Low-Temperature-Adapted Influenza A2/AA/6/60 Virus Vaccine in Man

Influenza A in Bovine Species: A Narrative Literature Review

It is quite intriguing that bovines were largely unaffected by influenza A, even though most of the domesticated and wild animals/birds at the human-animal interface succumbed to infection over the past few decades. Influenza A occurs on a very infrequent basis in bovine species and hence bovines were not considered to be susceptible hosts for influenza until the emergence of influenza D. This review describes a multifaceted chronological review of literature on influenza in cattle which comprises mainly of the natural infections/outbreaks, experimental studies, and pathological and seroepidemiological aspects of influenza A that have occurred in the past. The review also sheds light on the bovine models used in vitro and in vivo for influenza-related studies over recent years. Despite a few natural cases in the mid-twentieth century and seroprevalence of human, swine, and avian influenza viruses in bovines, the evolution and host adaptation of influenza A virus (IAV) in this species suffered a serious hindrance until the novel influenza D virus (IDV) emerged recently in cattle across the world. Supposedly, certain bovine host factors, particularly some serum components and secretory proteins, were reported to have anti-influenza properties, which could be an attributing factor for the resilient nature of bovines to IAV. Further studies are needed to identify the host-specific factors contributing to the differential pathogenetic mechanisms and disease progression of IAV in bovines compared to other susceptible mammalian hosts.

An open-label phase I trial of a live attenuated H2N2 influenza virus vaccine in healthy adults

Please cite this paper as: Talaat et al. (2012) An open‐label phase I trial of a live attenuated H2N2 influenza virus vaccine in healthy adults. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00350.x.

Background  Live attenuated influenza vaccines (LAIV) against a variety of strains of pandemic potential are being developed and tested. We describe the results of an open‐label phase I trial of a live attenuated H2N2 virus vaccine.

Objectives  To evaluate the safety, infectivity, and immunogenicity of a live attenuated H2N2 influenza virus vaccine.

Participants/methods  The A/Ann Arbor/6/60 (H2N2) virus used in this study is the attenuated, cold‐adapted, temperature‐sensitive strain that provides the genetic backbone of seasonal LAIV (MedImmune). We evaluated the safety, infectivity, and immunogenicity of two doses of 10⁷ TCID₅₀ of this vaccine administered by nasal spray 4 weeks apart to normal healthy seronegative adults.

Results  Twenty‐one participants received a first dose of the vaccine; 18 participants received a second dose. No serious adverse events occurred during the trial. The most common adverse events after vaccination were headache and musculoskeletal pain. The vaccine was restricted in replication: 24% and 17% had virus detectable by culture or rRT‐PCR after the first and second dose, respectively. Antibody responses to the vaccine were also restricted: 24% of participants developed an antibody response as measured by either hemagglutination‐inhibition assay (10%), or ELISA for H2 HA‐specific serum IgG (24%) or IgA (16%) after either one or two doses. None of the participants had a neutralizing antibody response. Vaccine‐specific IgG‐secreting cells as measured by enzyme‐linked immunospot increased from a mean of 0·5 to 2·0/10⁶ peripheral blood mononuclear cells (PBMCs); vaccine‐specific IgA‐secreting cells increased from 0·1 to 0·5/10⁶ PBMCs.

Conclusions  The live attenuated H2N2 1960 AA ca vaccine demonstrated a safety profile consistent with seasonal trivalent LAIV but was restricted in replication and minimally immunogenic in healthy seronegative adults.

Safety, immunogencity, and efficacy of a cold-adapted A/Ann Arbor/6/60 (H2N2) vaccine in mice and ferrets

We studied the attenuation, immunogenicity and efficacy of the cold-adapted A/Ann Arbor/6/60 (AA ca) (H2N2) virus in mice and ferrets to evaluate its use in the event of an H2 influenza pandemic. The AA ca virus was restricted in replication in the respiratory tract of mice and ferrets. In mice, 2 doses of vaccine elicited a >4-fold rise in hemagglutination-inhibition (HAI) titer and resulted in complete inhibition of viral replication following lethal homologous wild-type virus challenge. In ferrets, a single dose of the vaccine elicited a >4-fold rise in HAI titer and conferred complete protection against homologous wild-type virus challenge in the upper respiratory tract. In both mice and ferrets, the AA ca virus provided significant protection from challenge with heterologous H2 virus challenge in the respiratory tract. The AA ca vaccine is safe, immunogenic, and efficacious against homologous and heterologous challenge in mice and ferrets, supporting the evaluation of this vaccine in clinical trials.

Development and characterization of cold-adapted viruses for use as live virus vaccines

Representative viruses from twelve RNA and two DNA virus genera have been successfully adapted to growth at sub-optimal temperature (cold-adapted). In almost every case, there was a correlation between acquisition of the cold-adaptation phenotype and loss of virulence in the normal host whether animal or man. Overall, the best method of cold adaptation to develop a live virus vaccine line appeared to be a stepwise lowering of the growth temperature allowing time for multiple lesions to occur and/or be selected. In addition, the starting virus should be a recent isolate not as yet adapted to a tissue culture host and the cold-adaptation process should then occur in a host heterologous to the virus' normal host. These viruses have been reviewed in the light of their cold-adaptation method and successful production of an attenuated line as virus vaccine candidate. Finally, detailed information is presented for the cold-adaptation process in influenza virus.

Characterization and clinical evaluation of live influenza A vaccine prepared from a recombinant of the A/USSR/92/77 (H1N1) and the cold-adapted A/Ann Arbor/6/60 (H2N2) strains

Live influenza vaccine was prepared after genetic recombination of the A/USSR/92/77 (H1N1) strain with the cold-adapted A/Ann Arbor/6/60 (H2N2) strain. The recombinant contains the genes coding for the HA and NA proteins from the A/USSR/92/77 (H1N1) strain and the genes coding for the P1, P2, P3, NP, M and NS proteins from the A/Ann Arbor/6/60 (H2N2) strain. To assess the properties of this vaccine, it was administered under double-blind conditions to 14 healthy volunteers, while another 14 healthy volunteers received placebo. The vaccine virus appeared to be sufficiently attenuated. No febrile reactions were observed. The vaccinees showed an increase in mean serum haemagglutination-inhibiting antibody level from 19 to 73 after two vaccinations. From nasal swabs and antibody responses, it was concluded that the vaccine virus showed no transmission to the placebo group under conditions of close contact. Also, the vaccine virus was found to be genetically stable. It is concluded that this live influenza virus vaccine meets the requirements for safe use in humans. However, several problems still exist which may impede a general use of life influenza vaccines.

Evaluation of influenza A/Hong Kong/123/77 (H1N1) ts-1A2 and cold-adapted recombinant viruses in seronegative adult volunteers

Two attenuated influenza A donor viruses, the A/Udorn/72 ts-1A2 and the A/Ann Arbor/6/60 cold-adapted (ca) viruses, are being evaluated for their ability to reproducibly attenuate each new variant of influenza A virus to a specific and desired level by the transfer of one or more attenuating genes. Each of these donor viruses has been able to attenuate influenza A viruses belonging to the H3N2 subtype by the transfer of one or more attenuating genes. To determine whether these two donor viruses could attenuate a wild-type virus that belonged to a different influenza A subtype, ts-1A2 and ca recombinants of a wild-type virus representative of the A/USSR/77 (H1N1) Russian influenza strain were prepared and evaluated in adult doubly seronegative volunteers at several doses. The recombinants derived from both donor viruses were attenuated for the doubly seronegative adults. Less than 5% of infected vaccinees developed a febrile or systemic reaction, whereas five of six recipients of wild-type virus developed such a response. The 50% human infectious dose (HID(50)) for each recombinant was approximately 10(5.0) 50% tissue culture infective doses. The virus shed by the ts-1A2 and ca vaccinees retained the ts or ca phenotype, or both. This occurred despite replication of the recombinant viruses for up to 9 days. No evidence for transmission of the ca or ts-1A2 recombinant virus to controls was observed. A serum hemagglutination inhibition response was detected in less than 50% of the infected vaccinees. However, with the more sensitive enzyme-linked immunosorbent assay, a serological response was detected in 100% of the ca vaccinees given 300 HID(50) and approximately 70% of ca or ts vaccinees who received 10 to 32 HID(50) of virus. These results indicate that the recombinants derived from both donor viruses were satisfactorily attenuated and were stable genetically after replication in doubly seronegative adults although they induced a lower serum hemagglutination inhibition response than that found previously for H3N2 ts and ca recombinants.

Humoral and cellular immune responses of seronegative children vaccinated with a cold-adapted influenza A/HK/123/77 (H1N1) recombinant virus

Humoral and cell-mediated immune responses of young, seronegative children were assessed after intranasal vaccination with a cold-adapted influenza. A/HK/77 (H1N1) CR 35 recombinant virus. Vaccines shedding influenza virus experienced a rise in hemagglutinin-inhibition antibody 15 to 30 days after vaccination. Vaccinees showed low but significant lymphocyte transformation to A/USSR (H1N1) by day 8 after vaccination, which decreased to prevaccination levels at 30 to 34 days. The lymphocyte transformation response occurred before serum antibody rises were detected by hemagglutinin-inhibition assay. No change in lymphocyte responsiveness was observed after vaccination as measured by phytohemagglutinin stimulation. Lymphocytes responded to in vitro incubation with inactivated influenza (H1N1) virus by producing interferon. The interferon produced was of type I and was observed in vaccinees and nonvaccinees both before and after vaccination.

Studies in man with cold-recombinant influenza virus (H1N1) live vaccines

Two cold-recombinant influenza A (H1N1) viruses were tested in several groups of human volunteers. Only minor clinical symptoms were seen and no febrile reactions occurred. With serologically primed individuals virus shedding was low, but a high proportion showed rises in serum antibody levels after vaccination and mean titres were high. With serologically unprimed volunteers shedding was high, about 75% yielding viruses but only at low titres and for a short duration. No revertant viruses were found and there was no evidence of transmission to potentially susceptible individuals housed in close contact to the vaccinees. Serum antibody responses with unprimed volunteers were, however, low. Only about one half showed increases in serum antibody titres after vaccination and mean titres were low. Nevertheless, challenge with live attenuated virus indicated a high degree of protection based on virological evidence of infection.

Cold-adapted variants of influenza A virus: evaluation in adult seronegative volunteers of A/Scotland/840/74 and A/Victoria/3/75 cold-adapted recombinants derived from the cold-adapted A/Ann Arbor/6/60 strain

Influenza A/Scotland/74 (H3N2) and A/Victoria/75 (H3N2) cold-adapted (ca) recombinant viruses, prepared by mating the A/Ann Arbor/6/60 (H2N2) ca donor virus and influenza A wild-type virus, were evaluated in adult seronegative volunteers (serum hemagglutination-inhibiting antibody titer, </=1:8) for level of attenuation, antigenicity, and genetic stability of the temperature-sensitive and ca phenotypes. At 10(7.0) to 10(7.5) 50% tissue culture infective doses the A/Scotland/74 and A/Victoria/75 ca recombinant viruses were clearly attenuated and antigenic. However, one of eight vaccinees infected with 10(7.5) 50% tissue culture infective doses of the A/Scotland/74 ca recombinant had a febrile reaction (39 degrees C). At a 10-fold higher dose (10(8.5) 50% tissue culture infective doses), 4 of 12 A/Scotland/74 vaccinees had a febrile and/or systemic reaction. Febrile reactions were not observed in volunteers who received the A/Victoria/75 ca recombinant virus, whereas 3 of the 12 vaccinees had mild upper respiratory tract symptoms, in one instance associated with mild systemic manifestations. Significantly, the serum hemagglutination- and neuraminidase-inhibiting antibody responses were comparable to those induced by wild-type virus. Both ca recombinant viruses were shed in low titer for a short period of time. Each isolate retained the temperature-sensitive phenotype. However, there was evidence of genetic instability of the ca marker in that 7 of 24 isolates exhibited some loss of the ca property, and one isolate completely lost the capacity to produce plaques at 25 degrees C. The retention of a low level of residual reactogenicity in the A/Scotland/74 ca recombinant suggests that acquisition of the ca and temperature-sensitive phenotypes by a ca recombinant virus may not always bring about a satisfactory level of attenuation for individuals lacking hemagglutinin immunity.

Influenza virus infection in newborn rats: a possible marker of attenuation for man

The growth of parent influenza viruses A/England/939/69 and A/PR/8/34, and clones 6, 7, and 64C, derived by recombination, was studied in newborn rats. Using an inoculum of 10(4.0) EID50, influenza virus A/England/939/69 produced the highest titres of virus in rat turbinates at 48 hours after inoculation; clones 6 and 7 and A/PR/8/34 grew to lower titres; and clone 64C grew to the lowest titre. These differences were less apparent when 10(2.0) EID50 of virus was used as an inoculum, and rats were not infected by smaller inoculum of any of the virus strains. Infection with 10(4.0) EID50 of all viruses produced lung infection; at 48 hours after infection, the highest titres were recovered from rats infected with A/PR/8/34 and A/England/939/69 virus. Prior infection with A/England/939/69 or A/PR/8/34 increased the incidence of bacteraemia and meningitis following intranasal inoculation of Haemophilus influenzae type b; infection with clone 64C did not enhance bacterial meningitis, while infection with clone 6 gave an intermediate result. Volunteer studies with these viruses have shown that influenza virus A/England/939/69 was virulent, clones 6 and 7 were attenuated, clone 64C was over-attenuated, and A/PR/8/34 virus was noninfective for man. The relative titres of virus recovered from turbinates taken 48 hours after infection with 10(4.0) EID50 of virus and the ability of virus infection to enhance bacterial infection correlated with the property of virus attenuation for man for four of the five strains tested; however, no correlation was seen for A/PR/8/34 virus, which is a result also found in other laboratory tests designed to measure virulence for man.

Chemically-induced temperature sensitive mutants of dengue virus type 2. I. Isolation and partial characterization

Temperature sensitive (ts) mutants of dengue virus type 2 (DEN-2, TH-36 isolate) were induced by replication in primary hamster kidney cells treated with 5-azacytidine. Seven ts mutants were obtained from 138 clones isolated by an immunofluorescent cloning technique. Of these 7 ts mutants, 5 were sufficiently stable to permit partial characterization. Complementation was detected at very low but statistically significant levels between some ts mutants at 40 degrees C. Viral double-stranded RNA production was evaluated in LLC-MK2 cells at 30 degrees and 40 degrees C by micro-quantitative complement fixation. The results of complementation tests and RNA production tests indicated that the 4 of 5 stable ts mutants constitute 3 separate complementation groups (2 RNA+ and 1 RNA-groups), while a fifth ts mutant was RNA- but non-complementable. The data presented here indicate that a genetic system can be developed without employing traditional plaque or cytopathology methods. Further, the 5 DEN-2 ts mutants are believed to represent the only set of complementation-positive flavivirus mutants so far isolated.

Chemically induced temperature-sensitive mutants of dengue virus type 2: comparison of temperature sensitivity in vitro with infectivity suckling mice, hamsters, and rhesus monkeys

A series of temperature-sensitive (ts) mutants of dengue virus type 2 (DEN-2, TH-36 isolate) were induced by treatment with 5-azacytidine. These mutants and parental viruses were compared for the ts trait and/or attenuation in four systems: primary hamster kidney cells, suckling mice, golden Syrian hamsters, and rhesus monkeys. Seven clones judged to possess the ts trait in virto demonstrated a variety of patterns in vivo. On initial isolation, five of seven ts mutants exhibited reduced mouse lethality. The remaining two mutants possessed parental levels of mouse lethality. In hamsters, neither ts mutant nor parental viruses replicated very well, and then only when inoculated intracerebrally. Studies in rhesus monkeys indicated that all seven ts clones and parental viruses were capable of inducing abtibody responses; however, ts-1 and ts-2 failed to produce detectable viremia. After challenge with parental virus, all vaccinated monkeys demonstrated rapid secondary-type antibody response. Reversion from ts to ts(+) was confirmed to ts-1 in mice and ts-3 in monkeys, and was strongly suspected in several other instances.