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Definitions

• the present invention relates to immunogenic compositions comprising N. meningitidis capsular polysaccharides conjugated to a carrier protein. It additionally relates to vaccines and vaccine kits comprising N. meningitidis polysaccharide conjugates, processes for making the immunogenic compositions and vaccines and the use of the vaccines and immunogenic compositions of the invention in therapy. It also relates to methods of immunising against Neisserial infection using the N. meningitidis polysaccharide conjugates and the use of N. meningitidis polysaccharide conjugates in the manufacture of a medicament.
• Neisseria meningitidis is a Gram-negative human pathogen which causes bacterial meningitis. Based on the organism's capsular polysaccharide, twelve serogroups of N. meningitidis have been identified (A, B, C, H, I 1 K, L , 29E, W135, X, Y and Z). Serogroup A (MenA) is the most common cause of epidemic disease in sub-Saharan Africa. Serogroups B and C are responsible for the majority of cases in developing countries, with the remaining cases being caused by W135 and Y).
• Immunogenic compositions comprising N. meningitidis saccharides conjugated to carrier proteins are known in the art.
• WO 02/58737 discloses a vaccine comprising purified capsular polysacchrides from N. meningitidis serogroups A, C, W135 and Y conjugated to a carrier protein.
• this application teaches that the extracted N. meningitidis capsular polysaccharides should be depolymerised by heating in a hydrogen peroxide solution before conjugation.
• WO 03/07985 discloses conjugate vaccines comprising N. meningitidis saccharide selected from serogroups A, C, W135 and Y. The meningococcal capsular polysaccharides are extracted and then hydrolysed so that a selection of oligosaccharides derived from the capsular polysaccharides are used for conjugation to a carrier protein.
• WO 04/103400 also discloses multivalent meningococcal derived polysaccharide-protein conjugate containing capsular polysaccharides derived from N. meningitidis serogroups A, C, W135 and Y.
• This application teaches that, instead of using the large native capsular polysaccharide, the use of meningococcal polysaccharides of a smaller size is preferred. It suggests that capsular polysaccharides are partially depolymerised using mild oxidative conditions to give an average size of less than 100,000 daltons, preferably 12,000 to 25,000 daltons. There remains a need to develop improved conjugate vaccines against neisserial meningitis.
• the present invention concerns the provision of a meningococcal polysaccharide conjugate vaccine in which the size of the polysaccharides is larger than that taught in the literature.
• the focus of the art has been to use oligosaccharides for ease of conjugate production.
• the inventors has found that by using native or slightly sized polysaccharide conjugates, one or more of the following advantages may be realised: 1) a conjugate having high immieuxicity which is filterable; 2) immune memory may be enhanced (as in example three); 3) the alteration of the ratio of polysaccharide to protein in the conjugate such that the ratio of polysaccharide to protein (w/w) in the conjugate may be increased (this can result in a reduction of the carrier suppression effect); 4) immunogenic conjugates prone to hydrolysis (such as MenA conjugates) may be stabilised by the use of larger polysaccharides for conjugation.
• the use of larger polysaccharides can result in more cross-linking with the conjugate carrier and therefore less cleavage of free saccharide from the conjugate.
• the conjugate vaccines described in the prior art tend to depolymerise the polysaccharides prior to conjugation in order to improve conjugation.
• the present invention is directed to a different strategy and surprisingly shows that meningococcal conjugate vaccines retaining a larger size of polysaccharide provide a good immune response against meningococcal disease.
• an immunogenic composition comprising N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein the mean size of each N. meningitidis polysaccharide is above 5OkDa, 75kDa, 10OkDa, 11OkDa, 12OkDa or 13OkDa.
• a vaccine comprising the immunogenic composition of the invention and a pharmaceutically acceptable carrier.
• a vaccine kit for concomitant or sequential administration comprising two multi-valent immunogenic compositions for conferring protection in a host against disease caused by Bordetella pertussis, Clostridium tetani, Corynebacterium diphtheriae, Haemophilus influenzae and Neisseria meningitidis, said kit comprising a first container comprising :
• TT tetanus toxoid
• DT diphtheria toxoid
• wholecell or acellular pertussis components and a second container comprising:
• a process for making the immunogenic composition or vaccine of the invention comprising the step of mixing N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, optionally with a pharmaceutically acceptable excipient, wherein the average size of the or each N. meningitidis polysaccharide is above 5OkDa, 75kDa, 10OkDa, 11OkDa, 12OkDa or 13OkDa.
• a method of immunising a human host against disease caused by Neisseria meningitidis comprising administering to the host an immunoprotective dose of the immunogenic composition or vaccine of the invention.
• an immunogenic composition of the invention for use in the treatment or prevention of disease caused by Neisseria meningitidis.
• the immunogenic composition or vaccine of the invention in the manufacture of a medicament for the treatment or prevention of diseases caused by Neisseria meningitidis.
• FIG. 1 A - Bar chart showing GMC responses in an anti-MenY ELISA.
• ENYTT012 is a Men Y-TT conjugate prepared from native MenY polysaccharide.
• ENYTT014 is a MenY- TT conjugate prepared from microfluidised MenY polysaccharide which had undergone 40 cycles of microfluidisation.
• ENYTT015bis is a MenY-TT conjugate prepared from microfluidised MenY polysaccharide which had undergone 20 cycles of microfluidisation.
• ENYTT012 is a MenY-TT conjugate prepared from native MenY polysaccharide.
• ENYTT014 is a MenY- TT conjugate prepared from microfluidised MenY polysaccharide which had undergone 40 cycles of microfluidisation.
• ENYTT015bis is a MenY-TT conjugate prepared from microfluidised MenY polysaccharide which had undergone 20 cycles of microfluidisation.
• An immunogenic composition of the invention comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein the average size (weight-average molecular weight; Mw) of at least one, two, three or four or each N. meningitidis polysaccharide is above 5OkDa, 6OkDa, 75kDa, 10OkDa, 110kDa, 12OkDa or 13OkDa.
• the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is either a native polysaccharide or is sized by a factor up to x1.5, x2, x3, x4, x5, x6, x7, x8, x9 or x10 relative to the weight average molecular weight of the native polysaccharide.
• “native polysaccharide” refers to a polysaccharide that has not been subjected to a process, the purpose of which is to reduce the size of the polysaccharide.
• a polysaccharide can become slightly reduced in size during normal purification procedures. Such a polysaccharide is still native. Only if the polysaccharide has been subjected to sizing techniques would the polysaccharide not be considered native.
• sized by a factor up to x2 means that the polysaccharide is subject to a process intended to reduce the size of the polysaccharide but to retain a size more than half the size of the native polysaccharide.
• X3, x4 etc. are to be interpreted in the same way i.e. the polysaccharide is subject to a process intended to reduce the size of the polysaccharide but to retain a size more than a third, a quarter etc. the size of the native polysaccharide respectively.
• the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is native polysaccharide.
• the immunogenic composition comprises N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein at least one, two, three or four or each N. meningitidis polysaccharide is sized by a factor up to x1.5, x2, x3, x4, x5, x6, x7, x8, x9 or x10.
• the immunogenic compositions of the invention optionally comprise conjugates of : N.
• serogroup C capsular polysaccharide MenC
• serogroup A capsular polysaccharide MenA
• serogroup W135 capsular polysaccharide MenW
• serogroup Y capsular polysaccharide MenY
• serogroup C and Y capsular polysaccharides MenCY
• serogroup C and A capsular polysaccharides MenAC
• serogroup C and W capsular polysaccharides MenCW
• serogroup A and Y capsular polysaccharide MenAY
• serogroup A and W capsular polysaccharides MenAW
• serogroup W and Y capsular polysaccharides Men WY
• serogroup A, C and W capsular polysaccharide MenACW
• serogroup A, C and Y capsular polysaccharides MenACY
• serogroup A, W135 and Y capsular polysaccharides MenAWY
• the average size (or molecular weight) of at least one, two, three, four or each N. meningitidis polysaccharide is 50KDa - 150OkDa, 5OkDa - 50OkDa, 50 kDa - 300 KDa, 101 kDa - 150OkDa, 101 kDa - 50OkDa, or 101 kDa - 30OkDa as determined by MALLS.
• the MenA polysaccharide where present, has a molecular weight of 50-50OkDa, 50-10OkDa, 100-50OkDa, 55-90KDa, 60-7OkDa or 70-8OkDa or 60-8OkDa as determined by MALLS.
• the MenC polysaccharide where present, has a molecular weight of 100-20OkDa, 50-10OkDa, 100-15OkDa, 101-13OkDa, 150-21OkDa or 180-21OkDa as determined by MALLS.
• MenY polysaccharide where present, has a molecular weight of 60-19OkDa, 70-18OkDa, 80-17OkDa, 90-16OkDa, 100-15OkDa or 110-14OkDa, 50-10OkDa 1 100-14OkDa, 140-17OkDa or 150-16OkDa as determined by MALLS.
• MenW polysaccharide where present, has a molecular weight of 60-19OkDa, 70-18OkDa, 80-17OkDa, 90-16OkDa, 100-15OkDa, 110-14OkDa, 50-10OkDa or 120-14OkDa as determined by MALLS.
• the molecular weight or average molecular weight of a polysaccharide herein refers to the weight-average molecular weight (Mw) of the polysaccharide measured prior to conjugation and is measured by MALLS.
• Mw weight-average molecular weight
• the MALLS technique is well known in the art and is typically carried out as described in example 2.
• MALLS analysis of meningococcal saccharides two columns (TSKG6000 and 5000PWxI TOSOH Bioscience) may be used in combination and the saccharides are eluted in water.
• Saccharides are detected using a light scattering detector (for instance Wyatt Dawn DSP equipped with a 1OmW argon laser at 488nm) and an inferometric refractometer (for instance Wyatt Otilab DSP equipped with a P100 cell and a red filter at 498nm).
• a light scattering detector for instance Wyatt Dawn DSP equipped with a 1OmW argon laser at 488nm
• an inferometric refractometer for instance Wyatt Otilab DSP equipped with a P100 cell and a red filter at 498nm.
• N. meningitidis polysaccharides are native polysaccharides or native polysaccharides which have reduced in size during a normal extraction process.
• the N. meningitidis polysaccharides are sized by mechanical cleavage, for instance by microfluidisation or sonication.
• Microfluidisation and sonication have the advantage of decreasing the size of the larger native polysaccharides sufficiently to provide a filterable conjugate. Sizing is by a factor of no more than x20, x10, x8, x6, x5, x4, x3 , x2 or x1.5.
• the immunogenic composition comprises N. meningitidis conjugates that are made from a mixture of native polysaccharides and polysaccharides that are sized by a factor of no more than x20.
• polysaccharides from MenC and/or MenA are native.
• polysaccharides from MenY and/or MenW are sized by a factor of no more than x20, x10, x ⁇ , x6, x5, x4, x3 , x2 or x1.5.
• an immunogenic composition contains a conjugate made from MenY and/or MenW and/or MenC and/or MenA which is sized by a factor of no more then x20, x10, x ⁇ , x6, x5, x4, x3 , x2 or x1.5 and/or is microfluidised.
• an immunogenic composition contains a conjugate made from native MenA and/or MenC and/or MenW and/or MenY.
• an immunogenic composition comprises a conjugate made from native MenC.
• an immunogenic composition comprises a conjugate made from native MenC and MenA which is sized by a factor of no more than x20, x10, x8, x6, x5, x4, x3 , x2 or x1.5 and/or is microfluidised.
• an immunogenic composition comprises a conjugate made from native MenC and MenY which is sized by a factor of no more than x20, x10, x ⁇ , x6, x5, x4, x3 , x2 or x1.5 and/or is microfluidised.
• the polydispersity of the polysaccharide is 1-1.5, 1-1.3, 1-1.2, 1-1.1 or 1-1.05 and after conjugation to a carrier protein, the polydispersity of the conjugate is 1.0-2,5, 1.0-2.0. 1.0-1.5, 1.0-1.2, 1.5-2.5, 1.7-2.2 or 1.5-2.0. All polydispersity measurements are by MALLS.
• Polysaccharides are optionally sized up to 1.5, 2, 4, 6, 8, 10, 12, 14, 16, 18 or 20 times from the size of the polysaccharide isolated from bacteria.
• the immunogenic composition of the invention further comprises an antigen from N. meningitidis serogroup B.
• the antigen is optionally a capsular polysaccharide from N. meningitidis serogroup B (MenB) or a sized polysaccharide or oligosaccharide derived therefrom.
• the antigen is optionally an outer membrane vesicle preparation from N. meningitidis serogroup B as described in EP301992, WO 01/09350, WO 04/14417, WO 04/14418 and WO 04/14419.
• the immunogenic composition of the invention further comprises a H. influenzae b (Hib) capsular saccharide conjugated to a carrier protein.
• Hib H. influenzae b
• N. meningitidis polysaccharide(s) (and optionally Hib capsular saccharide) included in pharmaceutical compositions of the invention are conjugated to a carrier protein such as tetanus toxoid, tetanus toxoid fragment C, non-toxic mutants of tetanus toxin, diphtheria toxoid, CRM197, other non-toxic mutants of diphtheria toxin [such as CRM176, CRM 197, CRM228, CRM 45 (Uchida et al J. Biol. Chem.
• meningitidis serogroup B - EP0372501 synthetic peptides
• synthetic peptides EP0378881 , EP0427347)
• heat shock proteins WO 93/17712, WO 94/03208
• pertussis proteins WO 98/58668, EP0471 177
• cytokines, lymphokines, growth factors or hormones WO 91/01146
• artificial proteins comprising multiple human CD4+ T cell epitopes from various pathogen derived antigens (Falugi et al (2001 ) Eur J Immunol 31 ; 3816-3824) such as N19 protein (Baraldoi et al (2004) Infect lmmun 72; 4884-7) pneumococcal surface protein PspA (WO 02/091998) pneumolysin (Kuo et al (1995) Infect lmmun 63; 2706-13), iron uptake proteins (WO 01/72337), toxin A or B of C. difficile (WO 00/617
• the immunogenic composition of the invention uses the same carrier protein (independently) in at least two, three, four or each of the N. meningitidis polysaccharides.
• Hib may be conjugated to the same carrier protein as the at least one, two, three, four or each of the N. meningitidis polysaccharides.
• 1, 2, 3 or 4 of the N. meningitidis polysaccharides are independently conjugated to tetanus toxoid to make 1 , 2, 3 or 4 conjugates.
• a single carrier protein may carry more than one saccharide antigen (WO 04/083251 ).
• a single carrier protein might be conjugated to MenA and MenC; MenA and MenW; MenA and MenY; MenC and MenW; MenC and MenY; Men W and MenY; MenA, MenC and MenW; MenA, MenC and MenY; MenA, MenW and MenY; MenC, MenW and MenY; MenA, MenC, MenW and MenY; Hib and MenA; Hib and MenC; Hib and MenW; or Hib and MenY.
• the immunogenic composition of the invention comprises a N. meningitidis polysaccharide conjugated to a carrier protein selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
• the immunogenic composition of the invention comprises a Hib saccharide conjugated to a carrier protein selected from the group consisting of TT, DT, CRM 197, fragment C of TT and protein D.
• the immunogenic composition of the invention optionally comprises at least one meningococcal saccharide (for example MenA; MenC; MenW; MenY; MenA amd MenC; MenA and MenW; MenA and MenY; MenC and Men W; Men C and MenY; Men W and MenY; MenA, MenC and MenW; MenA, MenC and MenY; MenA, MenW and MwnY; MenC, MenW and MenY or MenA, MenC, MenW and MenY) conjugate having a ratio of Men saccharide to carrier protein of between 1 :5 and 5:1 , between 1 :2 and 5:1 , between 1 :0.5 and 1 :2.5 or between 1 :1.25 and 1 :2.5(w/w).
• meningococcal saccharide for example MenA; MenC; MenW; MenY; MenA amd MenC; MenA and MenW; MenA and MenY; MenC and Men W; Men C and MenY; Men W and MenY; MenA, Men
• the immunogenic composition of the invention optionally comprises a Hib saccharide conjugate having a ratio of Hib to carrier protein of between 1 :5 and 5:1 ; 1 :2 and 2:1 ; 1 :1 and 1 :4; 1 :2 and 1 :3.5; or around or exactly 1 :2.5 or 1:3 (w/w). By 'around' it is meant within 10% of the stated ratio.
• the ratio of saccharide to carrier protein (w/w) in a conjugate may be determined using the sterilized conjugate.
• the amount of protein is determined using a Lowry assay (for example Lowry et al (1951 ) J. Biol. Chem. 193, 265-275 or Peterson et al Analytical Biochemistry 100, 201-220 (1979)) and the amount of saccharide is determined using ICP-OES (inductively coupled plasma-optical emission spectroscopy) for MenA, DMAP assay for MenC and Resorcinol assay for MenW and MenY (Monsigny et al (1988) Anal. Biochem. 175, 525-530).
• ICP-OES inductively coupled plasma-optical emission spectroscopy
• the immunogenic composition of the invention the N. meningitidis polysaccharide(s) and/or the Hib saccharide is conjugated to the carrier protein via a linker, for instance a bifunctional linker.
• the linker is optionally heterobifunctional or homobifunctional, having for example a reactive amino group and a reactive carboxylic acid group, 2 reactive amino groups or two reactive carboxylic acid groups.
• the linker has for example between 4 and 20, 4 and 12, 5 and 10 carbon atoms.
• a possible linker is ADH.
• Other linkers include B-propionamido (WO 00/10599), nitrophenyl-ethylamine (Gever et al (1979) Med. Microbiol. Immunol. 165; 171-288), haloalkyl halides (US4057685), glycosidic linkages (US4673574, US4808700), hexane diamine and 6- aminocaproic acid (US4459286).
• the polysaccharide conjugates present in the immunogenic compositions of the invention may be prepared by any known coupling technique.
• the conjugation method may rely on activation of the saccharide with 1-cyano-4-dimethylamino pyridinium tetrafluoroborate (CDAP) to form a cyanate ester.
• CDAP 1-cyano-4-dimethylamino pyridinium tetrafluoroborate
• the activated saccharide may thus be coupled directly or via a spacer (linker) group to an amino group on the carrier protein.
• the spacer could be cystamine or cysteamine to give a thiolated polysaccharide which could be coupled to the carrier via a thioether linkage obtained after reaction with a maleimide- activated carrier protein (for example using GMBS) or a holoacetylated carrier protein (for example using iodoacetimide or N-succinimidyl bromoacetatebromoacetate).
• a maleimide- activated carrier protein for example using GMBS
• a holoacetylated carrier protein for example using iodoacetimide or N-succinimidyl bromoacetatebromoacetate.
• the cyanate ester (optionally made by CDAP chemistry) is coupled with hexane diamine or ADH and the amino-derivatised saccharide is conjugated to the carrier protein using using carbodiimide (e.g. EDAC or EDC) chemistry.
• carbodiimide e.g
• This may involve reduction of the anomeric terminus to a primary hydroxyl group, optional protection/deprotection of the primary hydroxyl group' reaction of the primary hydroxyl group with CDI to form a CDI carbamate intermediate and coupling the CDI carbamate intermediate with an amino group on a protein.
• the conjugates can also be prepared by direct reductive amination methods as described in US 4365170 (Jennings) and US 4673574 (Anderson). Other methods are described in EP-0-161-188, EP-208375 and EP-0-477508.
• a further method involves the coupling of a cyanogen bromide (or CDAP) activated saccharide derivatised with adipic acid hydrazide (ADH) to the protein carrier by Carbodiimide condensation (Chu C. et al Infect. Immunity, 1983 245 256), for example using EDAC.
• CDAP cyanogen bromide
• ADH adipic acid hydrazide
• a hydroxyl group (optionally an activated hydroxyl group for example a hydroxy! group activated by a cyanate ester) on a saccharide is linked to an amino or carboxylic group on a protein either directly or indirectly (through a linker).
• a linker is present, a hydroxyl group on a saccharide is optionally linked to an amino group on a linker, for example by using CDAP conjugation.
• a further amino group in the linker for example ADH) may be conjugated to a carboxylic acid group on a protein, for example by using carbodiimide chemistry, for example by using EDAC.
• the Hib or N. meningitidis capsular polysaccharide(s) is conjugated to the linker first before the linker is conjugated to the carrier protein.
• the Hib saccharide where present, is conjugated to the carrier protein using CNBr, or CDAP, or a combination of CDAP and carbodiimide chemistry (such as EDAC), or a combination of CNBr and carbodiimide chemistry (such as EDAC).
• CNBr is used to join the saccharide and linker and then carbodiimide chemistry is used to join linker to the protein carrier.
• At least one of the N. meningitidis capsular polysaccharides is directly conjugated to a carrier protein; optionally Men W and/or MenY and/or MenC saccharide(s) is directly conjugated to a carrier protein.
• MenW; MenY; MenC; MenW and MenY; MenW and MenC; MenY and MenC; or MenW, MenY and MenC are directly linked to the carrier protein.
• the at least one of the N. meningitidis capsular polysaccharides is directly conjugated by CDAP.
• MenW; MenY; MenC; MenW and MenY; MenW and MenC; MenY and MenC; or MenW, MenY and MenC are directly linked to the carrier protein by CDAP (see WO 95/08348 and WO 96/29094).
• CDAP CDAP
• all N. meningitidis capsular polysaccharides are conjugated to tetanus toxoid.
• the ratio of Men W and/or Y saccharide to carrier protein is between 1 :0.5 and 1 :2 (w/w) and/or the ratio of MenC saccharide to carrier protein is between 1 :0.5 and 1 :4 or 1 :1.25-1 :1.5 or 1 :0.5 and 1 :1.5 (w/w), especially where these saccharides are directly linked to the protein, optionally using CDAP.
• at least one of the N. meningitidis capsular polysaccharide(s) is conjugated to the carrier protein via a linker, for instance a bifunctional linker.
• the linker is optionally heterobifunctional or homobifunctional, having for example a reactive amine group and a reative carboxylic acid group, 2 reactive amine groups or 2 reactive carboxylic acid groups.
• the linker has for example between 4 and 20, 4 and 12, 5 and 10 carbon atoms.
• a possible linker is ADH.
• MenA; MenC; or MenA and MenC is conjugated to a carrier protein (for example tetanus toxoid) via a linker.
• a carrier protein for example tetanus toxoid
• At least one N. meningitidis polysaccharide is conjugated to a carrier protein via a linker using CDAP and EDAC.
• CDAP is used to conjugate the saccharide to a linker
• EDAC is used to conjugate the linker to a protein.
• conjugation via a linker results in a ratio of polysaccharide to carrier protein of of between 1 :0.5 and 1 :6; 1 :1 and 1 :5 or 1 :2 and 1 :4, for MenA; MenC; or MenA and MenC.
• the MenA capsular polysaccharide, where present is is at least partially O-acetylated such that at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one position.
• O-acetylation is for example present at least at the O-3 position of at least 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units.
• the MenC capsular polysaccharide, where present is is at least partially O-acetylated such that at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of ( ⁇ 2 ⁇ 9)-linked NeuNAc repeat units are O-acetylated at at least one or two positions.
• O-acetylation is for example present at the O-7 and/or O-8 position of at least 30%. 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units.
• the MenW capsular polysaccharide, where present is is at least partially O-acetylated such that at least 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one or two positions.
• O-acetylation is for example present at the O-7 and/or O-9 position of at least 30%. 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units.
• the MenY capsular polysaccharide, where present is at least partially
• O-acetylated such that at least 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units are O-acetylated at at least one or two positions.
• O-acetylation is present at the 7 and/or 9 position of at least 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95% or 98% of the repeat units.
• the percentage of O-acetylation refers to the percentage of the repeat units containing O- acetylation. This may be measured in the polysaccharide prior to conjugate and/or after conjugation.
• the immunogenic composition of the invention comprises a Hib saccharide conjugate and at least two N. meningitidis polysaccharide conjugates wherein the Hib conjugate is present in a lower saccharide dose than the mean saccharide dose of the at least two N. meningitidis polysaccharide conjugates.
• the Hib conjugate is present in a lower saccharide dose than the saccharide dose of each of the at least two N. meningitidis polysaccharide conjugates.
• the dose of the Hib conjugate may be at least 10%, 20%, 30%, 40%, 50%, 60%, 70% or 80% lower than the mean or lowest saccharide dose of the at least two further N. meningitidis polysaccharide conjugates.
• saccharide includes polysaccharides or oligosaccharides.
• Polysaccharides are isolated from bacteria or isolated from bacteria and sized to some degree by known methods (see for example EP497524 and EP497525) and optionally by microfluidisation. Polysaccharides can be sized in order to reduce viscosity in polysaccharide samples and/or to improve filterability for conjugated products.
• Oligosaccharides are characterised by typically being hydrolysed polysaccharides with a low number of repeat units (typically 5-30 repeat units).
• the mean dose is determined by adding the doses of all the further polysaccharides and dividing by the number of further polysaccharides.
• Further polysaccharides are all the polysaccharides within the immunogenic composition apart from Hib and can include N. meningitidis capsular polysaccharides.
• the "dose" is in the amount of immunogenic composition or vaccine that is administered to a human.
• a Hib saccharide is the polyribosyl phosphate (PRP) capsular polysaccharide of Haemophilus influenzae type b or an oligosaccharide derived therefrom.
• PRP polyribosyl phosphate
• At least two further bacterial saccharide conjugates' is to be taken to mean at least two further bacterial saccharide conjugates in addition to a Hib conjugate.
• the at least two further bacterial conjugates may include N. meningitidis capsular polysaccharide conjugates.
• the immunogenic compositions of the invention may comprise further saccharide conjugates derived from one or more of Neisseria meningitidis, Streptococcus pneumoniae, Group A Streptococci, Group B Streptococci, S. typhi, Staphylococcus aureus or Staphylococcus epidermidis.
• the immunogenic composition comprises capsular polysaccharides or oligosaccharides derived from one or more of serogroups A, C, W135 and Y of Neisseria meningitidis.
• a further embodiment comprises capsular polysaccharides or oligosaccharides derived from Streptococcus pneumoniae.
• the pneumococcal capsular polysaccharide or oligosaccharide antigens are optionally selected from serotypes 1 , 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F 1 20, 22F, 23F and 33F (optionally from serotypes 1 , 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F).
• a further embodiment comprises the Type 5, Type 8 or 336 capsular polysaccharides or oligosaccharides of Staphylococcus aureus.
• a further embodiment comprises the Type I, Type Il or Type III capsular polysaccharides of Staphylococcus epidermidis.
• a further embodiment comprises the Vi saccharide (poly or oligosaccharide) from S. typhi.
• a further embodiment comprises the Type Ia, Type Ic 1 Type II, Type III or Type V capsular polysaccharides or oligosaccharides of Group B streptocoocus.
• a further embodiment comprises the capsular polysaccharides or oligosaccharides of Group A streptococcus, optionally further comprising at least one M protein and optionally multiple types of M protein.
• the immunogenic composition of the invention contains each N. meningitidis capsular polysaccharide at a dose of between 0.1-20 ⁇ g; 1-1 O ⁇ g; 2-1 O ⁇ g, 2.5- 5 ⁇ g, around or exactly 5 ⁇ g; or around or exactly 2.5 ⁇ g.
• the immunogenic composition of the invention for example contains the Hib saccharide conjugate at a saccharide dose between 0.1 and 9 ⁇ g; 1 and 5 ⁇ g or 2 and 3 ⁇ g or around or exactly 2.5 ⁇ g and each of the N. meningitidis polysaccharide conjugates at a saccharide dose of between 2 and 20 ⁇ g, 3 and 10 ⁇ g, or between 4 and 7 ⁇ g or around or exactly 5 ⁇ g.
• the immunogenic composition of the invention contains a saccharide dose of the Hib saccharide conjugate which is for example less than 90%, 80%, 75%, 70%, 60%, 50%, 40%, 30%, 20% or 10% of the mean saccharide dose of at least two, three, four or each of the N. meningitidis polysaccharide conjugates.
• the saccharide dose of the Hib saccharide is for example between 20% and 60%, 30% and 60%, 40% and 60% or around or exactly 50% of the mean saccharide dose of at least two, three, four or each of the N. meningitidis polysaccharide conjugates.
• the immunogenic composition of the invention contains a saccharide dose of the Hib saccharide conjugate which is for example less than 90%, 80%, 75%,
• the saccharide dose of the Hib saccharide is for example between 20% and 60%, 30% and 60%, 40% and 60% or around or exactly 50% of the lowest saccharide dose of the at least two, three, four or each of the N. meningitidis polysaccharide conjugates.
• the saccharide dose of each of the at least two, three, four or each of the N. meningitidis polysaccharide conjugates is optionally the same, or approximately the same.
• immunogenic compositions of the invention are compositions consisting of or comprising:
• Hib conjugate and MenA conjugate and MenC conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w).
• the saccharide dose of MenA is greater than the saccharide dose of MenC.
• Hib conjugate and MenC conjugate and MenY conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8;4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w).
• the saccharide dose of MenC is greater than the saccharide dose of MenY.
• Hib conjugate and MenC conjugate and MenW conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8;4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w).
• the saccharide dose of MenC is greater than the saccharide dose of MenW.
• Hib conjugate and MenA conjugate and MenW conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8;4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w).
• the saccharide dose of MenA is greater than the saccharide dose of MenW.
• Hib conjugate and MenA conjugate and MenY conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:4:2, 1:4:1, 1:8:4, 1:6:3, 1:3:3, 1:4:4, 1:5:5, 1:6:6 (w/w).
• the saccharide dose of MenA is greater than the saccharide dose of MenY.
• Hib conjugate and MenW conjugate and MenY conjugate optionally at saccharide dose ratios of 1:2:2, 1:2:1, 1:1:2, 1:4:2, 1:2:4, 1:4:1, 1:1:4, 1:3;6, 1:1:3, 1:6:3, 1:3:3, 1:4:4, 1 :5:5, 1 :6:6 (w/w).
• the saccharide dose of MenY is greater than the saccharide dose of MenW.
• MenA, MenC, MenW and MenY at saccharide dose ratios of 1:1:1:1 or 2:1:1:1 or 1:2:1:1 or 2:2:1:1 or 1:3:1:1 or 1:4:1:1 (w/w).
• a further aspect of the invention is a vaccine comprising the immunogenic composition of the invention and a pharmaceutically acceptable excipient.
• the immunogenic composition of the invention is buffered at, or adjusted to, between pH 7.0 and 8.0, pH 7.2 and 7.6 or around or exactly pH 7.4.
• the immunogenic composition or vaccines of the invention are optionally lyophilised in the presence of a stabilising agent for example a polyol such as sucrose or trehalose.
• a stabilising agent for example a polyol such as sucrose or trehalose.
• the immunogenic composition or vaccine of the invention contains an amount of an adjuvant sufficient to enhance the immune response to the immunogen.
• Suitable adjuvants include, but are not limited to, aluminium salts (aluminium phosphate or aluminium hydroxide), squalene mixtures (SAF-1), muramyl peptide, saponin derivatives, mycobacterium cell wall preparations, monophosphoryl lipid A, mycolic acid derivatives, non-ionic block copolymer surfactants, Quil A, cholera toxin B subunit, polyphosphazene and derivatives, and immunostimulating complexes (ISCOMs) such as those described by Takahashi et al. (1990) Nature 344:873-875.
• aluminium salts aluminium phosphate or aluminium hydroxide
• SAF-1 squalene mixtures
• muramyl peptide saponin derivatives
• mycobacterium cell wall preparations monophosphoryl lipid A
• mycolic acid derivatives mycolic acid derivatives
• non-ionic block copolymer surfactants non-ionic block cop
• the immunologically effective amounts of the immunogens must be determined empirically. Factors to be considered include the immunogenicity, whether or not the immunogen will be complexed with or covalently attached to an adjuvant or carrier protein or other carrier, route of administrations and the number of immunising dosages to be administered. Such factors are known in the vaccine art and it is well within the skill of immunologists to make such determinations without undue experimentation.
• the active agent can be present in varying concentrations in the pharmaceutical composition or vaccine of the invention.
• the minimum concentration of the substance is an amount necessary to achieve its intended use, while the maximum concentration is the maximum amount that will remain in solution or homogeneously suspended within the initial mixture.
• the minimum amount of a therapeutic agent is optionally one which will provide a single therapeutically effective dosage.
• the minimum concentration is an amount necessary for bioactivity upon reconstitution and the maximum concentration is at the point at which a homogeneous suspension cannot be maintained.
• the amount is that of a single therapeutic application.
• each dose will comprise 1-100 ⁇ g of protein antigen, optionally 5-50 ⁇ g or 5-25 ⁇ g.
• Examples of doses of bacterial saccharides are 10-20 ⁇ g, 5-1 O ⁇ g, 2.5-5 ⁇ g or 1-2.5 ⁇ g.
• the preferred amount of the substance varies from substance to substance but is easily determinable by one of skill in the art.
• the vaccine preparations of the present invention may be used to protect or treat a mammal (for example a human patient) susceptible to infection, by means of administering said vaccine via systemic or mucosal route.
• a human patient is optionally an infant (under 12 months), a toddler (12-24, 12-16 or 12-14 months), a child (2-10, 3-8 or 3-5 years) an adolescent (12-25, 14-21 or 15-19 years) or an adult (any age over 12, 15, 18 or 21).
• administrations may include injection via the intramuscular, intraperitoneal, intradermal or subcutaneous routes; or via mucosal administration to the oral/alimentary, respiratory, genitourinary tracts.
• Intranasal administration of vaccines for the treatment of pneumonia or otitis media is preferred (as nasopharyngeal carriage of pneumococci can be more effectively prevented, thus attenuating infection at its earliest stage).
• the vaccine of the invention may be administered as a single dose, components thereof may also be co-administered together at the same time or at different times (for instance if saccharides are present in a vaccine these could be administered separately at the same time or 1-2 weeks after the administration of a bacterial protein vaccine for optimal coordination of the immune responses with respect to each other).
• 2 different routes of administration may be used.
• viral antigens may be administered ID (intradermal)
• IM intramuscular
• IN intranasal
• saccharides are present, they may be administered IM (or ID) and bacterial proteins may be administered IN (or ID).
• the vaccines of the invention may be administered IM for priming doses and IN for booster doses.
• Vaccine preparation is generally described in Vaccine Design ("The subunit and adjuvant approach” (eds Powell M. F. & Newman M.J.) (1995) Plenum Press New York). Encapsulation within liposomes is described by Fullerton, US Patent 4,235,877.
• a further aspect of the invention is a vaccine kit for concomitant or sequential administration comprising two multi-valent immunogenic compositions for conferring protection in a host against disease caused by Bordetella pertussis, Clostridium tetani, Corynebacterium diphtheriae and Neisseria meningitidis and optionally Haemophilus influenzae.
• the kit optionally comprises a first container comprising one or more of:
• TT tetanus toxoid
• DT diphtheria toxoid
• whole cell or acellular pertussis components and a second container comprising either:
• a further aspect of the invention is a vaccine kit for concomitant or sequential administration comprising two multi-valent immunogenic compositions for conferring protection in a host against diease caused by Streptococcus pneumoniae and Neisseria meningitidis and optionally Haemophilus influenzae.
• the kit optionally comprises a first container comprising:
• one or more conjugates of a carrier protein and a capsular saccharide from Streptococcus pneumoniae [where the capsular saccharide is optionally from a pneumococcal serotype selected from the group consisting of 1 , 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 1 1A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F].
• Hib saccharide conjugate and N. meningitidis capsular polysaccharides from at least one, two, three or four of serogroups A, C, W and Y conjugated to a carrier protein, wherein the average size of each N. meningitidis polysaccharide is above 5OkDa 1 75kDa, 10OkDa, 11OkDa, 12OkDa or 13OkDa, optionally lyophilised.
• Hib conjugate and the N. meningitidis polysaccharide conjugates are as described above.
• the Streptococcus pneumoniae vaccine in the vaccine kit of the present invention will comprise saccharide antigens (optionally conjugated), wherein the polysaccharides are derived from at least four serotypes of pneumococcus chosen from the group consisting of 1 , 2, 3, 4, 5, 6A, 6B, 7F 1 8, 9N, 9V, 10A, 11A, 12F, 14, 15B 1 17F, 18C, 19A 1 19F 1 20, 22F, 23F and 33F.
• the four serotypes include 6B, 14, 19F and 23F.
• at least 7 serotypes are included in the composition, for example those derived from serotypes 4, 6B, 9V, 14, 18C 1 19F, and 23F.
• compositions for instance at least 10, 11 , 12, 13 or 14 serotypes.
• the composition in one embodiment includes 11 capsular polysaccharides derived from serotypes 1 , 3, 4, 5, 6B 1 7F, 9V, 14, 18C, 19F and 23F (optionally conjugated).
• polysaccharide antigens are included, although further polysaccharide antigens, for example 23 valent (such as serotypes 1 , 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11 A, 12F 1 14, 15B, 17F, 18C 1 19A, 19F, 20, 22F, 23F and 33F) 1 are also contemplated by the invention.
• 23 valent such as serotypes 1 , 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11 A, 12F 1 14, 15B, 17F, 18C 1 19A, 19F, 20, 22F, 23F and 33F
• the pneumococcal saccharides are independently conjugated to any known carrier protein, for example CRM197, tetanus toxoid, diphtheria toxoid, protein D or any other carrier proteins as mentioned above.
• the vaccine kits of the invention comprise a third component.
• the kit optionally comprises a first container comprising one or more of:
• TT tetanus toxoid
• DT diphtheria toxoid
• a third container comprising:
• Immunogenic compositions comprising meningococcal conjugates, for example HibMenC, HibMenAC, HibMenAW, HibMenAY, HibMenCW, HibMenCY, HibMenWY, MenAC, MenAW, MenAY, MenCW, MenCY, MenWY or MenACWY, including kits of similar composition to those described above, optionally comprise antigens from measles and/or mumps and/or rubella and/or varicella.
• the meningococcal immunogenic composition contains antigens from measles, mumps and rubella or measles, mumps, rubella and varicella.
• these viral antigens are optionally present in the same container as the meningococcal and/or Hib saccharide conjugate(s). In an embodiment, these viral antigens are lyophilised.
• a further aspect of the invention is a process for making the immunogenic composition of the invention, comprising the step of mixing N. meningitidis capsular polysaccharides from at least one, two or three of serogroups A, C, W and Y conjugated to a carrier protein with a bacterial saccharide conjugate, wherein the average size of each N. meningitidis polysaccharide is above 5OkDa, 75kDa, 10OkDa, 1 1OkDa, 12OkDa or 13OkDa.
• Vaccine preparation is generally described in Vaccine Design ("The subunit and adjuvant approach” (eds Powell M. F. & Newman MJ.) (1995) Plenum Press New York). Encapsulation within liposomes is described by Fullerton, US Patent 4,235,877.
• a further aspect of the invention is a method of immunising a human host against disease caused by N. meningitidis and optionally Haemophilus influenzae infection comprising administering to the host an immunoprotective dose of the immunogenic composition or vaccine or kit of the invention.
• a further aspect of the invention is an immunogenic composition of the invention for use in the treatment or prevention of disease caused by N. meningitidis and optionally Haemophilus influenzae infection.
• a further aspect of the invention is use of the immunogenic composition or vaccine or kit of the invention in the manufacture of a medicament for the treatment or prevention of diseases caused by N. meningitidis and optionally Haemophilus influenzae infection.
• Hib PRP polysaccharide was activated by adding CNBr and incubating at pH10.5 for 6 minutes. The pH was lowered to pH8.75 and adipic acid dihyrazide (ADH) was added and incubation continued for a further 90 minutes.
• ADH adipic acid dihyrazide
• the activated PRP was coupled to purified tetanus toxoid via carbodiimide condensation using 1-ethyl-3-(3- dimethyl-aminopropyl)carbodiimide (EDAC).
• EDAC was added to the activated PRP to reach a final ratio of 0.6mg EDAC/mg activated PRP.
• the pH was adjusted to 5.0 and purified tetanus toxoid was added to reach 2mg TT/mg activated PRP.
• the resulting solution was left for three days with mild stirring. After filtration through a 0.45 ⁇ m membrane, the conjugate was purifed on a sephacryl S500HR (Pharmacia, Sweden) column equilibrated in 0.2M NaCI.
• MenC -TT conjugates were produced using native polysaccharides ( of over 15OkDa as measured by MALLS). MenA-TT conjugates were produced using either native polysaccharide or slightly microfluidised polysaccharide of over 6OkDa as measured by the MALLS method of example 2. MenW and MenY-TT conjugates were produced using sized polysaccharides of around 100-20OkDa as measured by MALLS (see example 2). Sizing was by microfluidisation using a homogenizer Emulsiflex C-50 apparatus. The polysaccharides were then filtered through a 0.2 ⁇ m filter.
• Activation and coupling were performed as described in WO96/29094 and WO 00/56360. Briefly, the polysaccharide at a concentration of 10-20mg/ml in 2M NaCI pH 5.5-6.0 was mixed with CDAPsolution (100mg/ml freshly prepared in acetonitrile/WFI, 50/50) to a final CDAP/polysaccharide ratio of 0.75/1 or 1.5/1. After 1.5 minutes, the pH was raised with sodium hydroxide to pH10.0. After three minutes tetanus toxoid was added to reach a protein/polysaccharide ratio of 1.5/1 for MenW, 1.2/1 for MenY, 1.5/1 for MenA or 1.5/1 for MenC. The reaction continued for one to two hours.
• glycine was added to a final ratio of glycine/PS (w/w) of 7.5/1 and the pH was adjusted to pH9.0. The mixture was left for 30 minutes.
• the conjugate was clarified using a 10 ⁇ m Kleenpak filter and was then loaded onto a Sephacryl S400HR column using an elution buffer of 15OmM NaCI, 1OmM or 5mM Tris pH7.5. Clinical lots were filtered on an Opticap 4 sterilizing membrane.
• the resultant conjugates had an average polysaccharide:protein ratio of 1 :1-1 :5 (w/w).
• MenA capsular polysaccharide to tetanus toxoid via a spacer the following method was used.
• the covalent binding of the polysaccharide and the spacer (ADH) is carried out by a coupling chemistry by which the polysaccharide is activated under controlled conditions by a cyanylating agent, 1-cyano-4-dimethylamino-pyridinium tetrafluoroborate (CDAP).
• CDAP 1-cyano-4-dimethylamino-pyridinium tetrafluoroborate
• the spacer reacts with the cyanylated PS through its hydrazino groups, to form a stable isourea link between the spacer and the polysaccharide.
• a 10mg/ml solution of MenA was treated with a freshly prepared 100mg/ml solution of CDAP in acetonitrile/water (50/50 (v/v)) to obtain a CDAP/MenA ratio of 0.75 (w/w). After 1.5 minutes, the pH was raised to pH 10.0. Three minutes later, ADH was added to obtain an ADH/MenA ratio of 8.9. The pH of the solution was decreased to 8.75 and the reaction proceeded for 2 hours.
• the purified TT solution and the PSA AH solution were diluted to reach a concentration of 10 mg/ml for PSA AH and 10mg/ml for TT.
• EDAC was added to the PS AH solution in order to reach a final ratio of 0.9 mg EDAC/mg PSA AH .
• the pH was adjusted to 5.0.
• the purified tetanus toxoid was added with a peristaltic pump (in 60 minutes) to reach 2 mg TT/mg PSA AH .
• the resulting solution was left 60 min at +25°C under stirring to obtain a final coupling time of 120 min.
• the conjugate was clarified using a 10 ⁇ m filter and was purified using a Sephacryl S400HR column.
• Detectors were coupled to a HPLC size exclusion column from which the samples were eluted.
• the laser light scattering detector measured the light intensities scattered at 16 angles by the macromolecular solution and on the other hand, an interferometric refractometer placed on-line allowed the determination of the quantity of sample eluted. From these intensities, the size and shape of the macromolecules in solution can be determined.
• the mean molecular weight in weight (M w ) is defined as the sum of the weights of all the species multiplied by their respective molecular weight and divided by the sum of weights of all the species.
• Root mean square radius: -Rw- and R 2 W is the square radius defined by:
• the polydispersity is defined as the ratio -Mw / Mn-.
• Meningococcal polysaccharides were analysed by MALLS by loading onto two HPLC columns (TSKG6000 and 5000PWxI) used in combination. 25 ⁇ l of the polysaccharide were loaded onto the column and was eluted with 0.75ml of filtered water.
• the polyaccharides are detected using a light scattering detector ( Wyatt Dawn DSP equipped with a 1OmW argon laser at 488nm) and an inferometric refractometer ( Wyatt Otilab DSP equipped with a P100 cell and a red filter at 498nm).
• the molecular weight polydispersities and recoveries of all samples were calculated by the Debye method using a polynomial fit order of 1 in the Astra 4.72 software.
• MenC meningococcal serogroup C conjugate vaccine
• Hib-MenC GSK Biological's Haemophilus influenzae b-meningococcal serogroup C conjugate vaccine
• Meningitec ® Each dose of Meningitec ® contains 10 ⁇ g of meningococcal serogroup C oligosaccharide conjugated to 15 ⁇ g of CRM197 and is produced by Wyeth.
• the GSK MenC conjugates contained native polysaccharides of about 20OkDa conjugated to tetanus toxoid (TT).
• Arm 1 consisted of four groups from a primary vaccination study who were primed at their age of 3, 4 and 5 months with the following vaccines:
• Group K MenC (10 ⁇ g), non-adsorbed onto aluminium salts (non-ads), tetanus toxoid (TT) conjugate and InfanrixTM hexa (MenC10-TT + InfanrixTM hexa)
• Group L Hib (10 ⁇ g)-MenC (10 ⁇ g), non-ads TT conjugate and InfanrixTM penta (Hib10-MenC10-TT + InfanrixTM penta)
• Group M Hib (5 ⁇ g)-MenC (5 ⁇ g), non-ads, TT conjugate and InfanrixTM penta (Hib5-MenC5-TT + InfanrixTM penta) • Group N: MeningitecTM and InfanrixTM hexa (MeningitecTM + InfanrixTM hexa)
• the two Hib-MenC-TT vaccine groups (Groups L and M) were kept blinded in the booster study as to the exact formulation of the candidate vaccine.
• Arm 2-(Group O) consisted of age-matched subjects not previously vaccinated with a meningococcal serogroup C vaccine (naive) but who had received routine pediatric vaccines according to the German Permanent Commission on Immunization.
• Demographics Determination of mean age in months (with median, range and standard deviation [SD]), and racial and gender composition of the ATP and Total vaccinated cohorts.
• Group K subjects primed with MenC10-TT + Infanrix. hexa
• Group L subjects primed with Hib10-MenC10-TT + Infanrix.
• penta subjects primed with Hib5-MenC5-TT + Infanrix.
• Group N subjects primed with Meningitec. + Infanrix. hexa
• Group O control subjects (i.e. subjects not primed with MenC conjugate vaccine) N: number of subjects with available results
• Group K subjects primed with MenC10-TT + Infanrix. hexa; Group L: subjects primed with Hib10-MenC10-TT + Infanrix. penta; Group M: subjects primed with Hib5-MenC5-l + Infanrix. penta; Group N: subjects primed with Meningitec. + Infanrix. hexa; N: number of subjects with available results
• Tritanrix is a DTPw vaccine marketed by GlaxoSmithKline Biologicals S.A.
• the 2.5/2.5/2.5 vaccine was a dose dilution of GSK Biologicals' Hib-MenAC 5/5/5 vaccine containing 2.5 ⁇ g of each of PRP-TT, MenA-TT and MenC-TT.
• the Hib-MenAC vaccine formulations were mixed extemporaneously with Tritanirix-HepB.
• GSK Biologicals' combined diphtheria-tetanus-whole cell Bordetella pertussis - hepatitis B (DTPw-HB) vaccine (Tritanrix-HepB) contains not less than 30 International Units (IU) of diphtheria toxoid, not less than 60 IU of tetanus toxoid, not less than 4IU of killed Bordetella pertussis and 10 ⁇ g of recombinant hepatitis B surface antigen.
• IU International Units
• Vaccination schedule/site One group received Tritanrix.-HepB vaccine intramuscularly in the left thigh and HiberixTM intramuscularly in the right thigh at 6, 10 and 14 weeks of age. Another group received TritanrixTM-HepB/HiberixTM vaccine intramuscularly in the left thigh and Meningitec vaccine intramuscularly in the right thigh at 6, 10 and 14 weeks of age.
• Vaccine/composition/dose/lot number The TritanrixTM-HepB vaccine used was as described above.
• HiberixTM contained 10 ⁇ g of PRP conjugated to tetanus toxoid. In the HiberixTM Group, it was mixed with sterile diluent and in the MeningitecTM Group it was mixed with
• One dose (0.5 ml) of Wyeth Lederle's MENINGITECTM vaccine contained: 10 ⁇ g of capsular oligosaccharide of meningococcal group C conjugated to 15 ⁇ g of
• GMC 18.10 15.34 21.35 26.51 22.93 30.79 23.40 20.05 27.30 0.15 0.15 0.15
• Example 5 Phase Il clinical trial administering Hib MenCY concomitantly with Infanrix penta according to a 2, 3 and 4 month schedule
• Study design A Phase II, open (partially double-blind * ) randomized controlled multi- center study with 5 groups receiving a three-dose primary schedule with vaccines as follows: Group Hib-MenCY 2.5/5/5: Hib-MenCY (2.5/5/5 ) + InfanrixTM penta Group Hib-MenCY 5/10/10: Hib-MenCY (5/10/10) + InfanrixTM penta Group Hib-MenCY 5/5/5: Hib-MenCY (5/5/5) + InfanrixTM penta Group Hib-MenC: Hib-MenC (5/5) + InfanrixTM penta Group Menjugate: MenjugateTM ** + InfanrixTM hexa (control).
• Hib-MenCY 2.5/5/5, Hib-MenCY 5/10/10 and Hib-MenC were administered in a double- blind manner while the Hib-MenCY 5/5/5 group and the Menjugate group were open.
• the 2.5/5/5, 5/10/10 and 5/5/5 formulations of Hib-MenCY contain MenC native polysaccharides and MenY polysaccharides which are microfluidized.
• **MenjugateTM contains 10 ⁇ g of MenC oligosaccharides conjugated to 12.5-25 ⁇ g of CRM197 per dose and is produced by Chiron. Vaccination at +/- 2, 3, 4 months of age (Study Month 0, Month 1 and Month 2), and blood samples (3.5ml) from all subjects prior to and one month post primary vaccination (Study Month 0 and Month 3).
• Table 6 Vaccines administered (study and control), group, schedule/site and dose
• anti-PSC IgG and anti-PSY IgG meningitidis serogroups C and Y polysaccharides
• anti-PRP IgG Hib polysaccharide polyribosil-ribitol-phosphate
• 5ELU/ml for anti-FHA, anti-PRN, anti-PT >0.1 IU/ml anti-tetanus toxoid (anti-TT).
• Month 3 only at one month after the third dose (Month 3) in all subjects for: anti-D, anti-HBs and anti-polio 1 , 2 and 3.
• ELISA assays with cut-offs 0.1 IU/ml for anti-diphtheria (anti-D); >10 mlU/ml for antihepatitis B (anti-HBs); and microneutralization test cut-off: 1 :8 for anti-polio type 1 , 2 and 3 (anti-polio 1 , 2 and 3).
• the seroprotection/seropositivity rates and geometric mean concentrations/ rates (GMCs/GMTs) with 95% confidence intervals (95% Cl) were computed per group, for SBA-MenC, anti-PSC, SBA-MenY, anti-PSY, anti-PRP, anti-Tetanus, anti-PT, anti-FHA and anti-PRN prior to and one month after vaccination; for anti-Diphtheria, anti-HBs, anti- Polio 1 , anti-Polio 2 and anti-Polio 3 one month after vaccination.
• Vaccine response (appearance of antibodies in subjects initially seronegative or at least maintenance of antibody concentrations in subjects initially seropositive) with 95% Cl for anti-PT, anti- PRN and anti-FHA were also computed one month after vaccination. Reverse cumulative curves for each antibody at Month 3 are also presented.
• the differences between the Hib- MenCY and the Hib- MenC groups, compared with the MenjugateTM control group were evaluated in an exploratory manner for each antibody, except for SBA-MenY and anti- PSY, in terms of (1) the difference between the MenjugateTM group (minus) the Hib- MenCY and Hib-MenC groups for the percentage of subjects above the specified cut-offs or with a vaccine response with their standardized asymptotic 95% Cl, (2) the GMC or GMT ratios of the MenjugateTM group over the Hib-MenCY and Hib-MenC groups with their 95% Cl. The same comparisons were done to evaluate the difference between each pair of Hib-MenCY formulations for anti-PRP, SBA-MenC, anti-PSC, SBA-MenY, anti-PSY and anti-TT antibodies.
• MenjugateTM 71 100 0 94 9 100 0 100 0 94 9 100 0
• MenjugateTM 71 100 0 94 9 100 0 100 0 94 9 100 0
• N number of subjects with available results.
• % percentage of subjects with concentration/titre within the specified range
• the MenC and Y polysaccharide conjugates produced a good immune response in all subjects with 100% of subjects producing above 0.3 ⁇ g/ml responses against MenC and MenY.
• Example 6 Phase Il clinical trial comparing three formulations of MenACWY-TT with Meninqitec MenC-CRM197 oliqosaccharide-coniuqate vaccine.
• This example reports a phase II, open (partially-blind), randomized, controlled dose-range study to evaluate the lmmunogenicity of three different formulations of GlaxoSmithKline Biological's meningococcal serogroups A, C, W-135, Y tetanus toxoid conjugate (MenACWY-TT) vaccine in comparison to a MenC oligosaccharide-CRM197 conjugate vaccine (Meningitec) when given as one dose to children aged 12-14 months.
• the clinical trial was an open (partially double-blind * ), controlled, multicentric study in which eligible subjects of 12-14 months were randomized (1 :1 :1 :1) to one of four parallel groups of 50 subjects to receive a single primary dose at Visit 1 as follows:
• Form 1T MenACWY-TT at a dose of 2.5 ⁇ g of MenA polysaccharide conjugated to tetanus toxoid (TT), 2.5 ⁇ g of MenC polysaccharide conjugated to TT, 2.5 ⁇ g of MenW polysaccharide conjugated to TT and 2.5 ⁇ g of MenY polysaccharide conjugated to TT.
• Form 2T MenACWY-TT at a dose of 5 ⁇ g of MenA polysaccharide conjugated to TT, 5 ⁇ g of MenC polysaccharide conjugated to TT, 5 ⁇ g of MenW polysaccharide conjugated to TT and 5 ⁇ g of MenY polysaccharide conjugated to TT.
• Form 3T MenACWY-TT at a dose of 2.5 ⁇ g of MenA polysaccharide conjugated to TT, 10 ⁇ g of MenC polysaccharide conjugated to TT, 2.5 ⁇ g of MenW polysaccharide conjugated to TT and 2.5 ⁇ g of MenY polysaccharide conjugated to TT.
• Ctrl T 10 ⁇ g MenC oligosaccharide conjugated to 12.5-25 ⁇ g CRM197 (MeningitecTM). * The three different MenACWY-TT formulations were administered in a double-blind manner.
• Vaccination schedule/site A single vaccine dose was administered intramuscularly in the left deltoid at Visit 1 (Study Month 0) according to randomized assignment. All candidate vaccines were supplied as a lyophilized pellet in a monodose vial (0.5 ml after reconstitution with the supplied saline diluent).
• Immunogenicity Measurement of titers/concentrations of antibodies against meningococcal vaccine antigen components in blood samples obtained prior to the study vaccine dose (Month 0) and approximately one month after the study vaccine dose (Month 1) in all subjects.
• meningitidis serogroups A, C, W-135 and Y anti- PSA, anti-PSC, anti-PSW and anti-PSY, assay cut-offs >0.3 ⁇ g/ml and >2 ⁇ g/ml
• tetanus toxoid anti-tetanus, assay cut-off 0.1 Ill/ml
• Antibody response in terms of the percentage of SBA-MenA, SBA-MenC, SBA-MenW and SBA-MenY responders one month after vaccination (the primary endpoint) is shown in Table 8.
• a response is defined as greater than or equal to a 4-fold increase for seropositive subjects or seroconversion for seronegative subjects before vaccination.
• Table 8 Vaccine responses for SBA antibody one month after vaccination
• Table 9 shows the numbers of subjects achieving SBA titres over cutoff points of 1 :8 and 1 :128 as well as GMTs.
• Vaccination with all three formulations of the ACWY-TT polysaccharide conjugate led to good SBA responses against MenA, MenC, MenW and MenY with 95-100% of subjects with titres greater than 1 :8.
• the 5/5/5/5 and 2.5/10/2.5/2.5 formulations of the polysaccharide conjugates produced a higher response against MenC than the oligosaccharide Meningitic vaccine as seen by a higher proportion of subjects having a titre greater than 1 :128 and the GMT readings.
• All three formulations of the ACWY-TT polysaccharide conjugate vaccine produced good immune responses against MenA, MenC, MenW and MenY with between 93% and 100% of subjects achieving titres grater than 0.3 ⁇ g/ml.
• Higher GMC readings were achieved using the 5/5/5/5 and 2/5/10/2.5/2.5 formulations of the ACWY-TT polysaccharide conjugate vaccine in comparison with MeningitecTM.
• Example 7 comparison of immunoqenicity of native and sized MenY polysaccharide conjugates
• mice female DBA/2 of 6-8 wk received two injections, 2 weeks apart, of PSY-TT by the subcutaneous route. Blood samples were taken 14 days after the second injection in order to perform anti-PSY ELISA and SBA using S1975 menY strain. Per injection, mice received 1 ⁇ g of PSY-TT( lyo non-ads formulation).
• Figure 1A shows the GMC results obtained in an ELISA for antisera raised against conjugates prepared from native MenY (ENYTT012), microfluidised MenY - 40 cycles (ENYTT014) and microfluidised MenY - 20 cycles (ENYTT015 bis). Higher GMCs were obtained where the MenY-TT was prepared from microfluidised MenY.

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