily available from commercial sources or may be obtained by methods known in the art. Other preferred oils are the tocopherols (see below). Mixtures of oils can be used.
  • Surfactants can be classified by their ‘HLB’ (hydrophile/lipophile balance). Preferred surfactants of the invention have a HLB of at least 10, preferably at least 15, and more preferably at least 16.
  • the invention can be used with surfactants including, but not limited to: the polyoxyethylene sorbitan esters surfactants (commonly referred to as the Tweens), especially polysorbate 20 and polysorbate 80; copolymers of ethylene oxide (EO), propylene oxide (PO), and/or butylene oxide (BO), sold under the DOWFAXTM tradename, such as linear EO/PO block copolymers; octoxynols, which can vary in the number of repeating ethoxy(oxy-1,2-ethanediyl) groups, with octoxynol-9 (Triton X-100, or t-octylphenoxypolyethoxyethanol) being of particular interest; (octylphenoxy)polyethoxyethanol
  • Non-ionic surfactants are preferred.
  • Preferred surfactants for including in the emulsion are polysorbate 80 (polyoxyethylene sorbitan monooleate; Tween 80), Span 85 (sorbitan trioleate), lecithin and Triton X-100.
  • surfactants can be used e.g. Tween 80/Span 85 mixtures.
  • a combination of a polyoxyethylene sorbitan ester such as polyoxyethylene sorbitan monooleate (Tween 80) and an octoxynol such as t-octylphenoxypolyethoxyethanol (Triton X-100) is also suitable.
  • Another useful combination comprises laureth 9 plus a polyoxyethylene sorbitan ester and/or an octoxynol.
  • Preferred amounts of surfactants are: polyoxyethylene sorbitan esters (such as polysorbate 80) 0.01 to 1%, in particular about 0.1%; octyl- or nonylphenoxy polyoxyethanols (such as Triton X-100, or other detergents in the Triton series) 0.001 to 0.1%, in particular 0.005 to 0.02%; polyoxyethylene ethers (such as laureth 9) 0.1 to 20%, preferably 0.1 to 10% and in particular 0.1 to 1% or about 0.5%.
  • polyoxyethylene sorbitan esters such as polysorbate 80
  • octyl- or nonylphenoxy polyoxyethanols such as Triton X-100, or other detergents in the Triton series
  • polyoxyethylene ethers such as laureth 9
  • oil-in-water emulsion adjuvants useful with the invention include, but are not limited to:
  • Preferred oil-in-water emulsions used with the invention comprise squalene and/or polysorbate 80.
  • the emulsions may be mixed with antigens during manufacture, or they may be mixed extemporaneously at the time of delivery.
  • the adjuvant and antigen may be kept separately in a packaged or distributed vaccine, ready for final formulation at the time of use.
  • the antigen will generally be in an aqueous form, such that the vaccine is finally prepared by mixing two liquids.
  • the volume ratio of the two liquids for mixing can vary (e.g. between 5:1 and 1:5) but is generally about 1:1. If emulsion and antigen are stored separately in a multidose kit (from which multiple unit doses can be taken) then the product may be presented as a vial containing emulsion and a vial containing aqueous antigen, for mixing to give adjuvanted liquid vaccine.
  • MF59 When used in formulating a vaccine, MF59 is preferably mixed with antigens in phosphate-buffered saline to preserve the long-term stability of MF59 formulations and to guarantee physiological pH and osmolarity values in the final vaccine.
  • This mixing can be at a 1:1 volume ratio.
  • the PBS can have pH 7.2.
  • compositions include a tocopherol
  • any of the ⁇ , ⁇ , ⁇ , ⁇ , ⁇ or ⁇ tocopherols can be used, but ⁇ -tocopherols are preferred.
  • the tocopherol can take several forms e.g. different salts and/or isomers. Salts include organic salts, such as succinate, acetate, nicotinate, etc. D- ⁇ -tocopherol and DL- ⁇ -tocopherol can both be used.
  • Tocopherols are advantageously included in vaccines for use in elderly patients (e.g. aged 60 years or older) because vitamin E has been reported to have a positive effect on the immune response in this patient group. They also have antioxidant properties that may help to stabilize the emulsions [121].
  • a preferred ⁇ -tocopherol is DL- ⁇ -tocopherol, and the preferred salt of this tocopherol is the succinate.
  • the succinate salt has been found to cooperate with TNF-related ligands in
  • compositions of the invention may comprise: (a) an antigenic component; and (b) a non-antigenic component.
  • the antigenic component can comprise or consist of the antigens discussed above.
  • the non-antigenic component can include carriers, adjuvants, excipients, buffers, etc., These non-antigenic components may have various sources. For example, they may be present in one of the antigen or adjuvant materials that is used during manufacture or may be added separately from those components.
  • compositions of the invention include one or more pharmaceutical carrier(s) and/or excipient(s).
  • a physiological salt such as a sodium salt.
  • Sodium chloride (NaCl) is preferred, which may be present at between 1 and 20 mg/ml.
  • Compositions will generally have an osmolality of between 200 mOsm/kg and 400 mOsm/kg, preferably between 240-360 mOsm/kg, and will more preferably fall within the range of 280-320 mOsm/kg. Osmolality has previously been reported not to have an impact on pain caused by vaccination [122], but keeping osmolality in this range is nevertheless preferred.
  • Compositions of the invention may include one or more buffers.
  • Typical buffers include: a phosphate buffer; a Tris buffer; a borate buffer; a succinate buffer; a histidine buffer; or a citrate buffer. Buffers will typically be included in the 5-20 mM range.
  • a composition of the invention can be substantially free from surfactants (prior to mixing with any emulsion adjuvant).
  • the composition of the invention can be substantially free from polysorbate 80 e.g. it contains less than 0.1 ⁇ g/ml of polysorbate 80, and preferably contains no detectable polysorbate 80.
  • a composition includes HBsAg, however, it will usually include polysorbate 20 e.g. if it was used during yeast disruption [29].
  • the pH of a composition of the invention will generally be between 6.0 and 7.5.
  • a manufacturing process may therefore include a step of adjusting the pH of a composition prior to packaging.
  • Aqueous compositions administered to a patient can have a pH of between 5.0 and 7.5, and more typically between 5.0 and 6.0 for optimum stability; where a diphtheria toxoid and/or tetanus toxoid is present, the pH is ideally between 6.0 and 7.0.
  • compositions of the invention are preferably sterile.
  • compositions of the invention are preferably non-pyrogenic e.g. containing ⁇ 1 EU (endotoxin unit, a standard measure; 1 EU is equal to 0.2 ng FDA reference standard Endotoxin EC-2 ‘RSE’) per dose, and preferably ⁇ 0.1 EU per dose.
  • ⁇ 1 EU endotoxin unit, a standard measure; 1 EU is equal to 0.2 ng FDA reference standard Endotoxin EC-2 ‘RSE’
  • compositions of the invention are preferably gluten free.
  • a vaccine product may be a suspension with a cloudy appearance. This appearance means that microbial contamination is not readily visible, and so the vaccine preferably contains an antimicrobial agent. This is particularly important when the vaccine is packaged in multidose containers.
  • Preferred antimicrobials for inclusion are 2-phenoxyethanol and thimerosal. It is preferred, however, not to use mercurial preservatives (e.g. thimerosal) during the process of the invention. Thus, between 1 and all of the components used in the process may be substantially free from mercurial preservative. However, the presence of trace amounts may be unavoidable if a component was treated with such a preservative before being used in the invention.
  • the final composition contains less than about 25 ng/ml mercury. More preferably, the final vaccine product contains no detectable thimerosal. This will generally be achieved by removing the mercurial preservative from an antigen preparation prior to its addition in the process of the invention or by avoiding the use of thimerosal during the preparation of the components used to make the composition. Mercury-free compositions are preferred.
  • compositions of the invention will generally be in aqueous form.
  • the invention can provide bulk material which is suitable for packaging into individual doses, which can then be distributed for administration to patients. Concentrations discussed above are typically concentrations in final packaged dose, and so concentrations in bulk vaccine may be higher (e.g. to be reduced to final concentrations by dilution).
  • compositions of the invention are preferably administered to patients in 0.5 ml unit doses.
  • References to 0.5 ml doses will be understood to include normal variance e.g. 0.5 ml ⁇ 0.05 ml.
  • multiple dose amounts will be extracted and packaged together in a single container e.g. 5 ml for a 10-dose multidose container (or 5.5 ml with 10% overfill).
  • Residual material from individual antigenic components may also be present in trace amounts in the final vaccine produced by the process of the invention.
  • the final vaccine product may retain trace amounts of formaldehyde (e.g. less than 10 ⁇ g/ml, preferably ⁇ 5 ⁇ g/ml).
  • Media or stabilizers may have been used during poliovirus preparation (e.g. Medium 199), and these may carry through to the final vaccine.
  • free amino acids e.g.
  • antigen preparations may be retained in the final vaccine at ⁇ 100 ⁇ g/ml, preferably ⁇ 10 ⁇ g/ml, each.
  • Other components from antigen preparations such as neomycin (e.g. neomycin sulfate, particularly from a poliovirus component), polymyxin B (e.g. polymyxin B sulfate, particularly from a poliovirus component), etc. may also be present at sub-nanogram amounts per dose.
  • a further possible component of the final vaccine which originates in the antigen preparations arises from less-than-total purification of antigens. Small amounts of B. pertussis, C. diphtheriae, C. tetani and S. cerevisiae proteins and/or genomic DNA may therefore be present.
  • antigen preparations are preferably treated to remove them prior to the antigens being used with the invention.
  • the final vaccine preferably contains less than 10 ng/ml, preferably ⁇ 1 ng/ml e.g. ⁇ 500 pg/ml or ⁇ 50 pg/ml of Vero cell DNA e.g. less than 10 ng/ml of Vero cell DNA that is ⁇ 50 base pairs long.
  • compositions of the invention are presented for use in containers.
  • Suitable containers include vials and disposable syringes (preferably sterile ones).
  • Processes of the invention may comprise a step of packaging the vaccine into containers for use.
  • Suitable containers include vials and disposable syringes (preferably sterile ones).
  • a composition of the invention is presented in a vial
  • this is preferably made of a glass or plastic material.
  • the vial is preferably sterilized before the composition is added to it.
  • vials may be sealed with a latex-free stopper.
  • the vial may include a single dose of vaccine, or it may include more than one dose (a ‘multidose’ vial) e.g. 10 doses.
  • a multidose vial When using a multidose vial, each dose should be withdrawn with a sterile needle and syringe under strict aseptic conditions, taking care to avoid contaminating the vial contents.
  • Preferred vials are made of colorless glass.
  • a vial can have a cap (e.g. a Luer lock) adapted such that a pre-filled syringe can be inserted into the cap, the contents of the syringe can be expelled into the vial (e.g. to reconstitute lyophilised material therein), and the contents of the vial can be removed back into the syringe.
  • a needle can then be attached and the composition can be administered to a patient.
  • the cap is preferably located inside a seal or cover, such that the seal or cover has to be removed before the cap can be accessed.
  • the syringe will not normally have a needle attached to it, although a separate needle may be supplied with the syringe for assembly and use.
  • Safety needles are preferred.
  • 1-inch 23-gauge, 1-inch 25-gauge and 5 ⁇ 8-inch 25-gauge needles are typical.
  • Syringes may be provided with peel-off labels on which the lot number and expiration date of the contents may be printed, to facilitate record keeping.
  • the plunger in the syringe preferably has a stopper to prevent the plunger from being accidentally removed during aspiration.
  • the syringes may have a latex rubber cap and/or plunger. Disposable syringes contain a single dose of vaccine.
  • the syringe will generally have a tip cap to seal the tip prior to attachment of a needle, and the tip cap is preferably made of butyl rubber. If the syringe and needle are packaged separately then the needle is preferably fitted with a butyl rubber shield. Grey butyl rubber is preferred. Preferred syringes are those marketed under the trade name “Tip-Lok”TM.
  • a glass container e.g. a syringe or a vial
  • a container made from a borosilicate glass rather than from a soda lime glass.
  • the container can then be enclosed within a box for distribution e.g. inside a cardboard box, and the box will be labeled with details of the vaccine e.g. its trade name, a list of the antigens in the vaccine (e.g. ‘hepatitis B recombinant’, etc.), the presentation container (e.g. ‘Disposable Prefilled Tip-Lok Syringes’ or ‘10 ⁇ 0.5 ml Single-Dose Vials’), its dose (e.g. ‘each containing one 0.5 ml dose’), warnings (e.g. ‘For Adult Use Only’ or ‘For Pediatric Use Only’), an expiration date, an indication, a patent number, etc.
  • Each box might contain more than one packaged vaccine e.g. five or ten packaged vaccines (particularly for vials).
  • the vaccine may be packaged together (e.g. in the same box) with a leaflet including details of the vaccine e.g. instructions for administration, details of the antigens within the vaccine, etc.
  • the instructions may also contain warnings e.g. to keep a solution of adrenaline readily available in case of anaphylactic reaction following vaccination, etc.
  • the packaged vaccine is preferably stored at between 2° C. and 8° C. It should not be frozen.
  • Vaccines can be provided in full-liquid form (i.e. where all antigenic components are in aqueous solution or suspension) after manufacture, or they can be prepared in a form where the vaccine can be prepared extemporaneously at the time/point of use by mixing together two components.
  • Such two-component embodiments include liquid/liquid mixing and liquid/solid mixing e.g. by mixing aqueous material with lyophilised material.
  • a vaccine can be made by mixing: (a) a first component comprising aqueous antigens and/or adjuvant; and (b) a second component comprising lyophilized antigens.
  • a vaccine in another embodiment can be made by mixing: (a) a first component comprising aqueous antigens and/or adjuvant; and (b) a second component comprising aqueous antigens.
  • a vaccine can be made by mixing: (a) a first component comprising aqueous antigens; and (b) a second component comprising aqueous adjuvant.
  • the two components are preferably in separate containers (e.g. vials and/or syringes), and the invention provides a kit comprising components (a) and (b).
  • Another useful liquid/lyophilised format comprises (a) an oil-in-water emulsion adjuvant and (b) a lyophilised component including one or more antigens.
  • a vaccine composition suitable for patient administration is obtained by mixing components (a) and (b).
  • component (a) is antigen-free, such that all antigenic components in the final vaccine are derived from component (b); in other embodiments component (a) includes one or more antigen(s), such that the antigenic components in the final vaccine are derived from both components (a) and (b).
  • Another useful liquid/lyophilised format comprises (a) an aqueous complex of an aluminium salt and a TLR agonist and (b) a lyophilised component including one or more antigens.
  • a vaccine composition suitable for patient administration is obtained by mixing components (a) and (b).
  • component (a) is antigen-free, such that all antigenic components in the final vaccine are derived from component (b); in other embodiments component (a) includes one or more antigen(s), such that the antigenic components in the final vaccine are derived from both components (a) and (b).
  • the invention provides a kit for preparing a combination vaccine, comprising components (a) and (b) as noted above.
  • the kit components are typically vials or syringes, and a single kit may contain both a vial and a syringe.
  • the invention also provides a process for preparing such a kit, comprising the following steps: (i) preparing an aqueous component vaccine as described above; (ii) packaging said aqueous combination vaccine in a first container e.g. a syringe; (iii) preparing an antigen-containing component in lyophilised form; (iv) packaging said lyophilised antigen in a second container e.g. a vial; and (v) packaging the first container and second container together in a kit.
  • the kit can then be distributed to physicians.
  • a liquid/lyophilised format is particularly useful for vaccines that include a conjugate component, particularly Hib and/or meningococcal and/or pneumococcal conjugates, as these may be more stable in lyophilized form.
  • conjugates may be lyophilised prior to their use with the invention.
  • a component is lyophilised it generally includes non-active components which were added prior to freeze-drying e.g. as stabilizers.
  • Preferred stabilizers for inclusion are lactose, sucrose and mannitol, as well as mixtures thereof e.g. lactose/sucrose mixtures, sucrose/mannitol mixtures, etc.
  • a final vaccine obtained by aqueous reconstitution of the lyophilised material may thus contain lactose and/or sucrose. It is preferred to use amorphous excipients and/or amorphous buffers when preparing lyophilised vaccines [123].
  • compositions of the invention include (1) diphtheria, tetanus and pertussis toxoids, inactivated poliovirus for Types 1, 2 & 3, plus (2) hepatitis B virus surface antigen and/or a Hib conjugate.
  • These compositions may consist of the antigens specified, or may further include antigens from additional pathogens (e.g. meningococcus ).
  • additional pathogens e.g. meningococcus
  • the compositions can be used as vaccines themselves, or as components of further vaccines.
  • composition includes both diphtheria and tetanus toxoids these may be present at various ratios. There is preferably an excess of diphtheria toxoid (measured in Lf units) e.g. between 2-4 ⁇ more diphtheria toxoid than tetanus toxoid, such as 2.5 ⁇ or 3 ⁇ more.
  • compositions of the invention are suitable for administration to human patients, and the invention provides a method of raising an immune response in a patient, comprising the step of administering a composition of the invention to the patient.
  • the invention also provides a composition of the invention for use in medicine.
  • the invention also provides the use of (i) at least a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and (ii) an aluminium salt adjuvant, in the manufacture of a combination vaccine which includes less than 0.2 mg Al +++ per unit dose.
  • the invention also provides the use of (i) at least a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and (ii) an aluminium salt adjuvant, in the manufacture of a combination vaccine which includes a low dose of each of a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid.
  • the invention also provides the use of (i) at least a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and (ii) an aluminium salt adjuvant, in the manufacture of a combination vaccine which includes a low dose of each of a diphtheria toxoid, a tetanus toxoid, and a pertussis toxoid and has less than 0.2 mg Al +++ per unit dose.
  • the invention also provides the use of (i) a diphtheria toxoid, a tetanus toxoid, a pertussis toxoid, and a Hib conjugate (ii) a hepatitis B virus surface antigen and/or an inactivated poliovirus antigen, and (iii) an oil-in-water emulsion adjuvant, in the manufacture of a combination vaccine.
  • Immunogenic compositions of the invention are preferably vaccines, for use in the prevention of at least diphtheria, tetanus, whooping cough. Depending on their antigen content the vaccines may also protect against bacterial meningitis, polio, hepatitis, etc.
  • a typical primary immunization schedule may involve administering more than one dose.
  • doses may be at: 0 & 6 months (time 0 being the first dose); at 0, 1, 2 & 6 months; at day 0, day 21 and then a third dose between 6 & 12 months; at 2, 4 & 6 months; at 3, 4 & 5 months; at 6, 10 & 14 weeks; at 2, 3 & 4 months; or at 0, 1, 2, 6 & 12 months.
  • Compositions can also be used as booster doses e.g. for children, in the second year of life.
  • compositions of the invention can be administered by intramuscular injection e.g. into the arm or leg.
  • a further aspect of the invention is an immunisation schedule for an infant (i.e. a child between birth and 1 year of age) in which only one or two DTP-containing compositions are administered.
  • the invention delivers fewer doses compared to the current normal 3-dose schedule, but without loss of immunoprotective effect.
  • the invention provides:
  • the vaccine can also include a TLR agonist which may be adsorbed to that aluminium salt.
  • the combination vaccine includes a pertussis toxoid. This may be incorporated into the vaccine as a protein within a cellular pertussis antigen, but it is preferred to use an acellular pertussis antigen, as discussed in more detail above.
  • no more than two doses of the vaccine are given to the infant i.e. the infant receives a single dose or two doses of the vaccine, but does not receive three (or more) doses.
  • the infant may, though, receive a third (and maybe further) dose later in their life i.e. after their first birthday or after their second birthday.
  • the one or two dose(s) is/are preferably given to the infant (i) between 1 and 5 months of age (ii) between 2 and 4 months of age (iii) between 3 and 5 months of age (iv) between 6 and 16 weeks of age or (v) between 0 and 3 months of age.
  • two doses may be given at (i) 1 & 2 months of age (ii) 2 & 4 months of age (iii) 3 & 4 months of age (iv) 2 & 3 months of age (v) 0 and 1 months of age, etc.
  • composition “comprising” encompasses “including” as well as “consisting” e.g. a composition “comprising” X may consist exclusively of X or may include something additional e.g. X+Y.
  • a process comprising a step of mixing two or more components does not require any specific order of mixing.
  • components can be mixed in any order. Where there are three components then two components can be combined with each other, and then the combination may be combined with the third component, etc.
  • an antigen is described as being “adsorbed” to an adjuvant, it is preferred that at least 50% (by weight) of that antigen is adsorbed e.g. 50%, 60%, 70%, 80%, 90%, 95%, 98% or more. It is preferred that diphtheria toxoid and tetanus toxoid are both totally adsorbed i.e. none is detectable in supernatant. Total adsorption of HBsAg can be used.
  • Amounts of conjugates are generally given in terms of mass of saccharide (i.e. the dose of the conjugate (carrier+saccharide) as a whole is higher than the stated dose) in order to avoid variation due to choice of carrier.
  • compositions include an aluminium salt adjuvant then preferably it does not also include an oil-in-water emulsion adjuvant. Conversely, where a composition includes an oil-in-water emulsion adjuvant then preferably it does not also include an aluminium salt adjuvant.
  • Phosphorous-containing groups employed with the invention may exist in a number of protonated and deprotonated forms depending on the pH of the surrounding environment, for example the pH of the solvent in which they are dissolved. Therefore, although a particular form may be illustrated herein, it is intended, unless otherwise mentioned, for these illustrations to merely be representative and not limiting to a specific protonated or deprotonated form.
  • TLR agonists can exist as pharmaceutically acceptable salts.
  • the compounds may be used in the form of their pharmaceutically acceptable salts i.e. physiologically or toxicologically tolerable salt (which includes, when appropriate, pharmaceutically acceptable base addition salts and pharmaceutically acceptable acid addition salts).
  • TLR agonists shown herein which may exist in tautomeric forms (i.e. in keto or enol forms)
  • the compound can be used in all such tautomeric forms.
  • a compound is administered to the body as part of a composition then that compound may alternatively be replaced by a suitable prodrug.
  • TSEs transmissible spongiform encephalopathies
  • BSE bovine spongiform encephalopathy
  • 3-valent (DTaP) or 6-valent (DTaP-HBsAg-IPV-Hib) vaccines were adjuvanted with aluminium hydroxide alone, aluminium hydroxide with pre-adsorbed ‘compound T’, poly(lactide-co-glycolide) microparticles (‘PLG’), and MF59 oil-in-water emulsion.
  • Aluminium hydroxide and aluminium hydroxide with pre-adsorbed ‘compound T’ were prepared in histidine buffer pH 6.5. At pH 6.5, aluminium hydroxide has a positive net charge, while most proteins have a negative net charge. The pH value was chosen to provide good adsorption of most of the tested antigens.
  • the PLG microparticles were prepared with dioctylsulfosuccinate (DSS) which confers a negative net charge to the microparticles.
  • DSS dioctylsulfosuccinate
  • the pellet containing the adjuvant-antigen complexes was resuspended in desorption buffer (4 ⁇ concentration: 0.5 M Na 2 HPO 4 pH, 8 g SDS, 25 g glycerol, 6.16 g DTT and bromophenol blue), the aluminium hydroxide was removed by centrifugation and the supernatant applied to an SDS-PAGE gel.
  • desorption buffer 4 ⁇ concentration: 0.5 M Na 2 HPO 4 pH, 8 g SDS, 25 g glycerol, 6.16 g DTT and bromophenol blue
  • the MF59 oil-in-water emulsion containing antigens were separated by centrifugation in an oily phase and an aqueous phase. Both the aqueous phase containing unabsorbed antigens and the oily phase presumably containing MF59-associated antigens were mixed with loading buffer and applied to an SDS-PAGE gel. After electrophoretic separation of the samples, the gels were either analysed by Coomassie Blue staining
  • the antigen adsorption profiles obtained using PLG showed an opposite trend to those seen in the presence of the other two adjuvants probably reflecting the negative net charge of PLG versus the positive net charge of aluminium hydroxide or aluminium hydroxide with pre-adsorbed ‘compound T’.
  • MF59 is a delivery system generally considered unable to physically interact with the antigens as shown by the lack of an antigen deposition at the injection site and independent clearance of MF59 and the antigens (see references 124 and 125).
  • 1:1, 1:3 and 1:10 ratios (v:v of MF59 to complete antigen formulation) were tested.
  • SDS-PAGE and Western blot analysis showed that all ten tested antigens were present in the aqueous phase of MF59-adjuvanted formulations.
  • the antigen profiles of MF59-adjuvanted formulations corresponded to the profiles of unadjuvanted formulations.
  • the INFANRIX HEXA product from GlaxoSmithKline contains ⁇ 30 IU diphtheria toxoid, ⁇ 40 IU tetanus toxoid, an acellular pertussis component (25/25/8 ⁇ g of PT/FHA/pertactin), 10 ⁇ g HBsAg, a trivalent IPV component (40/8/32 DU of types 1/2/3), and 10 ⁇ g Hib conjugate.
  • the vaccine is presented as a 5-valent aqueous vaccine which is used to reconstitute the Hib conjugate from its lyophilised form, to give a 0.5 ml aqueous unit dose for human infants which contains 0.95 mg aluminium hydroxide and 1.45 mg aluminium phosphate.
  • Osmolarity and pH were measured (and, if necessary, adjusted) after combining the components in order to ensure physiological acceptability.
  • the pH was between 5.9 and 7.1 and osmolarity was between 290-320 mOsm/kg (except one at >400 mOsm/kg).
  • the pH was between 5.5 and 6.8 and osmolarity was between 260-320 mOsm/kg (except one at >500 mOsm/kg).
  • a buffer control had pH 7.3 and 276 mOsm/kg.
  • antigens The integrity and immunogenicity of the combined antigens were also tested. None of antigens showed an altered analytical profile after being formulated as combinations i.e. the antigens and adjuvants are physically compatible together.
  • aluminium hydroxide alone all antigens adsorbed well to the adjuvant.
  • compound ‘T’ i.e. aluminium hydroxide which had been pre-mixed with ‘compound T’ to permit adsorption for formation of a stable adjuvant complex; ‘Al-T’ hereafter) all antigens adsorbed well, except that TT, pertactin and PT were partially desorbed.
  • mice Female Balb/c, 4 weeks old were immunised intramuscularly with 100 ⁇ l of each composition (i.e. 1 ⁇ 5 human dose volume) at days 0 and 28. Sera were collected 14 days after each injection. After the second immunisation IgG antibody titers were as follows:
  • IgG responses were also investigated by subclass. For most of the antigens in the 6-valent vaccines the adjuvants had little effect on IgG1 titers, but they did increase IgG2a and IgG2b titers. The best IgG2a and IgG2b titers were obtained with Al-T, and then with MF59.
  • Osmolarity and pH were measured (and, if necessary, adjusted) after dilution.
  • pH was between 6.1 and 7.0 and osmolarity was between 275-320 mOsm/kg.
  • a buffer control had pH 7.3 and 285 mOsm/kg.
  • mice were immunised in the same way as discussed above.
  • Total serum IgG titers after 2 immunisations were as follows:
  • adjuvants allowed a dose reduction of 5-fold or 10-fold while maintaining IgG titers which are comparable or higher to unadjuvanted antigens.
  • MF59 and Al-T in particular are useful for dose sparing of antigens in this manner.
  • the MF59 emulsion was mixed with antigens at a 1:1 volume ratio or at a 1:3 ratio (i.e. 1 ml of emulsion for every 3 ml of antigen, with 2 ml of buffer to maintain total volume) or at a 1:10 ratio.
  • the Al-T complex was prepared at 3 strengths having 2 mg/ml aluminium hydroxide with either 5 ⁇ g, 25 ⁇ g or 100 ⁇ g of ‘compound T’ per dose. For comparison a 1:100 antigen dose was tested in unadjuvanted form or with aluminium hydroxide alone. A 1:100 dilution of Infanrix Hexa was also used for comparison.
  • Osmolarity and pH were measured (and, if necessary, adjusted) after mixing (except for Infanrix Hexa).
  • pH was between 6.2 and 7.3 and osmolarity was between 270-320 mOsm/kg.
  • a buffer control had pH 7.3 and 280 mOsm/kg.
  • mice were immunised as before.
  • Total serum IgG titers after 2 immunisations were as follows:
  • Pediacel's, Daptacel's and Adacel's Pa components also contain fimbriae types 2 and 3.
  • Hib dose shows amount of PRP capsular saccharide ( ⁇ g).
  • IPV dose shows amounts of type 1, then type 2, then type 3 (measured in DU).
  • Tritanrix-HepB, Quinvaxem, TripVac HB and SII Q-Vac include whole-cell pertussis antigens

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