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Bernard MC, Boudet F, Pineda-Peña AC, Guinet-Morlot F. Inhibitory effect of concomitantly administered rabies immunoglobulins on the immunogenicity of commercial and candidate human rabies vaccines in hamsters. Sci Rep 2022; 12:6570. [PMID: 35449223 PMCID: PMC9023498 DOI: 10.1038/s41598-022-10281-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
The World Health Organization protocol for rabies post-exposure prophylaxis (PEP) recommends extensive wound washing, immediate vaccination, and administration of rabies immunoglobulin (RIG) in severe category III exposures. Some studies have shown that RIG can interfere with rabies vaccine immunogenicity to some extent. We investigated the interference of RIG on a next generation highly purified Vero cell rabies vaccine candidate (PVRV-NG) versus standard-of-care vaccines in a previously described hamster model. The interference of either human (h) or equine (e) RIG on the immune response elicited by PVRV-NG, Verorab® (purified Vero cell rabies vaccine, PVRV), and Imovax® Rabies (human diploid cell rabies vaccine; HDCV) was evaluated using the 4-dose Essen PEP regimen. The anti-rabies seroneutralizing titers and specific serum IgM titers were measured by fluorescent antibody virus neutralization test and enzyme-linked immunosorbent assay, respectively, for the vaccines administered with or without RIG. The RIG interference on PVRV-NG, observed transiently at Day 7, was similar to that on PVRV and tended to be lower than that on HDCV using both read-outs. In summary, the results generated in the hamster model showed that RIG induced similar or less interference on PVRV-NG than the standard-of-care vaccines.
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Affiliation(s)
- Marie-Clotilde Bernard
- Research & Development, Sanofi, Campus Mérieux, 1541 Avenue Marcel Mérieux, 69280, Marcy L'Etoile, France.
| | - Florence Boudet
- Research & Development, Sanofi, Campus Mérieux, 1541 Avenue Marcel Mérieux, 69280, Marcy L'Etoile, France
| | | | - Françoise Guinet-Morlot
- Research & Development, Sanofi, Campus Mérieux, 1541 Avenue Marcel Mérieux, 69280, Marcy L'Etoile, France
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Sharma D, Kamthania M. A new emerging pandemic of severe fever with thrombocytopenia syndrome (SFTS). Virusdisease 2021; 32:220-227. [PMID: 33942022 PMCID: PMC8082055 DOI: 10.1007/s13337-021-00656-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
The aim of this study is to make aware every one of the deadliest diseases named severe fever with thrombocytopenia syndrome (SFTS). It has become the worldwide pandemic in recent few years. It is a kind of haemorrhagic fever, caused by SFTS virus (SFTSV), a novel phlebovirus of family Bunyaviridae. This syndrome is also a tick-borne zoonosis that means the virus transmitted from tick bite (having virus) into human body, i.e. infection spread from animals to humans and also transmitted from human to human. Epidemiological data of SFTS was collected to know the nature/symptoms of SFTSV. First case of this disease has been reported in China, followed by Japan, South korea, Taiwan, USA and many other countries. Vertebrates are the host of this disease and tick functions as a vector, where the virus can undergo brisk changes using gene mutation, homologous recombination and reassortments. The major symptoms of hemorrhagic fever are fever, thrombocytopenia, leucopenia and gastrointestinal abnormalities. Sometimes in very severe cases, full body organ failure may also take place and average death rate in humans is nearly 10 %. Old aged peoples are more prone to SFTSV infection. Apart from the fact of increasing SFTSV related health problems to humans, the pathogenesis of SFTS virus in human is not entirely understood and no treatment to this virus is still available. The simplest way to protect our self from this infection is to refrain from tick bite. Therefore, this disease has evolved to produce serious health issues to humans in various countries of world including china. This review discussing about causative agent, epidemiology, pathogenesis, diagnosis and treatment of SFTS. In order to control the spread of SFTSV, we have to stop the viral transmission or to protect the easily vulnerable population from tick bites, avoiding direct contact of infectious and also to use personal protective devices for SFTS patients. So, the weather conditions, mode of transmission and creation of new therapeutics like vaccines and drugs are the main areas of forthcoming research.
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Affiliation(s)
- Divya Sharma
- Department of Life Sciences, IAMR College, Ghaziabad, Uttar Pradesh India
| | - Mohit Kamthania
- Department of Life Sciences, IAMR College, Ghaziabad, Uttar Pradesh India
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Kansagra K, Parmar D, Mendiratta SK, Patel J, Joshi S, Sharma N, Parihar A, Bhoge S, Patel H, Kalita P, Munshi R, Kurmi P, Shah R, Gupta A, Bhalla H, Bekkalele H, Verma R, Agarwal D, Sharma S, Gawande A, Chhaya G. A Phase 3, Randomised, Open-Label, Non-inferiority Trial Evaluating Anti-Rabies Monoclonal Antibody Cocktail (TwinrabTM) Against Human Rabies Immunoglobulin (HRIG). Clin Infect Dis 2020; 73:e2722-e2728. [PMID: 32556113 DOI: 10.1093/cid/ciaa779] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limited supply, cost and potential for severe adverse effects observed with the blood derived rabies immunoglobulin products has led to search for alternative therapies. This issue has been addressed by developing an antirabies monoclonal antibody cocktail. METHODS This is a phase 3, randomized, open-label, noninferiority trial conducted in patients with WHO category III exposure with suspected rabid animal. Eligible patients were assigned to either the test arm, TwinrabTM (docaravimab and miromavimab) or the reference arm, Human rabies immunoglobulin (HRIG; Imogam® Rabies-HT), in a ratio of 1:1. The primary endpoint was the comparison of responder rates between the two arms assessed as percentage of those with rabies virus neutralizing antibodies titers ≥ 0.5 IU/mL on day 14. RESULTS A total of 308 patients were equally randomized into the two arms. In the per-protocol (PP) population, there were 90.21% responders in the TwinrabTM arm and, 94.37% in the HRIG arm. The Geometric Mean of RFFIT titres in the PP on day 14 were 4.38 and 4.85 IU/mL, for the TwinrabTM and HRIG arms, respectively. There were no deaths or serious adverse events reported. CONCLUSIONS This study confirmed that TwinrabTM is non-inferior to HRIG in terms of providing an unbroken window of protection up to day 84. This trial in healthy adults with WHO category III exposure from suspected rabid animal also establishes the safety of TwinrabTM in patients with one WHO approved vaccine regimen (Essen). TRIALS REGISTRATION CTRI/2017/07/009038.
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Affiliation(s)
| | | | | | - Jatin Patel
- Clinical R & D, Cadila Healthcare Limited, India
| | - Shuchi Joshi
- Clinical R & D, Cadila Healthcare Limited, India
| | - Nitin Sharma
- Clinical R & D, Cadila Healthcare Limited, India
| | | | | | - Harilal Patel
- Drug metabolism and pharmacokinetic, Cadila Healthcare Limited, India
| | | | - Renuka Munshi
- TN Medical College and BYL Nair Charitable Hospital, Mumbai
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Gogtay NJ, Munshi R, Ashwath Narayana DH, Mahendra BJ, Kshirsagar V, Gunale B, Moore S, Cheslock P, Thaker S, Deshpande S, Karande S, Kumbhar D, Ravish HS, Harish BR, Pisal SS, Dhere R, Parulekar V, Blackwelder WC, Molrine DC, Kulkarni PS. Comparison of a Novel Human Rabies Monoclonal Antibody to Human Rabies Immunoglobulin for Postexposure Prophylaxis: A Phase 2/3, Randomized, Single-Blind, Noninferiority, Controlled Study. Clin Infect Dis 2019; 66:387-395. [PMID: 29020321 DOI: 10.1093/cid/cix791] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Lack of access to rabies immunoglobulin (RIG) contributes to high rabies mortality. A recombinant human monoclonal antibody (SII RMAb) was tested in a postexposure prophylaxis (PEP) regimen in comparison with a human RIG (HRIG)-containing PEP regimen. Methods This was a phase 2/3, randomized, single-blind, noninferiority study conducted in 200 participants with World Health Organization category III suspected rabies exposures. Participants received either SII RMAb or HRIG (1:1 ratio) in wounds and, if required, intramuscularly on day 0, along with 5 doses of rabies vaccine intramuscualarly on days 0, 3, 7, 14 and 28. The primary endpoint was the ratio of the day 14 geometric mean concentration (GMC) of rabies virus neutralizing activity (RVNA) as measured by rapid fluorescent focus inhibition test for SII RMAb recipients relative to HRIG recipients. Results One hundred ninety-nine participants received SII RMAb (n = 101) or HRIG (n = 98) and at least 1 dose of vaccine. The day 14 GMC ratio of RVNA for the SII RMAb group relative to the HRIG group was 4.23 (96.9018% confidence interval [CI], 2.59-6.94) with a GMC of of 24.90 IU/mL (95% CI, 18.94-32.74) for SII RMAb recipients and 5.88 IU/mL (95% CI, 4.11-8.41) for HRIG recipients. The majority of local injection site and systemic adverse reactions reported from both groups were mild to moderate in severity. Conclusions A PEP regimen containing SII RMAb was safe and demonstrated noninferiority to HRIG PEP in RVNA production. The novel monoclonal potentially offers a safe and potent alternative for the passive component of PEP and could significantly improve the management of bites from suspected rabid animals. Clincical Trials Registration CTRI/2012/05/002709.
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Affiliation(s)
- Nithya J Gogtay
- Department of Clinical Pharmacology, KEM Hospital and Seth G. S. Medical College, Mumbai, Maharashtra
| | - Renuka Munshi
- Department of Clinical Pharmacology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - D H Ashwath Narayana
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bengaluru
| | - B J Mahendra
- Department of Community Medicine, Mandya Institute of Medical Sciences, Karnataka
| | - Vikas Kshirsagar
- Department of Preventive and Social Medicine (Community Medicine), B. J. Government Medical College and Sassoon General Hospitals
| | - Bhagwat Gunale
- Serum Institute of India Pvt Ltd, Pune, Maharashtra, India
| | - Susan Moore
- Rabies Laboratory, Kansas State University, Manhattan
| | - Peter Cheslock
- MassBiologics, University of Massachusetts Medical School, Boston
| | - Saket Thaker
- Department of Clinical Pharmacology, KEM Hospital and Seth G. S. Medical College, Mumbai, Maharashtra
| | - Siddharth Deshpande
- Department of Clinical Pharmacology, KEM Hospital and Seth G. S. Medical College, Mumbai, Maharashtra
| | - Sunil Karande
- Department of Pediatrics, KEM Hospital and Seth G. S. Medical College
| | - Dipti Kumbhar
- Department of Clinical Pharmacology, BYL Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra
| | - H S Ravish
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bengaluru
| | - B R Harish
- Department of Community Medicine, Mandya Institute of Medical Sciences, Karnataka
| | | | - Rajeev Dhere
- Serum Institute of India Pvt Ltd, Pune, Maharashtra, India
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Sparrow E, Torvaldsen S, Newall AT, Wood JG, Sheikh M, Kieny MP, Abela-Ridder B. Recent advances in the development of monoclonal antibodies for rabies post exposure prophylaxis: A review of the current status of the clinical development pipeline. Vaccine 2018; 37 Suppl 1:A132-A139. [PMID: 30503659 DOI: 10.1016/j.vaccine.2018.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/27/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
Abstract
Despite successful control in many parts of the world, rabies virus continues to result in tens of thousands of deaths each year. Death from rabies can be prevented by timely and appropriate post exposure prophylaxis including wound cleaning and administration of vaccine and rabies immunoglobulin. Currently, rabies immunoglobulin is derived from the blood plasma of horses or humans and has several limitations relating to supply, cost and quality. Monoclonal antibodies produced through recombinant DNA technologies could potentially overcome these limitations. The first anti-rabies monoclonal antibody has recently gained regulatory approval in India and there are several other candidates being evaluated in clinical trials. Given the advances in the field, rabies monoclonal antibodies have been recently considered by the World Health Organization's Strategic Advisory Group of Experts on Immunization and included in updated WHO immunization policy recommendations for rabies published in April 2018. This article reviews the current landscape of the clinical trial development of anti-rabies monoclonal antibodies and the historical clinical trial pathways followed for blood-derived rabies immunoglobulin before discussing challenges in the clinical evaluation, regulatory approval, uptake and monitoring of these products.
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Affiliation(s)
- Erin Sparrow
- The World Health Organization, Geneva, Switzerland; School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia.
| | - Siranda Torvaldsen
- School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia; Clinical and Population Perinatal Health Research, The University of Sydney Northern Clinical School, NSW, Australia
| | - Anthony T Newall
- School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - James G Wood
- School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Mohamud Sheikh
- School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Marie Paule Kieny
- Institut national de la santé et de la recherche médicale, Paris, France
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Hanna K, Cruz MC, Mondou E, Corsi E, Vandeberg P. Safety and neutralizing rabies antibody in healthy subjects given a single dose of rabies immune globulin caprylate/chromatography purified. Clin Pharmacol 2018; 10:79-88. [PMID: 29983597 PMCID: PMC6027702 DOI: 10.2147/cpaa.s166454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Rabies immune globulin (RIG) and vaccination series are necessary for postexposure prophylaxis. A new formulation of RIG (human) purified by caprylate/chromatography (RIG-C) was evaluated. Trial registration ClinicalTrials.gov identifier: NCT02139657. Materials and methods This open-label, single-arm study in healthy subjects evaluated neutralizing rabies antibody concentrations produced from a single 20 IU/kg intramuscular (IM) dose of RIG-C as measured by rapid fluorescent focus inhibition test (50% neutralization endpoint) 1-hour postdose and on days 1, 2, 4, 6, 8, 10, 14, 18, and 21. Results Twelve subjects were enrolled into the study. No discontinuations, serious adverse events (AEs), or treatment-emergent clinically significant changes in laboratory parameters were observed. All AEs resolved and were mild except 1 moderate AE of oropharyngeal pain. Injection site pain (4 subjects) was most commonly reported. RIG-C produced a rapid increase in neutralizing rabies antibody: mean value 0.113 IU/mL at 24 hours after IM injection, peak on day 4 (0.132 IU/mL), persisting through day 21 (0.116 IU/mL). The mean reciprocal titer was 11.5 by day 2; the peak value of 12.1 was achieved on day 4; and a mean value ≥10.6 was maintained through day 21. Conclusion RIG-C was well tolerated and provided neutralizing rabies antibodies, which combined with vaccine series after rabies exposure, should result in effective prophylaxis per World Health Organization/Centers for Disease Control and Prevention guidelines.
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Affiliation(s)
- Kim Hanna
- Grifols Bioscience Research Group, Grifols Inc, Research Triangle Park, NC, USA,
| | - Maria Cristina Cruz
- Grifols Bioscience Research Group, Grifols Inc, Research Triangle Park, NC, USA,
| | - Elsa Mondou
- Grifols Bioscience Research Group, Grifols Inc, Research Triangle Park, NC, USA,
| | - Edward Corsi
- Grifols Bioscience Research Group, Grifols Inc, Research Triangle Park, NC, USA,
| | - Peter Vandeberg
- Grifols Bioscience Research Group, Grifols Inc, Research Triangle Park, NC, USA,
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Cates M, Donati M, Gillet S, Ustianowski A, Galloway J. Managing varicella zoster virus contact and infection in patients on anti-rheumatic therapy. Rheumatology (Oxford) 2018; 57:596-605. [PMID: 28575315 DOI: 10.1093/rheumatology/kex189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Indexed: 12/30/2022] Open
Abstract
Chickenpox and shingles can be more severe and occasionally life threatening in immunosuppressed patients. As such, some groups warrant a more detailed history, serological testing and consideration of prophylaxis following contact with the virus. Active disease may also require more aggressive treatment with antivirals. Guidance for the use of varicella zoster immunoglobulin has recently been updated by Public Health England with important implications for rheumatology patients.
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Affiliation(s)
- Matthew Cates
- Department of Rheumatology, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK
| | - Matthew Donati
- Department of Virology, Public Health England, Bristol, UK
| | - Sophie Gillet
- Department of Virology, United Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Andrew Ustianowski
- Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK
| | - James Galloway
- Department of Rheumatology, King's College London, London, UK
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Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis. THE LANCET. INFECTIOUS DISEASES 2014; 14:763-772. [DOI: 10.1016/s1473-3099(14)70718-2] [Citation(s) in RCA: 310] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Human antibody neutralizes severe Fever with thrombocytopenia syndrome virus, an emerging hemorrhagic Fever virus. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:1426-32. [PMID: 23863504 DOI: 10.1128/cvi.00222-13] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Severe fever with thrombocytopenia syndrome virus (SFTSV), a newly discovered member of the Bunyaviridae family, is the causative agent of an emerging hemorrhagic fever, SFTS, in China. Currently, there are no vaccines or effective therapies against SFTS. In this study, a combinatorial human antibody library was constructed from the peripheral lymphocytes of 5 patients who had recovered from SFTS. The library was screened against purified virions for the production of single-chain variable-region fragments (ScFv). Of the 6 positive clones, one clone (monoclonal antibody [MAb] 4-5) showed neutralizing activity against SFTSV infection in Vero cells. MAb 4-5 was found to effectively neutralize all of the clinical isolates of SFTSV tested, which were isolated from patients in China from 2010 to 2012. MAb 4-5 was found to bind a linear epitope in the ectodomain of glycoprotein Gn. Its neutralizing activity is attributed to blockage of the interactions between the Gn protein and the cellular receptor, indicating that inhibition of virus-cell attachment is its main mechanism. These data suggest that MAb 4-5 can be used as a promising candidate molecule for immunotherapy against SFTSV infection.
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Abstract
Rabies is a devastating encephalitis caused by RNA viruses that use mammals as reservoirs. In the United States, most naturally acquired human cases have come from bats. The use of appropriate preexposure and postexposure prophylaxis can be nearly 100% effective. If prophylaxis is not used, or is implemented incorrectly, the patient may develop clinical rabies, which is almost universally fatal. All health care practitioners should be familiar with the appropriate evaluation of patients presenting with a possible rabies exposure and ensure that expeditious and appropriate prophylaxis is provided to help prevent the development of this lethal disease.
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Affiliation(s)
- Kyle A Weant
- North Carolina Public Health Preparedness and Response, North Carolina Department of Health and Human Services, Raleigh, NC 27699-1900, USA.
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Gogtay N, Thatte U, Kshirsagar N, Leav B, Molrine D, Cheslock P, Kapre SV, Kulkarni PS. Safety and pharmacokinetics of a human monoclonal antibody to rabies virus: a randomized, dose-escalation phase 1 study in adults. Vaccine 2012; 30:7315-20. [PMID: 23010601 DOI: 10.1016/j.vaccine.2012.09.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/11/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rabies is an essentially fatal disease that is preventable with the timely administration of post-exposure prophylaxis (PEP). The high cost of PEP, which includes vaccine and hyperimmune globulin, is an impediment to the goal of preventing rabies in the developing world. Recently a recombinant human IgG(1) anti-rabies monoclonal antibody (SII RMab) has been developed in India to replace serum-derived rabies immunoglobulin. The present study was conducted to demonstrate the safety of SII RMab and to determine the dose resulting in neutralizing serum antibody titers comparable to human rabies immunoglobulin (HRIG) when administered in conjunction with rabies vaccine in a simulated PEP regimen. METHODS This randomized, open label, dose-escalation phase 1 study was conducted in healthy adults at a large tertiary care, referral, public hospital in India. Safety was assessed by active surveillance for adverse events along with standard laboratory evaluations and measurement of anti-drug antibodies (ADA). Anti-rabies antibody levels were measured by rapid fluorescent focus inhibition test (RFFIT) and ELISA. The study duration was 365 days. FINDINGS SII RMab was well tolerated with similar frequency of local injection site reactions to HRIG. The geometric mean concentrations of rabies neutralizing antibody in the vaccine plus SII RMab 10 IU/kg cohort were comparable to the vaccine plus HRIG 20 IU/kg cohort throughout the 365-day study period; day 14 geometric mean concentrations 23.4 IU/ml (95% CI 14.3, 38.2) vs. 15.3 IU/ml (95% CI 7.72, 30.3; p=NS), respectively. Future post-exposure prophylaxis studies of SII RMab at a dose of 10 IU/kg in conjunction with vaccine are planned.
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Affiliation(s)
- Nithya Gogtay
- KEM Hospital and Seth GS Medical College, Mumbai, India
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13
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Smith TG, Wu X, Franka R, E. Rupprecht C. Design of future rabies biologics and antiviral drugs. Adv Virus Res 2011; 79:345-63. [PMID: 21601054 DOI: 10.1016/b978-0-12-387040-7.00016-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In recent years, no major paradigm shifts have occurred in the utilization of new products for the prevention and control of rabies. Development of new cost-effective rabies biologics and antiviral drugs is critical in continuing to prevent and reduce disease. Current rabies vaccines are highly effective but have developed largely based on technical improvements in the vaccine industry. In the future, alternative approaches for improved vaccines, including novel avirulent rabies virus (RABV) vectors, should be pursued. Any rabies vaccine that is effective without the need for rabies immune globulin (RIG) will contribute fundamentally to disease prevention by reducing the cost and complexity of postexposure prophylaxis (PEP). The lack of high quality, affordable RIG is a continuing problem. Virus-specific monoclonal antibodies (mAbs) will soon fulfill the PEP requirement for passive immunity, currently met with RIG. Several relevant strategies for mAb production, including use of transgenic mice, humanization of mouse mAbs, and generation of human immune libraries, are underway. As a result of successful PEP and pre-exposure prophylaxis in developed countries, until recently, no significant focused efforts have been devoted to RABV-specific antiviral agents. To date, combination therapy including broad spectrum antiviral agents has been successful in only one case, and reports of antiviral activity are often conflicting. Current antiviral strategies target either the nucleoprotein or phosphoprotein, but drugs targeting the viral polymerase should be considered. Considering the lag from creation of new concepts to experimental development and clinical trials, many years will likely elapse between today's ideas and tomorrow's practices.
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Evidence for a 4-dose vaccine schedule for human rabies post-exposure prophylaxis in previously non-vaccinated individuals. Vaccine 2009; 27:7141-8. [DOI: 10.1016/j.vaccine.2009.09.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 09/03/2009] [Indexed: 11/18/2022]
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Cramer CH, Shieck V, Thomas SE, Kershaw DB, Magee JC, Lopez MJ. Immune response to rabies vaccination in pediatric transplant patients. Pediatr Transplant 2008; 12:874-7. [PMID: 18397211 DOI: 10.1111/j.1399-3046.2008.00936.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children have become engaged in a wider variety of activities as the success of solid organ transplantation has improved. These activities can result in exposure to infectious agents for which there are no data documenting the efficacy of standard treatment in children on immunosuppressive therapy. This is a retrospective review of five OLT patients and three RT patients who were potentially exposed to rabies during camp. They completed the immunoprophylaxis treatment for rabies exposure outlined by the CDC in the 2003 Red Book. Rabies titers were followed for six to 12 months post-immunization. All five OLT patients were on tacrolimus. All three RT patients were on tacrolimus, mycophenolate mofetil, and prednisone. At the time of exposure median age was 10.0 yr (8.4-17.3). None of the subjects developed rabies. A positive rabies titer, indicative of successful immunization, was present by one month in seven subjects and all subjects by six months. Rabies vaccination in pediatric transplant patients is safe and associated with the successful production of antirabies titers.
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Affiliation(s)
- Carl H Cramer
- Pediatric Nephrology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55095, USA.
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Bakker ABH, Python C, Kissling CJ, Pandya P, Marissen WE, Brink MF, Lagerwerf F, Worst S, van Corven E, Kostense S, Hartmann K, Weverling GJ, Uytdehaag F, Herzog C, Briggs DJ, Rupprecht CE, Grimaldi R, Goudsmit J. First administration to humans of a monoclonal antibody cocktail against rabies virus: safety, tolerability, and neutralizing activity. Vaccine 2008; 26:5922-7. [PMID: 18804136 DOI: 10.1016/j.vaccine.2008.08.050] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 07/22/2008] [Accepted: 08/31/2008] [Indexed: 11/25/2022]
Abstract
Immediate passive immune prophylaxis as part of rabies post-exposure prophylaxis (PEP) often cannot be provided due to limited availability of human or equine rabies immunoglobulin (HRIG and ERIG, respectively). We report first clinical data from two phase I studies evaluating a monoclonal antibody cocktail CL184 against rabies. The studies included healthy adult subjects in the USA and India and involved two parts. First, subjects received a single intramuscular dose of CL184 or placebo in a double blind, randomized, dose-escalation trial. Second, open-label CL184 (20IU/kg) was co-administered with rabies vaccine. Safety was the primary objective and rabies virus neutralizing activity (RVNA) was investigated as efficacy parameter. Pain at the CL184 injection site was reported by less than 40% of subjects; no fever or local induration, redness or swelling was observed. RVNA was detectable from day 1 to day 21 after a single dose of CL184 20 or 40IU/kg. All subjects had adequate (>0.5IU/mL) RVNA levels from day 14 onwards when combined with rabies vaccine. CL184 appears promising as an alternative to RIG in PEP.
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Rabies vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Kohl KS, Walop W, Gidudu J, Ball L, Halperin S, Hammer SJ, Heath P, Hennig R, Rothstein E, Schuind A, Varricchio F. Induration at or near injection site: case definition and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2007; 25:5839-57. [PMID: 17553602 DOI: 10.1016/j.vaccine.2007.04.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katrin S Kohl
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abstract
This paper reviews current use and evolving role of polyclonal and monoclonal antibody products for the prevention and treatment of viral diseases. Antibodies continue to be indicated for prophylaxis either prior to an anticipated exposure especially in situations of travel, or more commonly following an exposure. The predominant indication for use of antibody products is to prevent infection. With the availability of vaccines for the prevention of chickenpox, hepatitis A, hepatitis B, measles, rabies and smallpox, the role of passive immunization is reserved for susceptible individuals and those at high risk for complications of infection. Risks of transmission of infections associated with use of human plasma-derived products have been reduced by improvements in donor screening and virus removal and inactivation procedures. An additional safety concern has been addressed by the removal of thimerosal as a preservative. Within the last 5 years, two antibodies have been licensed for a viral indication, RespiGam and Synagis both for prevention of respiratory syncytial virus infection. RespiGam is a human plasma derived antibody and Synagis is a humanized monoclonal antibody, the first such antibody to be licensed for an infectious disease indication. CytoGam for prevention of cytomegalovirus infection in kidney transplant patients has recently been granted an expanded indication to include use in lung, liver, pancreas and heart transplant patients. As the use of therapeutics becomes more sophisticated, researchers may find better ways of using antibody products.
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Affiliation(s)
- L A Sawyer
- Virology Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 6700B Rockledge Drive, MSC-7630, Bethesda, MD 20892-7630, USA.
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