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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
  • A61K35/741—Probiotics
  • A61K35/744—Lactic acid bacteria, e.g. enterococci, pediococci, lactococci, streptococci or leuconostocs
  • A61K35/747—Lactobacilli, e.g. L. acidophilus or L. brevis
• • 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
• • 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
  • 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
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/10—Antimycotics
• • 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
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • 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
  • A61K2039/51—Medicinal preparations containing antigens or antibodies comprising whole cells, viruses or DNA/RNA
  • A61K2039/52—Bacterial cells; Fungal cells; Protozoal cells
  • A61K2039/522—Bacterial cells; Fungal cells; Protozoal cells avirulent or attenuated
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
  • A61K2039/541—Mucosal route
• • 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
• • 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
  • A61K2039/57—Medicinal preparations containing antigens or antibodies characterised by the type of response, e.g. Th1, Th2

Definitions

• compositions and methods for treatment of mucosal infections are “Compositions and methods for treatment of mucosal infections”.
• the present invention is concerned with novel vaccine compositions that induce mucosal protection and in particular to oral vaccines and to methods of enhancing mucosal resistance to infection or for treating established infections.
• BACKGROUND ART Endobronchitis has been used as a model of mucosal immunology and more specifically to reflect a particular balance of the host-parasite relationship at the mucosal surface.
• the normally sterile bronchus mucosa becomes colonised by "avirulent" bacteria wliich do not generally invade. Most prominent is non-typable Haemophilus influenzae
• NTHI acute bronchitis
• the original oral vaccine used killed NTHI to activate the common mucosal system to enhance release of lymphocytes (then considered to be antibody producing B lymphocytes) from the Peyer's patches along the small intestine, which relocated within the bronchus mucosa, producing IgA antibody which would prevent descent of bacteria into the bronchi.
• This concept has been superseded.
• This vaccine requires that (i) a single bacterial content and (ii) no added adjuvant. The absence of adjuvant was thought necessary to avoid the then considered restrictions imposed by the highly downregulated mucosal environment, ie additions of adjuvant to a simple single bacterial vaccine would enhance mucosal downregulation, reduce vaccine effectiveness, and even promote or exacerbate infection.
• a mucosally administrable composition comprising one or more antigens derived from at least one microorganism which is capable of causing infection at a mucosal surface and an adjuvant capable of inducing a Thl cellular immune response, wherein the adjuvant is not derived from a microorganism capable of causing infection at a mucosal surface.
• the antigen is derived from a bacterium, a fungus or a virus. Even more preferred is that the antigen is represented by the whole microorganism. As a further preference, when the antigen is a whole microorganism, it is a killed microorganism however it will be understood that live or live attenuated microorganisms may also be used effectively. It will also be understood however, that individual antigens or homogenates and sonicates of microorganisms can also be used with the expectation of achieving similar results.
• respiratory tract bacterial and fungal pathogens or those normally colonising the respiratory tract and having the potential to cause infection, for example NTE-I, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus albus, Staphylococcus aureus and the like, singularly or in combination.
• compositions of the present invention are intended to be administered orally and thus may be combined with the known pharmaceutically acceptable, carriers, solvents and excipients.
• the adjuvant used in the compositions of the present invention is a microorganism or a part thereof which is not an organism that is capable of causing infection at a mucosal surface and wliich can induce a cellular immune response of the Thl type.
• the adjuvant is a bacterium, for example one which can be selected from, but not limited to, lactic acid bacteria, Mycobacterium species or Bifidobacterium species. Even more preferred is the use of Lactobacillus acidophilus (L. acidophilus), Lactobacillus fermentum (L. fermentum) or Mycobacterium vaccae (M. vaccae), or parts thereof which are capable of inducing the Thl cellular response. Specially preferred is L.
• L. acidophilus, L. fermentum or M. vaccae may be used five or as an inactivated preparation, as long as they are capable of inducing the Thl response.
• L. acidophilus and L. fermentum is used as a live preparation.
• other bacteria would also be suitable as adjuvants (whether they have probiotic effect or not), for example the well known adjuvating bacteria such as for example L.casei, L. Plantarum, L. rhamnosus, Bifidobecterium breve and the like.
• the use of probiotic bacteria as adjuvants is preferred.
• compositions of the present invention may be in the form of a food product or a food supplement, such as for example a dairy product or supplement.
• a vaccine comprising the composition according to the first aspect.
• a method of therapeutic or prophylactic treatment of a mucosal infection comprising the administration to a subject requiring such treatment a composition according to the first aspect or a vaccine according to the second aspect.
• a subject requiring treatment may be administered initially only a part of the composition, for example the adjuvant in the form of bacteria such as L. acidophilus and L. fermentum, followed thereafter by the administration of the antigen or antigens intended to ultimately provide specific immunity to the potential pathogen.
• the initial treatment with the adjuvant may take the form of a single bolus dose but may also, and for preference, be administered in repeated doses for a period of time before the antigen is administered.
• the administration of the adjuvant may also continue after cessation of antigen administration.
• compositions and vaccines of the present invention can be applied to any potential mucosal pathogen and any mucosal surface, including but not limited to bucal cavity, the respiratory tract and the intestinal tract.
• compositions or vaccines of the present invention are aclministered orally but application to any mucosal surface, for example the mucosa of the respiratory tract or mucosa of the intestinal tract, is contemplated.
• compositions and vaccines of the present invention are advantageously used to induce mucosal protection against infection however they can also be used as prophylactics in the treatment of existing bacterial, fungal and/or viral mucosal infections. Further, the preferred use of the compositions and vaccines of the present invention is when the mucosal surfaces are already colonised by bacteria.
• a method of therapeutic or prophylactic treatment of a mucosal infection comprising the administration to a subject requiring such treatment the adjuvant part of a composition according to the first aspect, followed by the antigen part of a composition according to the first aspect.
• the treatment with the adjuvant part is by administration of a single bolus dose of adjuvant however treatment with the adjuvant part can also be by administration of repeated doses of adjuvant. More preferred however, is that the adjuvant and the antigen are co-administered.
• the administration of the adjuvant may continue after the administration of the antigen part.
• compositions and vaccines of the present invention may be administered to any mucosal surface and have the desired effect because of the common mucosal immune system.
• Preferred mucosal surfaces bucal cavity, the respiratory tract and the intestinal tract may be administered to any mucosal surface and have the desired effect because of the common mucosal immune system.
• Preferred mucosal surfaces bucal cavity, the respiratory tract and the intestinal tract may be administered to any mucosal surface and have the desired effect because of the common mucosal immune system.
• compositions or the vaccines are administered orally.
• the vaccine is administered in two courses, followed by a booster course.
• the preferred dosage of the adjuvant when the adjuvant is a whole live probiotic bacterium, is from about 1 x 10 8 to about 1 x 10 12 organisms.
• the preferred dosage of the antigen when the antigen is represented by a whole killed microorganism, is from about 1 x 10 8 to about 1 x 10 12 organisms. More preferred is a dosage wherein the ratio of whole killed microorganisms (antigen) to probiotic bacteria (adjuvant) is about 5:1 or greater.
• compositions or the vaccines are also preferred.
• administration of the compositions or the vaccines each year before outbreak of seasonal infections.
• FIGURE Figure 1 IL-4 and IFN- ⁇ production following feeding with Lactobacillus acidophilus
• a specific antigen relevant to mucosal infection eg whole bacteria such as Haemophilus influenzae
• non-specific bacteria ie. those that are not normally associated with mucosal infection
• protracted protection against mucosal infection can be achieved.
• the present invention is based on the notion that the non-specific bacteria used induce T cells to produce a particular cytokine response which amplifies the protection otherwise expected from administration of traditional vaccine preparations.
• Thl ie IFN- ⁇
• a non-specific bacteria such as lactic acid bacteria, have the capacity to downregulate IL-4 and to enhance IFN- ⁇ production in a highly "Th2- biased" murine model (see Example 1). It is also demonstrated herein that a non-specific bacterium such as lactobacillus provides additive protection in a rat model of non-typable Haemophilus influenzae (NTHI) clearance from the bronchus (shown to involve CD4 T cells, with no antibody) (see Example 2).
• NTHI non-typable Haemophilus influenzae
• the animal model used by way of example in the present studies is a model of colonisation, relevant to both therapy and prevention of infection. Colonisation is an essential determinant for infection and the model has been used in the context of other therapeutic and prophylactic vaccines to establish efficacy, dosage, dosage protocols and the like.
• a therapeutic oral vaccine combines: 1) specific bacteria which are found within the respiratory tract, singly or in combination (for example, but not limited to, NTHI, S.pneumoniae, Ps.aeruginosa, S.albus, S.aureus), as killed or live bacteria, and 2) non-specific bacteria (also referred to herein as probiotic bacteria), which have the capacity to switch mucosal immunity in the direction of a Thl T cell response (may also be used killed or live), for example, but not limited to, Lactobacillus species (eg. L. acidophilus) and/ 'or Mycobacterium species, (eg M.vaccae).
• specific bacteria which are found within the respiratory tract, singly or in combination
• non-specific bacteria also referred to herein as probiotic bacteria
• probiotic bacteria also referred to herein as probiotic bacteria
• This type of oral vaccine operates best when the mucosal surface is already colonised (as these bacteria re-stimulate newly relocated cells within the mucosa) ie functions as a therapeutic vaccine. It can, however, function as a prophylactic vaccine.
• enteric coated capsules may be used to release the bacterial contents along the small intestine.
• Another option is longer term use of the non-specific bacteria to create a more durable Thl mucosal environment, prior to the administration of the specific antigen(s) or bacteria intended to induce a specific immune response against the potential mucosal pathogen. The 'nonspecific' bacteria alone do not induce specific protection.
• the non-specific bacteria also enhance response to certain antigens given parenterally, particularly those influencing mucosal protection (by favouring a particular immune outcome).
• a combination of Gram+ve with Gram-ve bacteria as probiotic adjuvants has synergistic activity in this system and is also contemplated herein.
• Various respiratory mucosal surfaces can be protected as the mucosal immune system is common to all mucosal surfaces (eg bronchus, sinus, and middle ear among others).
• Example 1 Effect of probiotic bacteria on Thl/Th2 cytokine response
• mice were fed intragastrically using a feeding needle, various numbers of Lactobacillus acidophilus (obtained from University of New South Wales, School of Microbiology and Immunology Culture Collection, Sydney, Australia) on consecutive days for 2 weeks after which they were sensitised with 8 ⁇ g of ovalbumin (OVA) and aluminium hydroxide in 0.2 mL phosphate-buffered saline administered by peritoneal injection.
• OVA ovalbumin
• the mice were further fed ten times with L. acidophilus every two days for two weeks before they were sacrificed.
• Lymphocytes were isolated by teasing spleens through a sieve, washed with PBS, and resuspended at 10 x 10 6 One mL aliquots of the cell suspension were dispensed into wells of a 24- well flat-bottomed microtitre plate and stimulated with OVA (5 ⁇ g/mL). After incubation for 4 days the supernatants were collected and assayed for IL-4 and LFN- ⁇ production by standard ELISA techniques using IL-4 or IFN- ⁇ monoclonal antibody pairs. Briefly, wells of a 24-well microtitre plate were coated with a capture anti-IL-4 antibody.
• the colour development was read at 450/620 nm in an ELISA plate reader.
• IL-4 in unknown samples was quantitated by intrapolation using a standard curve. A similar procedure was used for measurement of IFN- ⁇ .
• Fig. 1 A and B demonstrate that feeding L. acidophilus resulted in the suppression of IL-4 production in dose-dependent manner (Fig. 1A) whereas the production of IFN- ⁇ was enhanced (Fig IB).
• Example 2 Enhanced clearance of NTHi from the respiratory tract induced by a single intra-lumenal dose of live L. acidophilus and killed NTHi
• DA rats (200-250 gm, 8-10 weeks old, Animal Resource Centre, Perth, WA ) were immunised by a single intra-lumenal (IL) injection (into the lumen of the small intestine) of 0.75 mL of PBS containing 5 x 10 9 killed NTHi alone or in combination with 2.5 x 10 10 L. acidophilus (as shown in Table 1).
• the IL dose was by direct injection into the intestinal lumen after exposing the duodenum by laparotomy. This is considered equivalent to an enteric-coated dose (as may be prepared for humans) being released into the gut lumen after oral ingestion.
• the rats were given an intra-tracheal (IT) boost with 50 ⁇ L of PBS alone (group A) or containing 5xl0 8 killed NTHI (groups B-D) on day 14.
• the rats were infected intra-tracheally with 5 x 10 8 live NTHI in 50 ⁇ L of PBS.
• the rats were sacrificed and the total number of NTHI in bronchial lavage (BAL) and lung homogenate (LH) was determined by plating out serial 10-fold dilutions of the BAL or LH onto chocolate agar plates. After overnight incubation at 37°C the number of colonies were counted.
• the total number of bacteria in BAL and LH expressed as colony forming units (CFU), as shown in Table 2.
• DA rats (200- 250 gm, 8-10 weeks old, Animal Resource Centre, Perth, WA) were fed by gavage with 5x10 10 L acidophilus in 1.0 mL PBS or PBS alone every 2 days for 7 days at which time the rats were immunised with formalin-killed NTHi (5 x 10 9 per rat) administered intralumenally (IL) in 0.5mL of PBS. Rats continued to be fed every 2 days for 2 weeks and were then boosted with 50 uL of PBS containing formalin killed NTHi (5 xlO 8 per rat) administered by the intratracheal (IT) route. After feeding with L.
• NTHi formalin-killed NTHi
• IL intralumenally
• the rats were infected IT with 50 uL of PBS containing 5 x 10 8 live NTHi. After 4 hrs, the levels of colonisation in the lung were determined in BAL and LH as described in Example 2. The immunization and feeding of the various groups is shown in Table 3. The bacterial recovery is shown in Table 4.
• Rats fed L acidophilus and immunised with killed NTHi were more resistant to infection by NTHi in the lungs than rats immunised with killed NTHi only or fed L. acidophilus only. Furthermore, rats fed by gavage with repeated doses of L acidophilus were more resistant to infection than rats given a single bolus of L. acidophilus (example 2). Not wishing to be bound by any particular mechanism of action, this data suggests that enhanced clearance may be due to increased colonisation in the gut with L. acidophilus following repeated feeding.
• Example 4 Intra-lumenal dosing with killed NTHi and live L. fermentum provides enhanced protection against a subsequent acute NTHi infection
• DA specific pathogen-free rats (177-200g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Groups of 5 rats were given a single injection into the gut lumen of the small intestine of 0.75 mL of PBS only or PBS containing either 5xl0 9 killed NTHi only, 5xl0 9 killed NTHi plus 2.5xl0 10 L. fermentum, or 2.5xl0 10 L. fermentum only as shown in Table 5 below. On day 14, rats in group A were sham-boosted IT with 50 ⁇ L of PBS and rats in groups B-D were boosted with 50 ⁇ L of PBS containing 5xl0 8 killed NTHi.
• Rats (5 per group) were given a single intra-lumenal dose of various combinations of killed NTHi and live L. fermentum as follows:
• DA specific pathogen-free rats (197-230g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Groups of 6 rats were given a single IL dose of PBS or a fixed dose of killed NTHi (5xl0 9 ) plus one of various doses of live L. acidophilus as shown in Table 7 below. On day 14, rats in group A were sham-boosted with 50 ⁇ L of PBS and rats in groups B-D were boosted with 50 ⁇ L of PBS containing 5x10 s killed NTHi. Boosting was by intra-tracheal delivery. On day 21 the rats were infected by intra-tracheal instillation of 5xl0 8 live NTHi in 50 ⁇ L of PBS.
• mice Four hours later rats were killed by an overdose of pentobarbitone administered intra-peritoneally.
• BAL broncho-alveolar lavage fluid
• the lungs were then homogenised in 10 mL of PBS to obtain lung homogenate (LH).
• LH lung homogenate
• the number of bacteria in BAL and LH was detennined by performing serial dilution of BAL and LH and plating known volumes on chocolate agar plates. After overnight incubation at 37°C the colonies were counted and the total number of colony-forming units (CFU) in
• lactobacillus The lower doses of lactobacillus are more effective than the higher doses. Again, without wishing to be bound by any particular mechanism of action, this dtata suggests that the 'adjuvant effect' may be operating differently from the lactobacillus- only effect.
• DA specific pathogen-free rats (187-213g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Rats (6 per group) were given a single
• the killed NTHi was contained in 0.3 mL of PBS.
• the IT boost was with PBS
• DA specific pathogen-free rats (187-219g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Rats (6 per group) were given a single
• the killed NTHi was contained in 0.3 mL of PBS.
• the IT boost was with PBS (group A) or 2xl0 7 killed NTHI (groups B-D) in 50 ⁇ L of PBS. Rats were infected intra- tracheally with 50 ⁇ L of PBS containing 5xl0 8 live NTHi. The bacteria recovered from
• DA specific pathogen-free rats (176-213g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Rats (6 per group) were given a single IL dose of killed NTHi as per regimen 3 in table 9, of various dose sizes as shown in
• the killed NTHi was contained in 0.3 mL of PBS.
• the IT boost was with 50 ⁇ L of PBS (group A) or 2xl0 7 killed NTHI in 50 ⁇ L of PBS (groups B-D). Rats were infected intra-tracheally with 50uL of PBS containing 5xl0 8 live NTHi. The bacteria recovered from BAL and LH is shown in Table 15.
• Table 14 Dose sizes tested in re imen 3
• Example 7 Long-term immunization with NTHi and L. acidophilus by a single IL dose.
• DA specific pathogen-free rats (201- 293 g) were obtained from the Central Animal house, University of Newcastle, Newcastle, NSW). Groups of 6 rats were given an IL dose of 0.75 mL of PBS or PBS containing 5xl0 9 killed NTHI or a mixture of 5xl0 9 killed NTHi and 2.5 x 10 10 live L. acidophilus as shown in Table 16. Rats were IT boosted 14 days later with 50 ⁇ L of PBS or PBS containing 5x10 s killed NTHi as shown in Table 16.

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