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• • 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
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Definitions

• the present invention relates to immunogenic compositions comprising bacterial capsular saccharides conjugated to a carrier protein, in particular those saccharides of N. meningitidis. It additionally relates to vaccines and vaccine kits comprising such saccharide 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 infection using the saccharide conjugates and the use of the saccharide 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, 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; the carrier protein having the known effect of turning the T- independent polysaccharide antigen into a T-dependent antigen capable of triggering an immune memory response.
• WO 02/58737 discloses a vaccine comprising purified capsular polysaccharides from N. meningitidis serogroups A, C, W135 and Y conjugated to a carrier protein.
• this application teaches that all polysaccharides should essentially be conjugated in the same way (through the same linker to the same protein carrier).
• the present invention concerns the provision of a meningococcal polysaccharide conjugate vaccine where conjugation of each polysaccharide is tailored (rather than being uniform) to achieve an efficacious combination vaccine.
• linker molecules to conjugate certain meningococcal saccharides to their protein carriers in combination with others that are directly conjugated.
• polysaccharides that are less good immunogens may be presented to the immune system via a linker, and those that are very good immunogens may be directly conjugated so that they do not dominate the immune response to the combination.
• an immunogenic composition comprising at least 2 different N.
• meningitidis capsular saccharides wherein one or more is/are selected from a first group consisting of MenA, MenC, MenY and MenW which is/are conjugated through a linker to a carrier protein(s), and one or more different saccharides is/are selected from a second group consisting of MenA, MenC, MenY and MenW which is/are directly conjugated to a carrier protein(s).
• MenA may be conjugated through a linker and MenC directly.
• MenCY vaccine MenC may be conjugated through a linker and MenY directly.
• MenACWY vaccine Men A may be conjugated through a linker and MenCWY directly, or MenAC may be conjugated through a linker and MenWY directly.
• a further consideration in a combination vaccine comprising various saccharides conjugated to the same carrier is the issue of carrier immune suppression: too much carrier may be used and the immune response may be dampened. With a uniform approach to conjugation the carrier will present a similar blend of B- and T- cell epitopes to the immune system. However if conjugation takes place at different chemical groups within the carrier protein for one saccharide versus another, the protein carriers are likely to be different to some extent in how they present themselves to the immune system.
• an immunogenic composition comprising at least 2 different saccharides conjugated separately to the same type of carrier protein (for instance tetanus toxoid), wherein one or more saccharide(s) is/are conjugated to the carrier protein via a first type of chemical group on the protein carrier, and one or more saccharide(s) is/are conjugated to the carrier protein via a second (different) type of chemical group on the protein carrier.
• carrier protein for instance tetanus toxoid
• the first and second types of chemical group may be present in the protein carrier on a mutually exclusive first and second set of amino acids of the protein carrier (for instance certain aspartic acid / glutamic acid residues in one set and certain lysine residues in the second).
• One saccharide may be conjugated to a carboxyl group on the carrier, and another on an amino group for instance. Such conjugation may involve conjugation on separate B- and/or T-cell epitopes for each different conjugate.
• MenA may be linked to a first type of chemical group (such as carboxyl) on the carrier protein and MenC linked to a second (such as amino).
• MenC may be linked to a first type of chemical group (such as carboxyl) on the carrier protein and MenY linked to a second (such as amino).
• MenACWY vaccine MenAC may be linked to a first type of chemical group (such as carboxyl) on the carrier protein and MenWY linked to a second (such as amino), or MenA may be linked to a first type of chemical group (such as carboxyl) on the carrier protein and MenCWY linked to a second (such as amino).
• 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 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.
• ENYTTOI 2 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 comprising at least 2 different N. meningitidis capsular saccharides, wherein one or more is/are selected from a first group consisting of MenA, MenC, MenY and MenW which is/are conjugated through a linker to a carrier protein(s), and one or more different saccharides is/are selected from a second group consisting of MenA, MenC, MenY and MenW which is/are directly conjugated to a carrier protein(s).
• the first group may consist of MenA and MenC
• the second group consist of MenC, MenY and MenW.
• Particular embodiments of the invention are immunogenic compositions comprising: MenA capsular saccharide conjugated through a linker to a carrier protein and MenC capsular saccharide directly conjugated to a carrier protein; MenC capsular saccharide conjugated through a linker to a carrier protein and MenY capsular saccharide directly conjugated to a carrier protein; MenA and MenC capsular saccharides conjugated through a linker to a carrier protein(s) and MenY and Men W capsular saccharides directly conjugated to a carrier protein(s); MenA capsular saccharide conjugated through a linker to a carrier protein and MenC, MenY and Men W capsular saccharides directly conjugated to a carrier protein(s).
• a Hib conjugate may also be included, which is linked to a carrier protein (see list of carriers above and below, for example TT) directly or through a linker.
• saccharide throughout this specification may indicate polysaccharide or oligosaccharide and includes both.
• 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 have a low number of repeat units (typically 5-30 repeat units) and are typically hydrolysed polysaccharides.
• N. meningitidis (and/or Hib) capsular saccharide may be conjugated to a carrier protein independently selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
• a carrier protein independently selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
• capsular saccharide may be conjugated to different carrier proteins from the others, in one embodiment they are all conjugated to the same carrier protein. For instance they may all be conjugated to the same carrier protein selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D. In this context CRM197 and DT may be considered to be the same carrier protein as they differ by only one amino acid. In an embodiment all the N. meningitidis (and/or Hib) capsular saccharides present are conjugated to TT.
• the saccharide could be conjugated to the same molecule of the protein carrier (carrier molecules having 2 more different saccharides conjugated to it) [see for instance WO 04/083251 ; for example, 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; MenA, MenC, MenW and MenY; Hib and MenA; Hib and MenC; Hib and MenC; Hib and MenW; or Hib and MenY].
• the saccharides may each be separately conjugated to different molecules of the protein carrier (each molecule of protein carrier only having one type of saccharide conjugated to it).
• Immunogenic compositions of the first aspect of the invention may also have any or all the additional characteristics of the second aspect of the invention and vice versa.
• an immunogenic composition comprising at least 2 different saccharide conjugates conjugated separately to the same type of carrier protein, wherein one or more saccharide(s) is/are conjugated to the carrier protein via a first type of chemical group on the protein carrier, and one or more saccharide(s) is/are conjugated to the carrier protein via a second (different) type of chemical group on the protein carrier.
• the 2 conjugates involve the same saccharide linked to the same carrier, but by different conjugation chemistries.
• 2 different saccharides are conjugated to different groups on the protein carrier.
• the saccharides are conjugated to the same carrier individually (for example, MenA is conjugated to tetanus toxoid through an amine group on the tetanus toxoid and MenC is conjugated to tetanus toxoid through a carboxylic acid group on a different molecule of tetanus toxoid.)
• the capsular saccharide(s) may be conjugated to the same carrier protein independently selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D.
• the first and second type of chemical group on the protein carrier are present on separate B- and/or T-cell epitopes on the carrier protein. That is, they are present on a different set of B- and/or T-cell epitopes from each other.
• B-cell epitopes for a carrier known methods may be used such as either or both of the following two methods: 2D-structure prediction and/or antigenic index prediction.
• 2D-structure prediction can be made using the PSIPRED program (from David Jones, Brunei Bioinformatics Group, Dept. Biological Sciences, Brunei University, Uxbridge UB8 3PH, UK).
• the antigenic index can be calculated on the basis of the method described by Jameson and Wolf (CABIOS 4:181-186 [1988]).
• T-helper cell epitopes are peptides bound to HLA class Il molecules and recognized by T-helper cells.
• the prediction of useful T-helper cell epitopes can be based on known techniques, such as the TEPITOPE method describe by Sturniolo at al. (Nature Biotech. 17: 555-561 [1999]).
• the saccharides may be selected from a group consisting of: N. meningitidis serogroup A capsular saccharide (MenA), N. meningitidis serogroup C capsular saccharide (MenC), N. meningitidis serogroup Y capsular saccharide (MenY), N. meningitidis serogroup W capsular saccharide (MenW), H. influenzae type b capsular saccharide (Hib), Group B
• Streptococcus group I capsular saccharide Group B Streptococcus group Il capsular saccharide, Group B Streptococcus group III capsular saccharide, Group B Streptococcus group IV capsular saccharide, Group B Streptococcus group V capsular saccharide,
• Staphylococcus aureus type 5 capsular saccharide Staphylococcus aureus type 8 capsular saccharide, Vi saccharide from Salmonella typhi, N. meningitidis LPS (such as
• the immunogenic composition of the invention consists of or comprises two or more different saccharides from the same genus of bacteria (e.g. Neisseria, Streptococcus, Staphylococcus, or Haemophilus).
• the first and second chemical groups present on the protein carrier are different from each other and are ideally natural chemical groups that may be readily used for conjugation purposes. They may be selected independently from the group consisting of: carboxyl groups, amino groups, sulphydryl groups, Hydroxyl groups, Imidazolyl groups,
• the first chemical group is carboxyl and the second is amino, or vice versa.
• the immunogenic composition comprises at least 2 different N. meningitidis capsular saccharides, wherein one or more is/are selected from a first group consisting of MenA and MenC which is/are conjugated to the carrier protein via the first type of chemical group on the protein carrier (for instance carboxyl), and one or more different saccharides is/are selected from a second group consisting of MenC, MenY and MenW which is/are conjugated to the carrier protein via the second type of chemical group on the protein carrier (for instance amino).
• a first group consisting of MenA and MenC which is/are conjugated to the carrier protein via the first type of chemical group on the protein carrier (for instance carboxyl)
• one or more different saccharides is/are selected from a second group consisting of MenC, MenY and MenW which is/are conjugated to the carrier protein via the second type of chemical group on the protein carrier (for instance amino).
• the immunogenic composition of the invention comprises MenA conjugated via the first type of chemical group (for instance carboxyl), and MenC conjugated via the second type of chemical group (for instance amino).
• the immunogenic composition comprises MenC conjugated via the first type of chemical group (for instance carboxyl), and MenY conjugated via the second type of chemical group (for instance amino).
• the immunogenic composition comprises MenA conjugated via the first type of chemical group (for instance carboxyl), and MenC, MenY and MenW conjugated via the second type of chemical group (for instance amino).
• first type of chemical group for instance carboxyl
• second type of chemical group for instance amino
• the immunogenic composition comprises MenA and MenC conjugated via the first type of chemical group (for instance carboxyl), and MenY and MenW conjugated via the second type of chemical group (for instance amino).
• Hib may also be present also conjugated to the same type of protein carrier.
• Hib may be conjugated to the carrier by the first or second type of chemical group. In one embodiment it is conjugated via a carboxyl group.
• the saccharides of the invention (in particular the N. meningitidis saccharides and/or the Hib capsular saccharide) included in pharmaceutical (immunogenic) compositions of the invention are conjugated to a carrier protein such as tetanus toxoid (TT), tetanus toxoid fragment C, non-toxic mutants of tetanus toxin [note all such variants of TT are considered to be the same type of carrier protein for the purposes of this invention], diphtheria toxoid (DT), 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 meningitidis serogroup B - EP0372501
• synthetic peptides EP0378881 , EP0427347
• heat shock proteins WO 93/17712, WO 94/03208
• pertussis proteins WO 98/58668, EP0471177
• cytokines lymphokines, growth factors or hormones
• 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), iron uptake proteins (WO 01/72337), toxin A or B of C. difficile (WO 00/61761) or Protein D (EP594610 and WO 00/56360).
• the immunogenic composition of the invention uses the same type of carrier protein (independently) in at least two, three, four or each of the saccharides (e.g. N. meningitidis capsular saccharides and/or Hib) contained therein.
• the saccharides e.g. N. meningitidis capsular saccharides and/or Hib
• Hib may be conjugated to the same type of carrier protein as the at least two, three, four or each of the N. meningitidis saccharides.
• 2, 3 or 4 of the N. meningitidis saccharides are independently conjugated to tetanus toxoid to make 2, 3 or 4 conjugates, and optionally Hib is also conjugated to TT.
• the immunogenic composition of the invention comprises a N. meningitidis saccharide conjugated to a carrier protein selected from the group consisting of TT 1 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, CRM197, 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 and 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 MenY; 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 and MenC; MenA and MenW; MenA and MenY; MenC and Men W; Men C and MenY; Men W and MenY; MenA, MenC and MenW
• 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).
• 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 comprises N. meningitidis saccharide conjugate(s) and/or the Hib saccharide conjugate wherein the N. meningitidis saccharide(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.
• 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 saccharide 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 via a carboxyl group on the protein carrier.
• 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 hydroxyl 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 saccharide(s) is conjugated to the linker first before the linker is conjugated to the carrier protein.
• the linker may be conjugated to the carrier before conjugation to the saccharide.
• Carboxyl for instance via aspartic acid or glutamic acid.
• this group is linked to amino groups on saccharides directly or to an amino group on a linker with carbodiimide chemistry e.g. with EDAC.
• Amino group (for instance via lysine).
• this group is linked to carboxyl groups on saccharides directly or to a carboxyl group on a linker with carbodiimide chemistry e.g. with EDAC.
• this group is linked to hydroxyl groups activated with CDAP or CNBr on saccharides directly or to such groups on a linker; to saccharides or linkers having an aldehyde group; to saccharides or linkers having a succinimide ester group.
• Sulphydryl for instance via cysteine.
• this group is linked to a bromo or chloro acetylated saccharide or linker with maleimide chemistry.
• this group is activated/modified with bis diazobenzidine.
• D) Hydroxyl group (for instance via tyrosine). In one embodiment this group is activated/modified with bis diazobenzidine.
• E) Imidazolyl group (for instance via histidine). In one embodiment this group is activated/modified with bis diazobenzidine.
• G lndolyl group (for instance via tryptophan).
• Aldehyde groups can be generated after different treatments known in the art such as: periodate, acid hydrolysis, hydrogen peroxide, etc.
• protein carrier chemical group that may be generally used for coupling with a saccharide are amino groups (for instance on lysine residues), COOH groups (for instance on aspartic and glutamic acid residues) and SH groups (if accessible) (for instance on cysteine residues).
• 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 saccharides 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.
• at least one of the N. meningitidis capsular saccharides 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 saccharides 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 :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 saccharide(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 saccharide 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.
• the conjugation via a linker results in a ratio of saccharide 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 saccharide, where present 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 saccharide, 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 saccharide 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 saccharide 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 saccharide prior to conjugate and/or after conjugation.
• the immunogenic composition, saccharide present, or each N. meningitidis capsular saccharide present is conjugated to TT.
• each N. meningitidis capsular saccharide is separately conjugated to a separate carrier protein.
• each N. meningitidis capsular saccharide conjugate has a saccharide:carrier ratio of 1 :5-5:1 or 1 :1-1 :4(w/w).
• at least one, two or three N. meningitidis capsular saccharide conjugate(s) is directly conjugated to a carrier protein.
• Men W and/or MenY, MenW and/or MenC, MenY and/or MenC, or MenW and MenC and MenY are directly conjugated to a carrier protein.
• meningitidis saccharide conjugate(s) is directly conjugated by CDAP chemistry.
• the ratio of Men W and/or Y saccharide to carrier protein is between 1 :0.5 and 1 :2 (w/w).
• the ratio of MenC saccharide to carrier protein is between 1 :0.5 and 1 :2 (w/w).
• at least one, two or three N are directly conjugated to a carrier protein.
• meningitidis capsular saccharide(s) are conjugated to the carrier protein via a linker (which may be bifunctional such as having two reactive amino groups (such as ADH) or two reactive carboxyl groups, or a reactive amino group at one end and a reactive carboxyl group at the other).
• the linker can have between 4 and 12 carbon atoms.
• the or each N. meningitidis capsular saccharide(s) conjugated via a linker are conjugated to the linker with CDAP chemistry.
• the carrier protein is conjugated to the linker using carbodiimide chemistry, for example using EDAC.
• the or each N are conjugated to the linker using carbodiimide chemistry, for example using EDAC.
• meningitidis capsular saccharide is conjugated to the linker before the carrier protein is conjugated to the linker.
• MenA is conjugated to a carrier protein via a linker (the ratio of MenA saccharide to carrier protein may be between 1 :2 and 1 :5 (w/w)).
• MenC is conjugated to a carrier protein via a linker (the ratio of MenC saccharide to carrier protein may be between 1 :2 and 1 :5 (w/w)).
• oligosaccharides for ease of conjugate production.
• the inventors have 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 through a 0.2 micron filter; 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 may lessen the liberation of free saccharide from the conjugate.
• conjugate vaccines described in the prior art tend to depolymerise the polysaccharides prior to conjugation in order to improve conjugation.
• the present inventors have found that meningococcal (or saccharide) conjugate vaccines retaining a larger size of saccharide can provide a good immune response against meningococcal disease.
• the immunogenic composition of the invention may thus comprise one or more saccharide conjugates wherein the average size of each saccharide before conjugation is above 5OkDa, 75kDa, 10OkDa, 11OkDa, 12OkDa or 13OkDa.
• the conjugate post conjugation should be readily filterable through a 0.2 micron filter such that a yield of more than 50, 60, 70, 80, 90 or 95% is obtained post filtration compared with the pre filtration sample.
• the immunogenic composition of the invention comprises N. meningitidis capsular saccharides 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 saccharide is above 5OkDa, 6OkDa, 75kDa, 10OkDa, 110kDa, 12OkDa or 13OkDa.
• the immunogenic composition may comprise N.
• meningitidis capsular saccharides 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 saccharide is either a native saccharide or is sized by a factor up to 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 saccharide that has not been subjected to a process, the purpose of which is to reduce the size of the saccharide.
• a polysaccharide can become slightly reduced in size during normal purification procedures. Such a saccharide 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 saccharide is subject to a process intended to reduce the size of the saccharide 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 saccharide 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.
• the immunogenic composition comprises N. meningitidis capsular saccharides 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 saccharide is native polysaccharide.
• the immunogenic composition comprises N. meningitidis capsular saccharides 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 saccharide is sized by a factor up to x1.5, x2, x3, x4, x5, x6, x7, x ⁇ , x9 or x10.
• the immunogenic compositions of the invention optionally comprise conjugates of : N. meningitidis serogroup C capsular saccharide (MenC), serogroup A capsular saccharide (MenA), serogroup W135 capsular saccharide (MenW), serogroup Y capsular saccharide (MenY), serogroup C and Y capsular saccharides (MenCY), serogroup C and A capsular saccharides (MenAC), serogroup C and W capsular saccharides (MenCW), serogroup A and Y capsular saccharide (MenAY), serogroup A and W capsular saccharides (MenAW), serogroup W and Y capsular saccharides (Men WY), serogroup A, C and W capsular saccharide (MenACW), serogroup A, C and Y capsular saccharides (MenACY); serogroup A, W135 and Y capsular saccharides (MenAWY), serogroup C, W135 and
• the average size of at least one, two, three, four or each N. meningitidis saccharide is between 50KDa and 150OkDa, 5OkDa and 50OkDa, 50 kDa and 300 KDa, 101 kDa and 150OkDa, 101 kDa and 50OkDa, 101 kDa and 30OkDa as determined by MALLS.
• the MenA saccharide where present, has a molecular weight of 50- 50OkDa, 50-10OkDa, 100-50OkDa, 55-90KDa, 60-7OkDa or 70-8OkDa or 60-8OkDa.
• the MenC saccharide where present, has a molecular weight of 100- 20OkDa, 50-10OkDa, 100-15OkDa, 101-13OkDa, 150-21OkDa or 180-21OkDa.
• MenY saccharide where present, has a molecular weight of 60- 19OkDa 1 70-18OkDa, 80-17OkDa, 90-16OkDa, 100-15OkDa or 110-14OkDa, 50-10OkDa, 100-14OkDa, 140-17OkDa or 150-16OkDa.
• MenW saccharide where present, has a molecular weight of 60- 19OkDa, 70-18OkDa, 80-17OkDa, 90-16OkDa, 100-15OkDa, 110-14OkDa, 50-10OkDa or 120-14OkDa.
• the molecular weight or average molecular weight of a saccharide herein refers to the weight-average molecular weight (Mw) of the saccharide measured prior to conjugation and is measured by MALLS.
• the MALLS technique is well known in the art and is typically carried out as described in example 2.
• two columns (TSKG6000 and 5000PWxI) 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).
• the N. meningitidis saccharides are native polysaccharides or native polysaccharides which have reduced in size during a normal extraction process.
• the N. meningitidis saccharides 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 (fro example through a 0.2 micron filter).
• 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 saccharides that are sized by a factor of no more than x20.
• saccharides from MenC and/or MenA are native.
• saccharides from MenY and/or MenW are sized by a factor of no more than x20, x10, x8, x6, x5, x4, x3 or x2.
• 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 x10 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 then x10 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 then x10 and/or is microfluidised.
• the polydispersity of the saccharide 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.
• Saccharides 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.
• each N. meningitidis saccharide is either a native polysaccharide or is sized by a factor of no more than x10. In a further embodiment each N. meningitidis capsular saccharide is a native polysaccharide. In a further embodiment at least one, two, three or four N. meningitidis capsular saccharide(s) is sized by microfluidization. In a further embodiment each N. meningitidis capsular saccharide is sized by a factor of no more than x10. In a further embodiment the N. meningitidis conjugates are made from a mixture of native polysaccharides and saccharides that are sized by a factor of no more than x10.
• capsular saccharide from serogroup Y is sized by a factor of no more than x10.
• capsular saccharides from serogroups A and C are native polysaccharides and saccharides from serogroups W135 and Y are sized by a factor of no more than x10.
• the average size of each N. meningitidis capsulear saccharide is between 50 kDa and 300 KDa or 5OkDa and 20OkDa.
• the immunogenic composition comprises a MenA capsular saccharide having an average size of above 5OkDa, 75kDa, 10OkDa or an average size of between 50-10OkDa or 55-90KDa or 60-8OkDa.
• the immunogenic composition comprises a MenC capsular saccharide having an average size of above 5OkDa, 75kDa, 10OkDa or between 100-20OkDa, 100-15OkDa, 80-12OkDa , 90-11OkDa, 150-20OkDa, 120-24OkDa, 140-22OkDa, 160-20OkDa or 190-20OkDa.
• the immunogenic composition comprises a MenY capsular saccharide, having an average size of above 5OkDa, 75kDa, 10OkDa or between 60- 19OkDa or 70-18OkDa or 80-17OkDa or 90-16OkDa or 100-15OkDa , 1 10-145kDa or 120- 14OkDa.
• the immunogenic composition comprises a MenW capsular saccharide having an average size of above 5OkDa, 75kDa, 10OkDa or between 60-19OkDa or 70-18OkDa or 80-17OkDa or 90-16OkDa or 100-15OkDa, 140-18OkDa, 150- 17OkDa or 110-14OkDa.
• the immunogenic composition of the invention may comprise a H. influenzae b capsular saccharide (Hib) conjugated to a carrier protein.
• Hib H. influenzae b capsular saccharide
• This may be conjugated to a carrier protein selected from the group consisting of TT, DT, CRM197, fragment C of TT and protein D, for instance TT.
• the Hib saccharide may be conjugated to the same carrier protein as for at least one, two, three or all of the N. meningitidis capsular saccharide conjugates, for instance TT.
• the ratio of Hib to carrier protein in the Hib capsular saccharide conjugate may be between 1 :5 and 5:1 (w/w), for instance between 1 :1 and 1 :4, 1 :2 and 1 :3.5 or around 1 :3 (w/w).
• the Hib capsular saccharide may be conjugated to the carrier protein via a linker (see above).
• the linker may bifunctional (with two reactive amino groups, such as ADH, or two reactive carboxylic acid groups, or a reactive amino group at one end and a reactive carboxylic acid group at the other end). It may have between 4 and 12 carbon atoms.
• Hib saccharide may be conjugated to the carrier protein or linker using CNBr or CDAP.
• the carrier protein may be conjugated to the Hib saccharide via the linker using a method comprising carbodiimide chemistry, for example EDAC chemistry (thus using the carboxyl chemical group on the carrier).
• the dose of the Hib saccharide conjugate may be between 0.1 and 9 ⁇ g, 1 and 5 ⁇ g or 2 and 3 ⁇ g of saccharide.
• the immunogenic composition of the invention comprises a Hib saccharide conjugate and at least two N. meningitidis saccharide conjugates wherein the Hib conjugate is present in a lower saccharide dose than the mean saccharide dose of the at least two N. meningitidis saccharide conjugates.
• the Hib conjugate is present in a lower saccharide dose than the saccharide dose of each of the at least two N. meningitidis saccharide 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 saccharide conjugates.
• the mean dose is determined by adding the doses of all the further saccharides and dividing by the number of further saccharides.
• Further saccharides are all the saccharides within the immunogenic composition apart from Hib and can include N. meningitidis capsular saccharides.
• 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 two further bacterial saccharide conjugates in addition to a Hib conjugate.
• the two further bacterial conjugates may include N. meningitidis capsulear saccharide 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 saccharides derived from one or more of serogroups A, C, W135 and Y of Neisseria meningitidis.
• a further embodiment comprises capsular saccharides derived from Streptococcus pneumoniae.
• the pneumococcal capsular saccharide antigens are optionally selected from serotypes 1 , 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11 A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 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 saccharides of Staphylococcus aureus.
• a further embodiment comprises the Type I, Type Il or Type III capsular saccharides of Staphylococcus epidermidis.
• a further embodiment comprises the Vi saccharide from S. typhi.
• a further embodiment comprises the Type Ia, Type Ic, Type II, Type III or Type V capsular saccharides of Group B streptocoocus.
• a further embodiment comprises the capsular saccharides of Group A streptococcus, optionally further comprising at least one M protein and optionally multiple types of M protein.
• the immunogenic compositions of the invention may also comprise a DTPa or DTPw vaccine (for instance one containing DT, TT, and either a whole cell pertussis (Pw) vaccine or an acellular pertussis (Pa) vaccine (comprising for instance pertussis toxoid,
• the immunogenic composition of the invention comprises a DTPwHepBHibMenAC vaccine where the HibMenAC component is as described above.
• Immunogenic compositions of the invention optionally comprise additional viral antigens conferring protection against disease caused by measles and/or mumps and/or rubella and/or varicella.
• immunogenic composition of the invention contains antigens from measles, mumps and rubella (MMR) or measles, mumps, rubella and varicella (MMRV).
• MMR measles, mumps and rubella
• MMRV measles, mumps, rubella and varicella
• these viral antigens are optionally present in the same container as the meningococcal and/or Hib saccharide conjugate(s).
• these viral antigens are lyophilised.
• 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, which may be conjugated to a protein carrier.
• 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 may comprise a dose of each saccharide conjugate between 0.1 and 20 ⁇ g, 2 and 10 ⁇ g, 2 and 6 ⁇ g or 4 and 7 ⁇ g of saccharide.
• the immunogenic composition of the invention contains each N. meningitidis capsular saccharide 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 comprises MenA, MenC, MenW and MenY (optionally conjugated to tetanus toxoid) in doses of 2.5, 2.5, 2.5 and 2.5 ⁇ g respectively, 5, 5, 5 and 5 ⁇ g respectively or 5, 5, 2,5 and 2.5 ⁇ g respectively.
• 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.
• 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 may contain 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 saccharide 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 saccharide 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%, 70%, 60%, 50%, 40%, 30%, 20% or 10% of the lowest saccharide dose of the at least two, three, four or each of the N. meningitidis saccharide 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 lowest saccharide dose of the at least two, three, four or each of the N. meningitidis saccharide conjugates.
• the saccharide dose of each of the at least two, three, four or each of the N. meningitidis saccharide 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 adjusted to or 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
• 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.
• 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.
• doses of bacterial saccharides are 10-20 ⁇ g, 5-1 O ⁇ g, 2.5-5 ⁇ g or 1-2.5 ⁇ g of saccharide in the conjugate.
• 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 (12-21 , 14-20 or 15-19 years) or an adult.
• These 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), whilst bacterial proteins may be administered IM (intramuscular) or IN (intranasal). If 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
• kits 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, 11 A, 12F 1 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F].
• an immunogenic composition of the invention as described above (for instance those comprising Men or HibMen saccharide conjugate combinations).
• an immunogenic composition of the invention for instance those comprising Men or HibMen saccharide conjugate combinations.
• 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 saccharides are derived from at least four serotypes of pneumococcus chosen from the group consisting of 1 , 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 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, 19F, and 23F.
• more than 7 serotypes are included in the composition, for instance at least 10, 11 , 12, 13 or 14 serotypes.
• the composition in one embodiment includes 10 or 11 capsular saccharides derived from serotypes 1 , 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F, and optionally 3 (all optionally conjugated).
• At least 13 saccharide antigens are included, although further saccharide antigens, for example 23 valent (such as serotypes 1 , 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F), are also contemplated by the invention.
• 23 valent such as serotypes 1 , 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 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
• one or more conjugates of a carrier protein and a capsular saccharide from Streptococcus pneumoniae [where the capsular saccharide is optionably from a pneumococcal serotype selected from the group consisting of 1 , 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11 A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F].
• an immunogenic composition of the invention as described above (for instance those comprising Men or HibMen saccharide conjugate combinations).
• a further aspect of the invention is a process for making the immunogenic composition or vaccine of the invention, comprising the step of mixing the saccharides of the invention, for instance mixing N. meningitidis capsular saccharides from at least one, two, three or all four of serogroups A, C, W and Y conjugated to a carrier protein with a pharmaceutically acceptable excipient.
• a further aspect of the invention is a method of immunising a human host against disease caused by bacteria, for example 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, optionally using a single dose.
• An independent aspect of the invention is a method of immunising a human host with an immunogenic composition
• an immunogenic composition comprising at least 2 different N. meningitidis capsular saccharide conjugates selected from the group consisting of serogroup A, C, W and Y (optionally MenA, C, W and Y) wherein a single dose administration (optionally to teenagers, aldults or children) results in a blood test taken one month after administration giving over 50%, 60%, 70%, 80%, 90% or 95% responders in an SBA assay measuring levels of response against MenA, MenC, MenW and/or MenY.
• the SBA assay is as described in Example 9 with responder assessed as described in Example 9.
• a further independent aspect of the invention is an immunogenic composition
• MenA , MenC, MenW and/or MenY conjugates which is capable of eliciting an immune response after a single dose such that over 50%, 60%, 70%, 80%, 90% or 95% of human subjects (children, teenagers or adults) inoculated are classified as responders in an SBA assay on blood extracted a month after inoculation (optionally using the criteria described in example 9).
• Such an immunogenic composition optionally has the further structural characteristics described herein.
• a further aspect of the invention is an immunogenic composition of the invention for use in the treatment or prevention of disease caused by bacteria, for example 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 bacteria for example N. meningitidis and optionally Haemophilus influenzae infection.
• Hib PRP polysaccharide The covalent binding of Haemophilus influenzae (Hib) PRP polysaccharide to TT was carried out by a coupling chemistry developed by Chu et al (Infection and Immunity 1983, 40 (1); 245-256).
• 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 dihydrazide (ADH) was added and incubation continued for a further 90 minutes.
• ADH adipic acid dihydrazide
• the activated PRP was coupled to purifed 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) or were slightly microfluidised. 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
• 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.
• MenC -TT conjugates were produced using native polysaccharides (of over 15OkDa as measured by MALLS) or were slightly microfluidised. 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. Sizing was by microfluidisation using a homogenizer Emulsiflex C-50 apparatus. The polysaccharides were then filtered through a 0.2 ⁇ m filter.
• MenA capsular polysaccharide to tetanus toxoid via a spacer
• 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.
• the PSAAH solution was concentrated to a quarter of its initial volume and then diafiltered with 30 volumes of 0.2M NaCI using a Filtron Omega membrane with a cut-off of 1OkDa, and the retentate was filtered.
• the purified TT solution and the PSAAH solution were diluted to reach a concentration of 10 mg/ml for PSAAH and 10mg/ml for TT.
• EDAC 1-ethyl-3-(3-dimethyl-aminopropyl) carbodiimide
• 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 PSAAH.
• the resulting solution was left 60 min at +25°C under stirring to obtain a final coupling time of 120 min.
• the solution was neutralised by addition of 1 M Tris-Hcl pH 7.5 (1/10 of the final volume) and left 30 minutes at +25°C then overnight at +2°C to +8°C.
• the conjugate was clarified using a 10 ⁇ m filter and was purified using a Sephacryl S400HR column (Pharmacia, Sweden). The column was equilibrated in 10 mM Tris-HCI (pH 7.0), 0.075 M NaCI and the conjugate (approx. 66OmL) was loaded on the column (+2°C to +8 0 C). The elution pool was selected as a function of optical density at 280 nm. Collection started when absorbance increased to 0.05. Harvest continued until the Kd reached 0.30. The conjugate was filter sterilised at +20 0 C, then stored at +2°C to +8°C.
• the resultant conjugate had a polysaccharide: protein ratio of 1 :2-1 :4 (w/w).
• MenC capsular polysaccharide to tetanus toxoid via a spacer
• 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 20mg/ml solution of MenC (pH6.0) (3.5 g) was treated with a freshly prepared 100mg/ml solution of CDAP in acetonitrile/water (50/50 (v/v)) to obtain a CDAP/MenC ratio of 1.5 (w/w).
• the pH was raised to pH 10.0.
• pH 5M NaCI was added to achieve a final concentration of 2M NaCI.
• ADH was added to obtain an ADH/MenC ratio of 8.9.
• the pH of the solution was decreased to 8.75 and the reaction proceeded for 2 hours (retained at 25 0 C).
• the PSCAH solution was concentrated to a minimum of 150 ml. and then diafiltered with 30 volumes of 0.2M NaCI using a Filtron Omega membrane with a cut-off of 1OkDa, and the retentate was filtered. Prior to the conjugation reaction, the purified TT solution and the PSCAH solution (2g scale) were diluted in 0.2M NaCI to reach a concentration of 15 mg/ml for PSCAH and 20mg/ml for TT.
• the purified tetanus toxoid was added to the PSCAH solution in order to reach 2 mg TT/mg PSCAH.
• the pH was adjusted to 5.0.
• EDAC (16.7 mg/ml in Tris 0.1 M pH 7.5) was added with a peristaltic pump (in 10 minutes) to reach a final ratio of 0.5 mg EDAC/mg PSCAH.
• the resulting solution was left 110 min at +25°C under stirring and pH regulation to obtain a final coupling time of 120 min.
• the solution was then neutralized by addition of 1 M Tris-Hcl pH 9.0 (1/10 of final volume) and left 30 minutes at +25°C then overnight at +2°C to +8°C.
• the conjugate was clarified using a 10 ⁇ m filter and was purified using a Sephacryl S400HR column (Pharmacia, Sweden). The column was equilibrated in 10 mM Tris-HCI (pH 7.0), 0.075 M NaCI and the conjugate (approx. 46OmL) was loaded on the column (+2°C to +8°C). The elution pool was selected as a function of optical density at 280 nm. Collection started when absorbance increased to 0.05. Harvest continued until the Kd reached 0.20. The conjugate was filter sterilised at +20 0 C, then stored at +2°C to +8°C. The resultant conjugate had a polysaccharide:protein ratio of 1 :2-1 :4 (w/w).
• 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).
• Group K MenC (10 ⁇ g), non-adsorbed (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 MenCO C C OD C conjugate vaccine) N: number of subjects with available results
• Group K subjects primed with MenC10-TT + InfanrixTM hexa
• Group L subjects primed with Hib10-MenC10-TT + InfanrixTM penta
• Group M subjects primed with Hib5-MenC5- TT + InfanrixTM penta
• Group N subjects primed with MeningitecTM + InfanrixTM hexa
• N number of subjects with available results
• Tritanrix is a DTPw vaccine marketted 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 Hiberix. intramuscularly in the right thigh at 6, 10 and 14 weeks of age. Another group received Tritanrix.-HepB/Hiberix. 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 Tritanrix.-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
• 5EL.U/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).
• 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.
• the overall incidences of local and general solicited symptoms were computed by group according to the type of symptom, their intensity and relationship to vaccination (as percentages of subjects reporting general, local, and any solicited symptoms within the 8 days following vaccination and their exact 95% Cl). Incidences of unsolicited symptoms were computed per group. For Grade 3 symptoms, onset ⁇ 48 hours, medical attention, duration, relationship to vaccination and outcomes were provided. Serious Adverse Events were fully described.
• Hib-MenC Hib-Men (5/5)+ InfanrixTM hexa
• 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 Men ACWY-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 (MeningitecTM) 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,
• 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 1 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 IU/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.
• 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.
• Example 8 Clinical trial assessing the effect of a linker in MenA in a MenACWY conjugate vaccine
• the blood samples were used to asess the percentage of SBA-MenA, SBA-MenC, SBA- MenW135 and SBA-MenY responders one month after the vaccine dose.
• a vaccine response was defined as 1 ) for initially seronegative subjects - a post-vaccination antibody titre > 1/32 at 1 month or 2) for initially seropositive subjects - antibody titre of > 4 fold the pre-vaccination antibody titre.
• Example 9 Clinical trial assessing the effect of a linker in MenA and MenC conjugates in a MenACWY conjugate vaccine
• the blood samples were used to asess the percentage of SBA-MenA, SBA-MenC, SBA- MenW135 and SBA-MenY responders one month after the vaccine dose.
• a vaccine response was defined as 1) for initially seronegative subjects - a post-vaccination antibody titre > 1/32 at 1 month or 2) for initially seropositive subjects - antibody titre of > 4 fold the pre-vaccination antibody titre.

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