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Boero E, Carducci M, Keeley AJ, Berlanda Scorza F, Iturriza-Gómara M, Moriel DG, Rossi O. A flow cytometry-based assay to determine the ability of anti-Streptococcus pyogenes antibodies to mediate monocytic phagocytosis in human sera. J Immunol Methods 2024; 528:113652. [PMID: 38458312 DOI: 10.1016/j.jim.2024.113652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
Streptococcus pyogenes, commonly referred to as Group A Streptococcus (Strep A), causes a spectrum of diseases, with the potential to progress into life-threatening illnesses and autoimmune complications. The escalating threat of antimicrobial resistance, stemming from the prevalent reliance on antibiotic therapies to manage Strep A infections, underscores the critical need for the development of disease control strategies centred around vaccination. Phagocytes play a critical role in controlling Strep A infections, and phagocytosis-replicating assays are essential for vaccine development. Traditionally, such assays have employed whole-blood killing or opsonophagocytic methods using HL-60 cells as neutrophil surrogates. However, assays mimicking Fcγ receptors- phagocytosis in clinical contexts are lacking. Therefore, here we introduce a flow cytometry-based method employing undifferentiated THP-1 cells as monocytic/macrophage model to swiftly evaluate the ability of human sera to induce phagocytosis of Strep A. We extensively characterize the assay's precision, linearity, and quantification limit, ensuring robustness. By testing human pooled serum, the assay proved to be suitable for the comparison of human sera's phagocytic capability against Strep A. This method offers a valuable complementary assay for clinical studies, addressing the gap in assessing FcγR-mediated phagocytosis. By facilitating efficient evaluation of Strep A -phagocyte interactions, it may contribute to elucidating the mechanisms required for the prevention of infections and inform the development of future vaccines and therapeutic advancements against Strep A infections.
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Affiliation(s)
- Elena Boero
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Alexander J Keeley
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK; Vaccines and Immunity Theme, Medical Research Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, P. O. Box 273, the Gambia
| | | | - Miren Iturriza-Gómara
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Danilo Gomes Moriel
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
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2
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Mancini F, Caradonna V, Alfini R, Aruta MG, Vitali CG, Gasperini G, Piccioli D, Berlanda Scorza F, Rossi O, Micoli F. Testing S. sonnei GMMA with and without Aluminium Salt-Based Adjuvants in Animal Models. Pharmaceutics 2024; 16:568. [PMID: 38675229 PMCID: PMC11054012 DOI: 10.3390/pharmaceutics16040568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Shigellosis is one of the leading causes of diarrheal disease in low- and middle-income countries, particularly in young children, and is more often associated with antimicrobial resistance. Therefore, a preventive vaccine against shigellosis is an urgent medical need. We have proposed Generalised Modules for Membrane Antigens (GMMA) as an innovative delivery system for Shigella sonnei O-antigen, and an Alhydrogel formulation (1790GAHB) has been extensively tested in preclinical and clinical studies. Alhydrogel has been used as an adsorbent agent with the main purpose of reducing potential GMMA systemic reactogenicity. However, the immunogenicity and systemic reactogenicity of this GMMA-based vaccine formulated with or without Alhydrogel have never been compared. In this work, we investigated the potential adjuvant effect of aluminium salt-based adjuvants (Alhydrogel and AS37) on S. sonnei GMMA immunogenicity in mice and rabbits, and we found that S. sonnei GMMA alone resulted to be strongly immunogenic. The addition of neither Alhydrogel nor AS37 improved the magnitude or the functionality of vaccine-elicited antibodies. Interestingly, rabbits injected with either S. sonnei GMMA adsorbed on Alhydrogel or S. sonnei GMMA alone showed a limited and transient body temperature increase, returning to baseline values within 24 h after each vaccination. Overall, immunisation with unadsorbed GMMA did not raise any concern for animal health. We believe that these data support the clinical testing of GMMA formulated without Alhydrogel, which would allow for further simplification of GMMA-based vaccine manufacturing.
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Affiliation(s)
- Francesca Mancini
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
| | - Valentina Caradonna
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
| | - Maria Grazia Aruta
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
| | | | | | | | | | - Omar Rossi
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), 53100 Siena, Italy
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Batani G, Vezzani G, Lashchuk S, Allaoui A, Cardamone D, Raso MM, Boero E, Roscioli E, Ridelfi M, Gasperini G, Pizza M, Rossi O, Berlanda Scorza F, Micoli F, Rappuoli R, Sala C. Development of a visual Adhesion/Invasion Inhibition Assay to assess the functionality of Shigella-specific antibodies. Front Immunol 2024; 15:1374293. [PMID: 38680489 PMCID: PMC11045934 DOI: 10.3389/fimmu.2024.1374293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Shigella is the etiologic agent of a bacillary dysentery known as shigellosis, which causes millions of infections and thousands of deaths worldwide each year due to Shigella's unique lifestyle within intestinal epithelial cells. Cell adhesion/invasion assays have been extensively used not only to identify targets mediating host-pathogen interaction, but also to evaluate the ability of Shigella-specific antibodies to reduce virulence. However, these assays are time-consuming and labor-intensive and fail to assess differences at the single-cell level. Objectives and methods Here, we developed a simple, fast and high-content method named visual Adhesion/Invasion Inhibition Assay (vAIA) to measure the ability of anti-Shigellaantibodies to inhibit bacterial adhesion to and invasion of epithelial cells by using the confocal microscope Opera Phenix. Results We showed that vAIA performed well with a pooled human serum from subjects challenged with S. sonnei and that a specific anti-IpaD monoclonal antibody effectively reduced bacterial virulence in a dose-dependent manner. Discussion vAIA can therefore inform on the functionality of polyclonal and monoclonal responses thereby supporting the discovery of pathogenicity mechanisms and the development of candidate vaccines and immunotherapies. Lastly, this assay is very versatile and may be easily applied to other Shigella species or serotypes and to different pathogens.
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Affiliation(s)
- Giampiero Batani
- Monoclonal Antibody Discovery Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
| | - Giacomo Vezzani
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Sabrina Lashchuk
- Monoclonal Antibody Discovery Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
| | - Abdelmounaaim Allaoui
- The Microbiology Laboratory, University Mohammed VI Polytechnic, Ben, Guerir, Morocco
| | - Dario Cardamone
- Data Science for Health Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
| | | | - Elena Boero
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Emanuele Roscioli
- Monoclonal Antibody Discovery Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
| | - Matteo Ridelfi
- Monoclonal Antibody Discovery Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
| | - Gianmarco Gasperini
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Mariagrazia Pizza
- Department of Life Sciences, Imperial College, London, United Kingdom
| | - Omar Rossi
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | | | - Francesca Micoli
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | | | - Claudia Sala
- Monoclonal Antibody Discovery Laboratory, Fondazione Toscana Life Sciences, Siena, Italy
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Conti V, Rossi O, Clarkson KA, Mancini F, Nakakana UN, Sarakinou E, Callegaro A, Ferruzzi P, Acquaviva A, Arora AK, Marchetti E, Necchi F, Frenck RW, Martin LB, Kaminski RW, Podda A, Micoli F. Putative correlates of protection against shigellosis assessing immunomarkers across responses to S. sonnei investigational vaccine. NPJ Vaccines 2024; 9:56. [PMID: 38459072 PMCID: PMC10923941 DOI: 10.1038/s41541-024-00822-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 03/10/2024] Open
Abstract
Shigella spp. are a leading bacterial cause of diarrhea. No widely licensed vaccines are available and there is no generally accepted correlate of protection. We tested a S. sonnei Generalized Modules for Membrane Antigen (GMMA)-based vaccine (1790GAHB) in a phase 2b, placebo-controlled, randomized, controlled human infection model study (NCT03527173) enrolling healthy United States adults aged 18-50 years. We report analyses evaluating immune responses to vaccination, with the aim to identify correlates of risk for shigellosis among assessed immunomarkers. We found that 1790GAHB elicited S. sonnei lipopolysaccharide specific α4β7+ immunoglobulin (Ig) G and IgA secreting B cells which are likely homing to the gut, indicating the ability to induce a mucosal in addition to a systemic response, despite parenteral delivery. We were unable to establish or confirm threshold levels that predict vaccine efficacy facilitating the evaluation of vaccine candidates. However, serum anti-lipopolysaccharide IgG and bactericidal activity were identified as potential correlates of risk for shigellosis.
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Affiliation(s)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | - Kristen A Clarkson
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Horizon Therapeutics, Deerfield, IL, USA
| | | | | | | | | | | | | | | | | | | | - Robert W Frenck
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura B Martin
- GSK Vaccines Institute for Global Health, Siena, Italy
- US Pharmacopeial Convention, Rockville, MD, USA
| | - Robert W Kaminski
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Latham BioPharm Group, Cambridge, MA, USA
| | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
- Independent Consultant, Siena, Italy
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5
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Carducci M, Whitcombe A, Rovetini L, Massai L, Keeley AJ, de Silva TI, Bennett J, Berlanda Scorza F, Iturriza M, Moreland NJ, Moriel DG, Rossi O. Development and characterization of a hemolysis inhibition assay to determine functionality of anti-Streptolysin O antibodies in human sera. J Immunol Methods 2024; 526:113618. [PMID: 38237697 PMCID: PMC10921352 DOI: 10.1016/j.jim.2024.113618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
The high burden of disease and the long-lasting sequelae following Streptococcus pyogenes (Strep A) infections make the development of an effective vaccine a global health priority. Streptolysin O (SLO), is a key toxin in the complex pathogenesis of Strep A infection. Antibodies are elicited against SLO after natural exposure and represent a key target for vaccine-induced immunity. Here we present the setup and characterization of a hemolysis assay to measure functionality of anti-SLO antibodies in human sera. Assay specificity, precision, linearity, reproducibility, and repeatability were determined. The assay was demonstrated to be highly sensitive, specific, reproducible, linear and performed well in assessing functionality of anti-SLO antibodies induced by exposed individuals. Moreover, different sources of critical reagents, in particular red- blood cells, have been compared and had minimal impact on assay performance. The assay presented here has throughput suitable for evaluating sera in vaccine clinical trials and sero-epidemiological studies to gain further insights into the functionality of infection- and vaccine-induced antibodies.
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Affiliation(s)
- Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Alana Whitcombe
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Luca Rovetini
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Luisa Massai
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Alexander J Keeley
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; Vaccines and Immunity Theme, Medical Research Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, the Gambia; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Thushan I de Silva
- Vaccines and Immunity Theme, Medical Research Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, the Gambia; Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Julie Bennett
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand; Department of Public Health, University of Otago, Wellington, New Zealand
| | - Francesco Berlanda Scorza
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Miren Iturriza
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Nicole J Moreland
- School of Medical Sciences and Maurice Wilkins Centre, The University of Auckland, Auckland, New Zealand
| | - Danilo G Moriel
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), GSK Global Health Vaccines R&D, via Fiorentina 1, 53100 Siena, Italy.
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Gasperini G, Massai L, De Simone D, Raso MM, Palmieri E, Alfini R, Rossi O, Ravenscroft N, Kuttel MM, Micoli F. O-Antigen decorations in Salmonella enterica play a key role in eliciting functional immune responses against heterologous serovars in animal models. Front Cell Infect Microbiol 2024; 14:1347813. [PMID: 38487353 PMCID: PMC10937413 DOI: 10.3389/fcimb.2024.1347813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Different serovars of Salmonella enterica cause systemic diseases in humans including enteric fever, caused by S. Typhi and S. Paratyphi A, and invasive nontyphoidal salmonellosis (iNTS), caused mainly by S. Typhimurium and S. Enteritidis. No vaccines are yet available against paratyphoid fever and iNTS but different strategies, based on the immunodominant O-Antigen component of the lipopolysaccharide, are currently being tested. The O-Antigens of S. enterica serovars share structural features including the backbone comprising mannose, rhamnose and galactose as well as further modifications such as O-acetylation and glucosylation. The importance of these O-Antigen decorations for the induced immunogenicity and cross-reactivity has been poorly characterized. Methods These immunological aspects were investigated in this study using Generalized Modules for Membrane Antigens (GMMA) as delivery systems for the different O-Antigen variants. This platform allowed the rapid generation and in vivo testing of defined and controlled polysaccharide structures through genetic manipulation of the O-Antigen biosynthetic genes. Results Results from mice and rabbit immunization experiments highlighted the important role played by secondary O-Antigen decorations in the induced immunogenicity. Moreover, molecular modeling of O-Antigen conformations corroborated the likelihood of cross-protection between S. enterica serovars. Discussion Such results, if confirmed in humans, could have a great impact on the design of a simplified vaccine composition able to maximize functional immune responses against clinically relevant Salmonella enterica serovars.
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Affiliation(s)
| | - Luisa Massai
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
| | | | | | - Elena Palmieri
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch, South Africa
| | - Michelle M. Kuttel
- Department of Computer Science, University of Cape Town, Rondebosch, South Africa
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7
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Kapulu MC, Muthumbi E, Otieno E, Rossi O, Ferruzzi P, Necchi F, Acquaviva A, Martin LB, Orindi B, Mwai K, Kibet H, Mwanzu A, Bigogo GM, Verani JR, Mbae C, Nyundo C, Agoti CN, Nakakana UN, Conti V, Bejon P, Kariuki S, Scott JAG, Micoli F, Podda A. Age-dependent acquisition of IgG antibodies to Shigella serotypes-a retrospective analysis of seroprevalence in Kenyan children with implications for infant vaccination. Front Immunol 2024; 15:1340425. [PMID: 38361949 PMCID: PMC10867106 DOI: 10.3389/fimmu.2024.1340425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Background Shigellosis mainly affects children under 5 years of age living in low- and middle-income countries, who are the target population for vaccination. There are, however, limited data available to define the appropriate timing for vaccine administration in this age group. Information on antibody responses following natural infection, proxy for exposure, could help guide vaccination strategies. Methods We undertook a retrospective analysis of antibodies to five of the most prevalent Shigella serotypes among children aged <5 years in Kenya. Serum samples from a cross-sectional serosurvey in three Kenyan sites (Nairobi, Siaya, and Kilifi) were analyzed by standardized ELISA to measure IgG against Shigella sonnei and Shigella flexneri 1b, 2a, 3a, and 6. We identified factors associated with seropositivity to each Shigella serotype, including seropositivity to other Shigella serotypes. Results A total of 474 samples, one for each participant, were analyzed: Nairobi (n = 169), Siaya (n = 185), and Kilifi (n = 120). The median age of the participants was 13.4 months (IQR 7.0-35.6), and the male:female ratio was 1:1. Geometric mean concentrations (GMCs) for each serotype increased with age, mostly in the second year of life. The overall seroprevalence of IgG antibodies increased with age except for S. flexneri 6 which was high across all age subgroups. In the second year of life, there was a statistically significant increase of antibody GMCs against all five serotypes (p = 0.01-0.0001) and a significant increase of seroprevalence for S. flexneri 2a (p = 0.006), S. flexneri 3a (p = 0.006), and S. sonnei (p = 0.05) compared with the second part of the first year of life. Among all possible pairwise comparisons of antibody seropositivity, there was a significant association between S. flexneri 1b and 2a (OR = 6.75, 95% CI 3-14, p < 0.001) and between S. flexneri 1b and 3a (OR = 23.85, 95% CI 11-54, p < 0.001). Conclusion Children living in low- and middle-income settings such as Kenya are exposed to Shigella infection starting from the first year of life and acquire serotype-specific antibodies against multiple serotypes. The data from this study suggest that Shigella vaccination should be targeted to infants, ideally at 6 or at least 9 months of age, to ensure children are protected in the second year of life when exposure significantly increases.
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Affiliation(s)
- Melissa C. Kapulu
- KEMRI-Wellcome Trust Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Esther Muthumbi
- KEMRI-Wellcome Trust Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | | | | | | | | | - Kennedy Mwai
- KEMRI-Wellcome Trust Programme, Kilifi, Kenya
- Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Godfrey M. Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jennifer R. Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | | | | | - Philip Bejon
- KEMRI-Wellcome Trust Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - J. Anthony G. Scott
- KEMRI-Wellcome Trust Programme, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
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8
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Oldrini D, Di Benedetto R, Carducci M, De Simone D, Massai L, Alfini R, Galli B, Brunelli B, Przedpelski A, Barbieri JT, Rossi O, Giannelli C, Rappuoli R, Berti F, Micoli F. Testing a Recombinant Form of Tetanus Toxoid as a Carrier Protein for Glycoconjugate Vaccines. Vaccines (Basel) 2023; 11:1770. [PMID: 38140177 PMCID: PMC10747096 DOI: 10.3390/vaccines11121770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Glycoconjugate vaccines play a major role in the prevention of infectious diseases worldwide, with significant impact on global health, enabling the polysaccharides to induce immunogenicity in infants and immunological memory. Tetanus toxoid (TT), a chemically detoxified bacterial toxin, is among the few carrier proteins used in licensed glycoconjugate vaccines. The recombinant full-length 8MTT was engineered in E. coli with eight individual amino acid mutations to inactivate three toxin functions. Previous studies in mice showed that 8MTT elicits a strong IgG response, confers protection, and can be used as a carrier protein. Here, we compared 8MTT to traditional carrier proteins TT and cross-reactive material 197 (CRM197), using different polysaccharides as models: Group A Streptococcus cell-wall carbohydrate (GAC), Salmonella Typhi Vi, and Neisseria meningitidis serogroups A, C, W, and Y. The persistency of the antibodies induced, the ability of the glycoconjugates to elicit booster response after re-injection at a later time point, the eventual carrier-induced epitopic suppression, and immune interference in multicomponent formulations were also evaluated. Overall, immunogenicity responses obtained with 8MTT glycoconjugates were compared to those obtained with corresponding TT and, in some cases, were higher than those induced by CRM197 glycoconjugates. Our results support the use of 8MTT as a good alternative carrier protein for glycoconjugate vaccines, with advantages in terms of manufacturability compared to TT.
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Affiliation(s)
- Davide Oldrini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Roberta Di Benedetto
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Daniele De Simone
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Luisa Massai
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Barbara Galli
- GSK, via Fiorentina 1, 53100 Siena, Italy; (B.G.); (B.B.); (F.B.)
| | | | - Amanda Przedpelski
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.P.); (J.T.B.)
| | - Joseph T. Barbieri
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.P.); (J.T.B.)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Carlo Giannelli
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
| | - Rino Rappuoli
- Fondazione Biotecnopolo, via Fiorentina 1, 53100 Siena, Italy;
| | - Francesco Berti
- GSK, via Fiorentina 1, 53100 Siena, Italy; (B.G.); (B.B.); (F.B.)
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy; (D.O.); (R.D.B.); (M.C.); (D.D.S.); (L.M.); (R.A.); (O.R.); (C.G.)
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9
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Di Benedetto R, Mancini F, Caradonna V, Aruta MG, Giannelli C, Rossi O, Micoli F. Comparison of Shigella GMMA and glycoconjugate four-component formulations in animals. Front Mol Biosci 2023; 10:1284515. [PMID: 38046812 PMCID: PMC10690372 DOI: 10.3389/fmolb.2023.1284515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Shigellosis is leading bacterial cause of diarrhea with high prevalence in children younger than 5 years in low- and middle-income countries, and increasing number of reports of Shigella cases associated to anti-microbial resistance. No vaccines against Shigella are still licensed, but different candidates based on the O-antigen portion of lipopolysaccharides are in clinic. Generalized Modules for Membrane Antigens (GMMA) have been proposed as an alternative delivery system for the O-antigen, and a 4-component vaccine candidate (altSonflex1-2-3), containing GMMA from S. sonnei and S. flexneri 1b, 2a and 3a is being tested in a phase 1/2 clinical trial, with the aim to elicit broad protection against the most prevalent Shigella serotypes. Here, the 4-component GMMA vaccine candidate has been compared to a more traditional glycoconjugate formulation for the ability to induce functional antibodies in mice and rabbits. In mice, in the absence of Alhydrogel, GMMA induce higher IgG antibodies than glycoconjugates and stronger bactericidal titers against all Shigella serotypes. In the presence of Alhydrogel, GMMA induce O-antigen specific IgG levels similar to traditional glycoconjugates, but with a broader range of IgG subclasses, resulting in stronger bactericidal activity. In rabbits, GMMA elicit higher functional antibodies than glycoconjugates against S. sonnei, and similar responses to S. flexneri 1b, 2a and 3a, independently from the presence of Alhydrogel. Different O-antigen based vaccines against Shigella are now in clinical stage and it will be of particular interest to understand how the preclinical findings in the different animal models translate in humans.
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Affiliation(s)
- Roberta Di Benedetto
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | | | | | | | - Carlo Giannelli
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Siena, Italy
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10
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Keeley AJ, Groves D, Armitage EP, Senghore E, Jagne YJ, Sallah HJ, Drammeh S, Angyal A, Hornsby H, de Crombrugghe G, Smeesters PR, Rossi O, Carducci M, Peno C, Bogaert D, Kampmann B, Marks M, Shaw HA, Turner CR, de Silva TI. Streptococcus pyogenes Colonization in Children Aged 24-59 Months in the Gambia: Impact of Live Attenuated Influenza Vaccine and Associated Serological Responses. J Infect Dis 2023; 228:957-965. [PMID: 37246259 PMCID: PMC10547459 DOI: 10.1093/infdis/jiad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/02/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Immunity to Streptococcus pyogenes in high burden settings is poorly understood. We explored S. pyogenes nasopharyngeal colonization after intranasal live attenuated influenza vaccine (LAIV) among Gambian children aged 24-59 months, and resulting serological response to 7 antigens. METHODS A post hoc analysis was performed in 320 children randomized to receive LAIV at baseline (LAIV group) or not (control). S. pyogenes colonization was determined by quantitative polymerase chain reaction (qPCR) on nasopharyngeal swabs from baseline (day 0), day 7, and day 21. Anti-streptococcal IgG was quantified, including a subset with paired serum before/after S. pyogenes acquisition. RESULTS The point prevalence of S. pyogenes colonization was 7%-13%. In children negative at day 0, S. pyogenes was detected at day 7 or 21 in 18% of LAIV group and 11% of control group participants (P = .12). The odds ratio (OR) for colonization over time was significantly increased in the LAIV group (day 21 vs day 0 OR, 3.18; P = .003) but not in the control group (OR, 0.86; P = .79). The highest IgG increases following asymptomatic colonization were seen for M1 and SpyCEP proteins. CONCLUSIONS Asymptomatic S. pyogenes colonization appears modestly increased by LAIV, and may be immunologically significant. LAIV could be used to study influenza-S. pyogenes interactions. Clinical Trials Registration. NCT02972957.
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Affiliation(s)
- Alexander J Keeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infection, Immunity, and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Danielle Groves
- Department of Infection, Immunity, and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Edwin P Armitage
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Elina Senghore
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Ya Jankey Jagne
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Hadijatou J Sallah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Sainabou Drammeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Adri Angyal
- Department of Infection, Immunity, and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Hailey Hornsby
- Department of Infection, Immunity, and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Gabrielle de Crombrugghe
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de BruxellesBrussels, Belgium
| | - Pierre R Smeesters
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pediatrics, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de BruxellesBrussels, Belgium
| | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Chikondi Peno
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Debby Bogaert
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Beate Kampmann
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Charité Centre for Global Health and Institut für Internationale Gesundheit, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Helen A Shaw
- Vaccines Division, Scientific Research and Innovation Group, Medicines and Healthcare Products Regulatory Agency, Potters Bar, United Kingdom
| | - Claire R Turner
- School of Biosciences, University of Sheffield, Sheffield, United Kingdom
| | - Thushan I de Silva
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infection, Immunity, and Cardiovascular Disease, Medical School, University of Sheffield, Sheffield, United Kingdom
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
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11
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Rossi O, Citiulo F, Giannelli C, Cappelletti E, Gasperini G, Mancini F, Acquaviva A, Raso MM, Sollai L, Alfini R, Aruta MG, Vitali CG, Pizza M, Necchi F, Rappuoli R, Martin LB, Berlanda Scorza F, Colucci AM, Micoli F. A next-generation GMMA-based vaccine candidate to fight shigellosis. NPJ Vaccines 2023; 8:130. [PMID: 37670042 PMCID: PMC10480147 DOI: 10.1038/s41541-023-00725-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Shigellosis is a leading cause of diarrheal disease in low-middle-income countries (LMICs). Effective vaccines will help to reduce the disease burden, exacerbated by increasing antibiotic resistance, in the most susceptible population represented by young children. A challenge for a broadly protective vaccine against shigellosis is to cover the most epidemiologically relevant serotypes among >50 Shigella serotypes circulating worldwide. The GMMA platform has been proposed as an innovative delivery system for Shigella O-antigens, and we have developed a 4-component vaccine against S. sonnei, S. flexneri 1b, 2a and 3a identified among the most prevalent Shigella serotypes in LMICs. Driven by the immunogenicity results obtained in clinic with a first-generation mono-component vaccine, a new S. sonnei GMMA construct was generated and combined with three S. flexneri GMMA in a 4-component Alhydrogel formulation (altSonflex1-2-3). This formulation was highly immunogenic, with no evidence of negative antigenic interference in mice and rabbits. The vaccine induced bactericidal antibodies also against heterologous Shigella strains carrying O-antigens different from those included in the vaccine. The Monocyte Activation Test used to evaluate the potential reactogenicity of the vaccine formulation revealed no differences compared to the S. sonnei mono-component vaccine, shown to be safe in several clinical trials in adults. A GLP toxicology study in rabbits confirmed that the vaccine was well tolerated. The preclinical study results support the clinical evaluation of altSonflex1-2-3 in healthy populations, and a phase 1-2 clinical trial is currently ongoing.
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Affiliation(s)
- Omar Rossi
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
| | | | | | | | - Gianmarco Gasperini
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
- GSK Vaccines Srl, Siena, Italy
| | | | | | | | - Luigi Sollai
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
| | - Renzo Alfini
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
| | | | | | - Mariagrazia Pizza
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
- GSK Vaccines Srl, Siena, Italy
- Imperial College, London, United Kingdom
| | | | - Rino Rappuoli
- GSK Vaccines Srl, Siena, Italy
- Fondazione Biotecnopolo, Siena, Italy
| | - Laura B Martin
- GSK Global Health Vaccines R&D (GVGH), Siena, Italy
- US Pharmacopoeia, Rockville, Maryland, USA
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12
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Necchi F, Giannelli C, Acquaviva A, Alfini R, Monaci V, Arato V, Rossi O, Micoli F. From an in vivo to an in vitro relative potency (IVRP) assay to fully characterize a multicomponent O-antigen based vaccine against Shigella. Carbohydr Polym 2023; 314:120920. [PMID: 37173008 DOI: 10.1016/j.carbpol.2023.120920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
Outer membrane vesicles (OMV) represent an innovative platform for the design of polysaccharide based vaccines. Generalized Modules for Membrane Antigens (GMMA), OMV released from engineered Gram-negative bacteria, have been proposed for the delivery of the O-Antigen, key target for protective immunity against several pathogens including Shigella. altSonflex1-2-3 is a GMMA based vaccine, including S. sonnei and S. flexneri 1b, 2a and 3a O-Antigens, with the aim to elicit broad protection against the most prevalent Shigella serotypes, especially affecting children in low-middle income countries. Here we developed an In Vitro Relative Potency assay, based on recognition of O-Antigen by functional monoclonal antibodies selected to bind the key epitopes of the different O-Antigen active ingredients, directly applied to our Alhydrogel-formulated vaccine. Heat-stressed altSonflex1-2-3 formulations were generated and extensively characterized. The impact of detected biochemical changes in in vivo and in vitro potency assays was assessed. The overall results showed how the in vitro assay can replace the use of animals, overcoming the inherently high variability of in vivo potency studies. The entire panel of physico-chemical methods developed will contribute to detect suboptimal batches and will be valuable to perform stability studies. The work on Shigella vaccine candidate can be easily extended to other O-Antigen based vaccines.
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Affiliation(s)
- Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Carlo Giannelli
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Alessandra Acquaviva
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Valentina Monaci
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Vanessa Arato
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
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13
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Aruta MG, Lari E, De Simone D, Semplici B, Semplici C, Dale H, Chirwa E, Kadwala I, Mbewe M, Banda H, Iturriza-Gomara M, Gordon M, Nyirenda T, Piu P, Pizza M, Berlanda Scorza F, Grappi S, Canals R, Rossi O. Characterization of Enzyme-Linked Immunosorbent Assay (ELISA) for Quantification of Antibodies against Salmonella Typhimurium and Salmonella Enteritidis O-Antigens in Human Sera. BioTech (Basel) 2023; 12:54. [PMID: 37606441 PMCID: PMC10443281 DOI: 10.3390/biotech12030054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
Nontyphoidal Salmonella (NTS) is a leading cause of morbidity and mortality caused by enteric pathogens worldwide in both children and adults, and vaccines are not yet available. The measurement of antigen-specific antibodies in the sera of vaccinated or convalescent individuals is crucial to understand the incidence of disease and the immunogenicity of vaccine candidates. A solid and standardized assay used to determine the level of specific anti-antigens IgG is therefore of paramount importance. In this work, we presented the characterization of a customized enzyme-linked immunosorbent assay (ELISA) with continuous readouts and a standardized definition of EU/mL. We assessed various performance parameters: standard curve accuracy, dilutional linearity, intermediate precision, specificity, limits of blanks, and quantification. The simplicity of the assay, its high sensitivity and specificity coupled with its low cost and the use of basic consumables and instruments without the need of high automation makes it suitable for transfer and application to different laboratories, including resource-limiting settings where the disease is endemic. This ELISA is, therefore, fit for purpose to be used for quantification of antibodies against Salmonella Typhimurium and Salmonella Enteritidis O-antigens in human samples, both for vaccine clinical trials and large sero-epidemiological studies.
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Affiliation(s)
- Maria Grazia Aruta
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
| | - Elisa Lari
- VisMederi S.r.l., 53100 Siena, Italy; (E.L.); (B.S.); (C.S.); (P.P.); (S.G.)
| | - Daniele De Simone
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
| | - Bianca Semplici
- VisMederi S.r.l., 53100 Siena, Italy; (E.L.); (B.S.); (C.S.); (P.P.); (S.G.)
| | - Claudia Semplici
- VisMederi S.r.l., 53100 Siena, Italy; (E.L.); (B.S.); (C.S.); (P.P.); (S.G.)
| | - Helen Dale
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Esmelda Chirwa
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Innocent Kadwala
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
| | - Maurice Mbewe
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
| | - Happy Banda
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
| | - Miren Iturriza-Gomara
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
| | - Melita Gordon
- Malawi Liverpool Wellcome Trust Programme, Blantyre 30096, Malawi; (H.D.); (E.C.); (I.K.); (M.M.); (H.B.); (M.G.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Tonney Nyirenda
- Pathology Department, Kamuzu University of Health Sciences, Blantyre 312225, Malawi;
| | - Pietro Piu
- VisMederi S.r.l., 53100 Siena, Italy; (E.L.); (B.S.); (C.S.); (P.P.); (S.G.)
| | - Mariagrazia Pizza
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
- Imperial College South Kensington Campus, London SW7 2AZ, UK
| | - Francesco Berlanda Scorza
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
| | - Silvia Grappi
- VisMederi S.r.l., 53100 Siena, Italy; (E.L.); (B.S.); (C.S.); (P.P.); (S.G.)
| | - Rocío Canals
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., 53100 Siena, Italy; (M.G.A.); (D.D.S.); (M.I.-G.); (M.P.); (F.B.S.)
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14
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Boero E, Vezzani G, Micoli F, Pizza M, Rossi O. Functional assays to evaluate antibody-mediated responses against Shigella: a review. Front Cell Infect Microbiol 2023; 13:1171213. [PMID: 37260708 PMCID: PMC10227456 DOI: 10.3389/fcimb.2023.1171213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
Shigella is a major global pathogen and the etiological agent of shigellosis, a diarrheal disease that primarily affects low- and middle-income countries. Shigellosis is characterized by a complex, multistep pathogenesis during which bacteria use multiple invasion proteins to manipulate and invade the intestinal epithelium. Antibodies, especially against the O-antigen and some invasion proteins, play a protective role as titres against specific antigens inversely correlate with disease severity; however, the context of antibody action during pathogenesis remains to be elucidated, especially with Shigella being mostly an intracellular pathogen. In the absence of a correlate of protection, functional assays rebuilding salient moments of Shigella pathogenesis can improve our understanding of the role of protective antibodies in blocking infection and disease. In vitro assays are important tools to build correlates of protection. Only recently animal models to recapitulate human pathogenesis, often not in full, have been established. This review aims to discuss in vitro assays to evaluate the functionality of anti-Shigella antibodies in polyclonal sera in light of the multistep and multifaced Shigella infection process. Indeed, measurement of antibody level alone may limit the evaluation of full vaccine potential. Serum bactericidal assay (SBA), and other functional assays such as opsonophagocytic killing assays (OPKA), and adhesion/invasion inhibition assays (AIA), are instead physiologically relevant and may provide important information regarding the role played by these effector mechanisms in protective immunity. Ultimately, the review aims at providing scientists in the field with new points of view regarding the significance of functional assays of choice which may be more representative of immune-mediated protection mechanisms.
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Affiliation(s)
- Elena Boero
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Giacomo Vezzani
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Mariagrazia Pizza
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
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15
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Perrotti G, Goker F, Rossi O, Nowakowska J, Russillo A, Beltramini G, Tartaglia GM, Testori T, Del Fabbro M, Mortellaro C. 3D Computed Tomography vs. 2D radiography: comparison of 3D direct anthropometry with 2D norm calculations and analysis of differences in soft tissue measurements. Eur Rev Med Pharmacol Sci 2023; 27:46-60. [PMID: 37129335 DOI: 10.26355/eurrev_202304_31321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of this study was twofold: (1) to compare soft tissue measurements of the same distances obtained from 3D computed tomography reconstructions with 2D cephalometric radiograms, (2) to compare data from 3D measurements from direct anthropometry and 2D "norms" for the facial measurements. PATIENTS AND METHODS A total of 40 Caucasian patients that had their CBCT scans for various dental and dentoskeletal reasons were enrolled in this study. All the patients had large field of view (from the forehead to the chin). The data were stored in DICOM format and imported into a software for 3D reconstructions. After 3D facial soft tissue model generation, the distances between 18 soft tissue points were measured. The 3D soft tissue analysis was performed, and the facial indices were calculated. The mean 3D values were compared with 2D measurements performed on lateral cephalograms and Arnett's and Farkas' norms. The measurements were statistically compared using Student's t-test. RESULTS Assessments from 2D and 3D measurements showed no statistical difference except for the distance Pogonion (for both male and female) and Labial superius prominence (females) to the True Vertical Line in 2D /Plane in case of 3D measurements. There was a significant difference between all 3D measurements and Arnett's and anthropometric Farkas' "norms". The mean difference between Farkas' "norms" and 3D measurements was within 3 mm for 70% of measurements. CONCLUSIONS According to the results, 3D soft tissue analysis allows for complete diagnostic determination. The 3D "norms" are to be verified on a greater sample.
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16
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Mancini F, Alfini R, Caradonna V, Monaci V, Carducci M, Gasperini G, Piccioli D, Biagini M, Giannelli C, Rossi O, Pizza M, Micoli F. Exploring the Role of GMMA Components in the Immunogenicity of a 4-Valent Vaccine against Shigella. Int J Mol Sci 2023; 24:ijms24032742. [PMID: 36769063 PMCID: PMC9916818 DOI: 10.3390/ijms24032742] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Shigellosis is the leading cause of diarrheal disease, especially in children of low- and middle-income countries, and is often associated with anti-microbial resistance. Currently, there are no licensed vaccines widely available against Shigella, but several candidates based on the O-antigen (OAg) portion of lipopolysaccharides are in development. We have proposed Generalized Modules for Membrane Antigens (GMMA) as an innovative delivery system for OAg, and a quadrivalent vaccine candidate containing GMMA from S. sonnei and three prevalent S. flexneri serotypes (1b, 2a and 3a) is moving to a phase II clinical trial, with the aim to elicit broad protection against Shigella. GMMA are able to induce anti-OAg-specific functional IgG responses in animal models and healthy adults. We have previously demonstrated that antibodies against protein antigens are also generated upon immunization with S. sonnei GMMA. In this work, we show that a quadrivalent Shigella GMMA-based vaccine is able to promote a humoral response against OAg and proteins of all GMMA types contained in the investigational vaccine. Proteins contained in GMMA provide T cell help as GMMA elicit a stronger anti-OAg IgG response in wild type than in T cell-deficient mice. Additionally, we observed that only the trigger of Toll-like Receptor (TLR) 4 and not of TLR2 contributed to GMMA immunogenicity. In conclusion, when tested in mice, GMMA of a quadrivalent Shigella vaccine candidate combine both adjuvant and carrier activities which allow an increase in the low immunogenic properties of carbohydrate antigens.
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Affiliation(s)
- Francesca Mancini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
- Correspondence:
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Valentina Caradonna
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Valentina Monaci
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Gianmarco Gasperini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | | | | | - Carlo Giannelli
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Mariagrazia Pizza
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100 Siena, Italy
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Pitirollo O, Di Benedetto R, Henriques P, Gasperini G, Mancini F, Carducci M, Massai L, Rossi O, Volbeda AG, Codée JDC, Berlanda Scorza F, Moriel DG, Necchi F, Lay L, Adamo R, Micoli F. Elucidating the role of N-acetylglucosamine in Group A Carbohydrate for the development of an effective glycoconjugate vaccine against Group A Streptococcus. Carbohydr Polym 2023; 311:120736. [PMID: 37028871 DOI: 10.1016/j.carbpol.2023.120736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
Group A Carbohydrate (GAC), conjugated to an appropriate carrier protein, has been proposed as an attractive vaccine candidate against Group A Streptococcus infections. Native GAC consists of a polyrhamnose (polyRha) backbone with N-acetylglucosamine (GlcNAc) at every second rhamnose residue. Both native GAC and the polyRha backbone have been proposed as vaccine components. Here, chemical synthesis and glycoengineering were used to generate a panel of different length GAC and polyrhamnose fragments. Biochemical analyses were performed confirming that the epitope motif of GAC is composed of GlcNAc in the context of the polyrhamnose backbone. Conjugates from GAC isolated and purified from a bacterial strain and polyRha genetically expressed in E. coli and with similar molecular size to GAC were compared in different animal models. The GAC conjugate elicited higher anti-GAC IgG levels with stronger binding capacity to Group A Streptococcus strains than the polyRha one, both in mice and in rabbits. This work contributes to the development of a vaccine against Group A Streptococcus suggesting GAC as preferable saccharide antigen to include in the vaccine.
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Affiliation(s)
- Olimpia Pitirollo
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; Department of Chemistry and CRC Materiali Polimerici (LaMPo), University of Milan, Via C. Golgi 19, 20133 Milan, Italy.
| | - Roberta Di Benedetto
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | | | - Gianmarco Gasperini
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Francesca Mancini
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Luisa Massai
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Anne Geert Volbeda
- Leiden Institute of Chemistry, Leiden University, Einsteinweg 55, 2300 RA Leiden, the Netherlands
| | - Jeroen D C Codée
- Leiden Institute of Chemistry, Leiden University, Einsteinweg 55, 2300 RA Leiden, the Netherlands.
| | | | - Danilo Gomes Moriel
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Luigi Lay
- Department of Chemistry and CRC Materiali Polimerici (LaMPo), University of Milan, Via C. Golgi 19, 20133 Milan, Italy.
| | | | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
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18
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Sambataro S, Rossi O, Bocchieri S, Fastuca R, Oppermann N, Levrini L, Cicciù M, Caprioglio A. Comparison of cephalometric changes in Class II growing patients with increased vertical dimension after high-pull and cervical headgear treatment. Eur J Paediatr Dent 2023; 24:36-41. [PMID: 36853216 DOI: 10.23804/ejpd.2023.24.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
AIM The aim of the present study was to evaluate the cephalometric changes in growing Class II patients with increased vertical dimension treated with cervical or high-pull headgear, by using an untreated control group with similar skeletal characteristics. MATERIALS From the initial sample, 56 patients satisfied the inclusion and exclusion criteria; 20 patients were treated with cervical headgear (CHG), 15 with high-pull headgear (HHG), and 21 were not treated (CG). Cephalograms were available for each subject at baseline (T1) and after treatment/observation time (T2) for the three groups. A total of 17 measurements were taken on the lateral head films. Group comparison among CHG, HHG and CG was done using ANOVA test. CONCLUSION In Class II high-angle growing patients, cervical headgear seems to be preferred in the correction of maxillary protrusion, molar relationship and increased anterior facial height. Extrusion of the upper molar may favour forward repositioning of the mandible and clockwise rotation in Class II patients with increased vertical dimension.
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Affiliation(s)
- S Sambataro
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - O Rossi
- Department of Medicine and Surgery, Section of Orthodontics, University of Insubria, Varese-Como, Italy
| | - S Bocchieri
- Department of Medicine and Surgery, Section of Orthodontics, University of Insubria, Varese-Como, Italy
| | | | - N Oppermann
- Department of Orthodontics, University of Illinois at Chicago, Chicago, USA
| | - L Levrini
- Department of Human Sciences, Innovation and Territory, University of Insubria, Varese-Como, Italy
| | - M Cicciù
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - A Caprioglio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy - Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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19
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Mancini F, Micoli F, Rossi O. Study of Agonists of TLRs as Vaccine Adjuvants. Methods Mol Biol 2023; 2700:249-269. [PMID: 37603186 DOI: 10.1007/978-1-0716-3366-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Vaccines adjuvants are critically needed to enhance the effectiveness of subunit vaccines. Due to their ability to link the innate with the adaptive immune response, Toll-like receptor (TLR) agonists have received great attention as adjuvants in vaccines against severe and complex diseases such as cancer, AIDS, and malaria. Here, we describe in vitro assays, e.g., the Monocyte Activation Test, TLR-specific activation assay, and TLR-blocking experiments, used to assess TLR agonists adjuvanted vaccines' safety and to characterize their ability to stimulate the innate immunity. Such assays are physiologically relevant as they work with human cells and allow to overcome the complexity and variability related to in vivo assays.
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Affiliation(s)
| | | | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
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20
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Rossi O, Mastroeni P. Editorial: Pattern recognition receptors at the crosstalk between innate and adaptive immune systems and implications for vaccine development. Front Cell Infect Microbiol 2022; 12:1088029. [PMID: 36530438 PMCID: PMC9755836 DOI: 10.3389/fcimb.2022.1088029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy,*Correspondence: Omar Rossi,
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21
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Torres MI, Farelo H, Otero P, Di Cugno M, Kozak A, Ruibal G, Rodriguez P, Fenili C, Sequera A, Álvarez G, Anselmo C, Araque S, Barrios V, Belloni J, Blanco C, Burakowski D, Cabral F, Cãceres L, Castillo MS, Cateura M, Cepero MI, Corbatta C, De La Colina A, De Miguel L, Delgado V, Dominguez C, Dragani V, Fillipini S, Foglino E, Gasparin A, Gerosa P, Golinelli B, Herrero D, Isaack K, Laguarde M, Lalosa L, López M, Lucero V, Mallo MV, Marina C, Minotti F, Mora ME, Palacios M, Paz Pacheco J, Perez Bonetti L, Podadas Gaspa S, Rios E, Rossi O, Sanhueza N, Sosa S, Surbando L, Vargas R. ODP109 PARATHYROID HORMONE AND 25 OH VITAMINA D IN PREGNANCY: DATA FROM AN ARGENTINEAN COHORT SUPPORTING SUPPLEMENTATION. J Endocr Soc 2022. [PMCID: PMC9625022 DOI: 10.1210/jendso/bvac150.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Vitamin D (Vit D) deficiency has become a global health care issue, as it affects a great number of women during pregnancy and lactation. Vit D levels are critical during pregnancy, being the mother the only source of them for the developing fetus; an enzymatic system for conversion of 25OH VitD into 1-25(OH) 2 VitD is present in the placenta, thus reinforcing the importance of VitD during gestation. VitD deficiency has been associated with obstetric complications and adverse outcomes in offspring, affecting skeletal, immunological and respiratory systems. It is known that prenatal supplements available do not contain enough VitD to fulfil requirements. It is generally accepted that elevated PTH is an indicator of VitD deficiency, and Hysaj O et al (2021) showed that 25OH VitD is a statistically significant determinant of PTH levels in early and late pregnancy. Aim To evaluateVitD status and its relationship to parathyroid hormone (PTH) in a cohort of pregnant women representative of multiple Argentinian regions. Subjects and Methods Data from samples of 423 pregnant women in 1st and 2nd trimester were collected between 2016 and 2021. VitD was measured in different platforms: DiaSorin Liaison CLIA (n=184), Roche COBAS ECLIA (n=166), Abbott ARCHITECT CMIA (n=33), Biomérieux VIDAS ELFA (n=18) and Siemens CENTAUR CLIA (n=16). PTH (ng/L) was measured in 162 samples by SIEMENS IMMULITE CLIA and Roche COBAS ECLIA. As VitD is light-exposure dependent, we considered warm and high light-exposure season period from December to March and cold and low light season from April to September. VITD (ng/L) levels were classified as Deficient (<20), Insufficient (between 21 and 29) and Sufficient (>30) (Endocrine Society, 2014). Results From 423 data collected, 102 were excluded because of lacking information on VitD supplementation. From the remaining non supplemented 321 samples, 48% resulted insufficient, 30% deficient and 22% sufficient for VitD (groups comparison: p< 0. 05, Kruskal Wallis-Dunn test). The seasonal period and pregnancy trimester distributions didn't show significant differences. Similar results of VitD insufficiency were found in the major used platforms, regardless the seasonal period considered. PTH results expressed as median and interquartile range were (ng/L): 32. 0 (13.7-169. 0) in Deficient pregnancies (N=92), 23.7(13.3-88. 0) in Insufficient (n=50) and 18.7 (9.8-55.7) in Sufficient (n=20). Conclusions This study shows VitD inadequate levels in 78% in non-supplemented pregnancies, regardless season or measurement platform. Relative elevated levels of PTH were associated to pregnancies with VitD deficiency, evidenciating a regulatory role according to published data. To improve VitD status during pregnancy it would be advisable to pose new strategies for prenatal supplements developed by a multidisciplinary professional team. Presentation: No date and time listed
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Piccioli D, Alfini R, Monaci V, Arato V, Carducci M, Aruta MG, Rossi O, Necchi F, Anemona A, Bartolini E, Micoli F. Antigen presentation by Follicular Dendritic cells to cognate B cells is pivotal for Generalised Modules for Membrane Antigens (GMMA) immunogenicity. Vaccine 2022; 40:6305-6314. [PMID: 36137901 DOI: 10.1016/j.vaccine.2022.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
GMMA has been proposed as a potent technology platform for the design of safe, effective and affordable vaccines. As GMMA are vesicles blebbing out of the outer membrane of Gram-negative bacteria, they contain lipopolysaccharides, lipoproteins and peptidoglycans that stimulate immune cells via Toll-like Receptors 4 (TLR4) or TLR2. Being basically nanoparticles, GMMA can be efficiently captured by Follicular Dendritic Cells (FDC) for antigen presentation to cognate B cells. GMMA have shown to be highly immunogenic in preclinical and clinical studies and the engagement of TLR4 and TLR2 or antigen presentation by FDC may have a prominent role in GMMA immunogenicity, which is well worth investigating. By using GMMA derived from Shigella sonnei and Salmonella Typhimurium, we show for the first time that the antigen presentation by FDC to cognate B cells plays a major role in the induction of an effective humoral immune response upon immunization with GMMA by using both models. The engagement of TLR4 is critical to elicit an optimal antibody production, but its effect on antibody functionality is dependent on GMMA type and is dispensable when immunizing with Alum adjuvant, whereas TLR2 does not have any role for GMMA immunogenicity. Our findings represent a substantial advancement of the knowledge on GMMA mode of action and shed a light on novel perspectives for the design of safer and more effective GMMA-based vaccines. ONE SENTENCE SUMMARY: The study demonstrated that the antigen presentation by FDC to cognate B cells plays a major role for GMMA immunogenicity.
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Affiliation(s)
| | - Renzo Alfini
- GSK Vaccine Institute for Global Health (GVGH), Siena, Italy
| | | | - Vanessa Arato
- GSK Vaccine Institute for Global Health (GVGH), Siena, Italy
| | | | | | - Omar Rossi
- GSK Vaccine Institute for Global Health (GVGH), Siena, Italy
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23
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Triggianese P, Senter R, Petraroli A, Zoli A, Lo Pizzo M, Bignardi D, Di Agosta E, Agolini S, Arcoleo F, Rossi O, Modica S, Greco E, Chimenti MS, Spadaro G, De Carolis C, Cancian M. Pregnancy in women with Hereditary Angioedema due to C1-inhibitor deficiency: Results from the ITACA cohort study on outcome of mothers and children with in utero exposure to plasma-derived C1-inhibitor. Front Med (Lausanne) 2022; 9:930403. [PMID: 36186797 PMCID: PMC9515414 DOI: 10.3389/fmed.2022.930403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background In women with Hereditary Angioedema (HAE) due to C1-inhibitor (C1INH) deficiency (C1INH-HAE), pregnancy counseling and treatment can be challenging. Despite the evidence of the immediate favorable outcome and safety of plasma-derived (pd)C1INH concentrate, there are no data regarding any difference among women who underwent or not pdC1INH during pregnancy or on children with in utero exposure to pdC1INH. The present interview study aimed at analyzing outcome of C1INH-HAE mothers and children according to pdC1INH-exposure during pregnancies. Methods C1INH-HAE women who experienced at least 1 pregnancy were included from seven centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). The interview study retrospectively analyzed pregnancies who underwent (group 1) or not (group 2) pdC1INH. The overall goals of the study included immediate and long-term outcomes, in terms of outcomes in the time interval between pregnancy and survey. Results A total of 168 pregnancies from 87 included women were analyzed. At term delivery (>37 gestation-week, GW) has been registered in 73.8% of cases, while spontaneous abortion (SA) occurred in 14.2% of cases with a mean GW 7 ± 2. The group 1 including pdC1INH-treated pregnancies comprised a third of the cohort (51/168, time interval 1.5 ± 10.4 yrs), while the group 2 represented 69.6% (117/168, time interval 32.8 ± 14 yrs). The same prevalence of SA occurred when comparing group 1 (11.7%) with group 2 (15.4%) with a similar GW at SA. The group 1 was older at the pregnancy time and younger at the interview than the group 2 (P < 0.01 for both); moreover, the group 1 showed a higher prevalence of cesarean delivery (P < 0.0001). The overall prevalence of obstetrical syndromes was similar between two groups: however, gestational diabetes was described only in pdC1INH-untreated pregnancies. In utero pdC1INH-exposed children (n = 45) did not show differences compared with unexposed ones (n = 99) in neonatal short-term outcomes. Conclusion Through appropriate management and counseling, most of C1INH-HAE women undergo successful pregnancy and delivery. For pregnant C1INH-HAE women being treated with pdC1INH, our findings are reassuring and might lead to an improvement of both the knowledge about treatments and the experience of HAE itself.
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Affiliation(s)
- P. Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
- *Correspondence: P. Triggianese
| | - R. Senter
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
| | - A. Petraroli
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - A. Zoli
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - M. Lo Pizzo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - D. Bignardi
- Department of Medicine Integrated With the Territory, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - E. Di Agosta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Agolini
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, Ancona, Italy
| | - F. Arcoleo
- Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - O. Rossi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - S. Modica
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - E. Greco
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. S. Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - G. Spadaro
- Centro Interdipartimentale di Ricerca in Scienze Immunologiche di Base e Cliniche (CISI) dell'Università degli Studi di Napoli Federico II, Naples, Italy
| | - C. De Carolis
- Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Cancian
- Department of Systems Medicine, University Hospital of Padua, Padua, Italy
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Kapulu MC, Nakakana U, Sciré AS, Sarakinou E, Conti V, Rossi O, Acquaviva A, Necchi F, Obiero CW, Martin LB, Bejon P, Njuguna P, Micoli F, Podda A. Complement-mediated serum bactericidal activity of antibodies elicited by the Shigella sonnei GMMA vaccine in adults from a shigellosis-endemic country: Exploratory analysis of a Phase 2a randomized study. Front Immunol 2022; 13:971866. [PMID: 36203568 PMCID: PMC9531247 DOI: 10.3389/fimmu.2022.971866] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Shigella is associated with a significant burden of disease worldwide among individuals of all ages and is the major cause of moderate and severe diarrhea in children under five years of age in low- and middle-income countries. Several candidate vaccines against Shigella species are currently under clinical development. The investigational 1790GAHB vaccine against Shigella sonnei is based on GMMA (Generalized Modules for Membrane Antigens) technology. The vaccine was well tolerated and induced high antibody levels in early-phase clinical trials in both Shigella-endemic and non-endemic settings. The present analysis assessed the bactericidal activity of antibodies induced by 1790GAHB in healthy Kenyan adults during a phase 2a, controlled, randomized study (NCT02676895). Participants received two doses of 1790GAHB 4 weeks apart containing either 1.5/25 µg or 6/100 µg O antigen/protein, or active comparator vaccines (Control). Serum bactericidal activity (SBA) against S. sonnei was assessed at pre-vaccination (D1), 28 days post-first dose (D29) and 28 days post-second dose (D57), using a luminescence-based assay. Most participants had SBA titers above the lower limit of quantification of the assay at D1. SBA geometric mean titers increased 3.4-fold in the 1.5/25 µg group and 6.3-fold in the 6/100 µg group by D29 and were maintained at D57. There was no increase in SBA geometric mean titers in the Control group. A strong correlation was observed between SBA titers and anti-S. sonnei lipopolysaccharide serum immunoglobulin G antibody concentrations (Pearson correlation coefficient = 0.918), indicating that SBA can effectively complement enzyme-linked immunosorbent assay data by indicating the functionality of 1790GAHB-induced antibodies.
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Affiliation(s)
- Melissa C. Kapulu
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Usman Nakakana
- GSK Vaccines Institute for Global Health, Siena, Italy
- *Correspondence: Usman Nakakana,
| | | | | | | | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | | | | | | | - Philip Bejon
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Patricia Njuguna
- Clinical Research Department, KEMRI-Wellcome Trust Programme, Kilifi, Kenya
| | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
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25
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Mancini F, Micoli F, Rossi O. Setup and Characterization of a High-Throughput Luminescence-Based Serum Bactericidal Assay (L-SBA) to Determine Functionality of Human Sera against Shigella flexneri. BioTech 2022; 11:biotech11030029. [PMID: 35997337 PMCID: PMC9396978 DOI: 10.3390/biotech11030029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Shigellosis represents a major public health problem worldwide. The morbidity of the disease, especially in children in developing countries, together with the increase of antimicrobial resistance make a vaccine against Shigella an urgent medical need. Several vaccines under development are targeting Shigella lipopolysaccharide (LPS), whose extreme diversity renders necessary the development of multivalent vaccines. Immunity against Shigella LPS can elicit antibodies capable of killing bacteria in a serotype-specific manner. Therefore, although a correlation of protection against shigellosis has not been established, demonstration of vaccine-elicited antibody bactericidal activity may provide one means of vaccine protection against Shigella. To facilitate Shigella vaccine development, we have set up a high-throughput serum bactericidal assay based on luminescence readout (L-SBA), which has been already used to determine the functionality of antibodies against S. sonnei in multiple clinical trials. Here we present the setup and intra-laboratory characterization of L-SBA against three epidemiologically relevant Shigella flexneri serotypes using human sera. We assessed the linearity, repeatability and reproducibility of the method, demonstrating high assay specificity to detect the activity of antibodies against each homologous strain without any heterologous aspecificity against species-related and non-species-related strains; this assay is ready to be used to determine bactericidal activity of clinical sera raised by multivalent vaccines and in sero-epidemiological studies.
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Palmieri E, Kis Z, Ozanne J, Di Benedetto R, Ricchetti B, Massai L, Carducci M, Oldrini D, Gasperini G, Aruta MG, Rossi O, Kontoravdi C, Shah N, Mawas F, Micoli F. GMMA as an Alternative Carrier for a Glycoconjugate Vaccine against Group A Streptococcus. Vaccines (Basel) 2022; 10:vaccines10071034. [PMID: 35891202 PMCID: PMC9324507 DOI: 10.3390/vaccines10071034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Group A Streptococcus (GAS) causes about 500,000 annual deaths globally, and no vaccines are currently available. The Group A Carbohydrate (GAC), conserved across all GAS serotypes, conjugated to an appropriate carrier protein, represents a promising vaccine candidate. Here, we explored the possibility to use Generalized Modules for Membrane Antigens (GMMA) as an alternative carrier system for GAC, exploiting their intrinsic adjuvant properties. Immunogenicity of GAC-GMMA conjugate was evaluated in different animal species in comparison to GAC-CRM197; and the two conjugates were also compared from a techno-economic point of view. GMMA proved to be a good alternative carrier for GAC, resulting in a higher immune response compared to CRM197 in different mice strains, as verified by ELISA and FACS analyses. Differently from CRM197, GMMA induced significant levels of anti-GAC IgG titers in mice also in the absence of Alhydrogel. In rabbits, a difference in the immune response could not be appreciated; however, antibodies from GAC-GMMA-immunized animals showed higher affinity toward purified GAC antigen compared to those elicited by GAC-CRM197. In addition, the GAC-GMMA production process proved to be more cost-effective, making this conjugate particularly attractive for low- and middle-income countries, where this pathogen has a huge burden.
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Affiliation(s)
- Elena Palmieri
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Zoltán Kis
- The Sargent Centre for Process Systems Engineering, Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (Z.K.); (C.K.); (N.S.)
- Department of Chemical and Biological Engineering, The University of Sheffield, Mappin Street, Sheffield S1 3JD, UK
| | - James Ozanne
- The National Institute for Biological Standards and Control (NIBSC), South Mimms EN6 3QG, UK; (J.O.); (F.M.)
| | - Roberta Di Benedetto
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Beatrice Ricchetti
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Luisa Massai
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Davide Oldrini
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Gianmarco Gasperini
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Maria Grazia Aruta
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
| | - Cleo Kontoravdi
- The Sargent Centre for Process Systems Engineering, Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (Z.K.); (C.K.); (N.S.)
| | - Nilay Shah
- The Sargent Centre for Process Systems Engineering, Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; (Z.K.); (C.K.); (N.S.)
| | - Fatme Mawas
- The National Institute for Biological Standards and Control (NIBSC), South Mimms EN6 3QG, UK; (J.O.); (F.M.)
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (R.D.B.); (B.R.); (L.M.); (M.C.); (D.O.); (G.G.); (M.G.A.); (O.R.)
- Correspondence: ; Tel.: +39-0577-539087
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Di Ciaula A, Bonfrate L, Portincasa P, Appice C, Belfiore A, Binetti M, Cafagna G, Campanale G, Carrieri A, Cascella G, Cataldi S, Cezza A, Ciannarella M, Cicala L, D'Alitto F, Dell'Acqua A, Dell'Anna L, Diaferia M, Erroi G, Fiermonte F, Galerati I, Giove M, Grimaldi L, Mallardi C, Mastrandrea E, Mazelli GD, Mersini G, Messina G, Messina M, Montesano A, Noto A, Novielli ME, Noviello M, Palma MV, Palmieri VO, Passerini F, Perez F, Piro C, Prigigallo F, Pugliese S, Rossi O, Stasi C, Stranieri R, Vitariello G. Nitrogen dioxide pollution increases vulnerability to COVID-19 through altered immune function. Environ Sci Pollut Res Int 2022; 29:44404-44412. [PMID: 35133597 PMCID: PMC9200946 DOI: 10.1007/s11356-022-19025-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
Abstract
Previous ecological studies suggest the existence of possible interplays between the exposure to air pollutants and SARS-CoV-2 infection. Confirmations at individual level, however, are lacking. To explore the relationships between previous exposure to particulate matter < 10 μm (PM10) and nitrogen dioxide (NO2), the clinical outcome following hospital admittance, and lymphocyte subsets in COVID-19 patients with pneumonia. In 147 geocoded patients, we assessed the individual exposure to PM10 and NO2 in the 2 weeks before hospital admittance. We divided subjects according to the clinical outcome (i.e., discharge at home vs in-hospital death), and explored the lymphocyte-related immune function as an index possibly affecting individual vulnerability to the infection. As compared with discharged subjects, patients who underwent in-hospital death presented neutrophilia, lymphopenia, lower number of T CD45, CD3, CD4, CD16/56 + CD3 + , and B CD19 + cells, and higher previous exposure to NO2, but not PM10. Age and previous NO2 exposure were independent predictors for mortality. NO2 concentrations were also negatively related with the number of CD45, CD3, and CD4 cells. Previous NO2 exposure is a co-factor independently affecting the mortality risk in infected individuals, through negative immune effects. Lymphopenia and altered lymphocyte subsets might precede viral infection due to nonmodifiable (i.e., age) and external (i.e., air pollution) factors. Thus, decreasing the burden of air pollutants should be a valuable primary prevention measure to reduce individual susceptibility to SARS-CoV-2 infection and mortality.
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Affiliation(s)
- Agostino Di Ciaula
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy.
- International Society of Doctors for Environment (ISDE), Arezzo, Italy.
| | - Leonilde Bonfrate
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | | | - C Appice
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Belfiore
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Binetti
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Cafagna
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Campanale
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Carrieri
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Cascella
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - S Cataldi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Cezza
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Ciannarella
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - L Cicala
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - F D'Alitto
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Dell'Acqua
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - L Dell'Anna
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Diaferia
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Erroi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - F Fiermonte
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - I Galerati
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Giove
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - L Grimaldi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - C Mallardi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - E Mastrandrea
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G D Mazelli
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Mersini
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Messina
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Messina
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Montesano
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - A Noto
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M E Novielli
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M Noviello
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - M V Palma
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - V O Palmieri
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - F Passerini
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - F Perez
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - C Piro
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - F Prigigallo
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - S Pugliese
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - O Rossi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - C Stasi
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - R Stranieri
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - G Vitariello
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
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Tondi S, Clemente B, Esposito C, Sammicheli C, Tavarini S, Martin LB, Rossi O, Micoli F, Bartolini E, Brazzoli M, Ulivieri C, Blohmke CJ, Schiavetti F. Dissecting in Vitro the Activation of Human Immune Response Induced by Shigella sonnei GMMA. Front Cell Infect Microbiol 2022; 12:767153. [PMID: 35186786 PMCID: PMC8851470 DOI: 10.3389/fcimb.2022.767153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022] Open
Abstract
Generalized Modules for Membrane Antigens (GMMA) are outer membrane exosomes purified from Gram-negative bacteria genetically mutated to increase blebbing and reduce risk of reactogenicity. This is commonly achieved through modification of the lipid A portion of lipopolysaccharide. GMMA faithfully resemble the bacterial outer membrane surface, and therefore represent a powerful and flexible platform for vaccine development. Although GMMA-based vaccines have been demonstrated to induce a strong and functional antibody response in animals and humans maintaining an acceptable reactogenicity profile, the overall impact on immune cells and their mode of action are still poorly understood. To characterize the GMMA-induced immune response, we stimulated human peripheral blood mononuclear cells (hPBMCs) with GMMA from Shigella sonnei. We studied GMMA both with wild-type hexa-acylated lipid A and with the corresponding less reactogenic penta-acylated form. Using multicolor flow cytometry, we assessed the activation of immune cell subsets and we profiled intracellular cytokine production after GMMA stimulation. Moreover, we measured the secretion of thirty cytokines/chemokines in the cell culture supernatants. Our data indicated activation of monocytes, dendritic, NK, B, and γδ T cells. Comparison of the cytokine responses showed that, although the two GMMA have qualitatively similar profiles, GMMA with modified penta-acylated lipid A induced a lower production of pro-inflammatory cytokines/chemokines compared to GMMA with wild-type lipid A. Intracellular cytokine staining indicated monocytes and dendritic cells as the main source of the cytokines produced. Overall, these data provide new insights into the activation of key immune cells potentially targeted by GMMA-based vaccines.
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Affiliation(s)
- Serena Tondi
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Bruna Clemente
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | - Carmen Esposito
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | - Chiara Sammicheli
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | - Simona Tavarini
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | - Laura B. Martin
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health S.R.L. (GVGH), Siena, Italy
| | - Omar Rossi
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health S.R.L. (GVGH), Siena, Italy
| | - Francesca Micoli
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health S.R.L. (GVGH), Siena, Italy
| | - Erika Bartolini
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | - Michela Brazzoli
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
| | | | - Christoph J. Blohmke
- GlaxoSmithKline (GSK), Artificial Intelligence & Machine Learning (AIML), London, United Kingdom
| | - Francesca Schiavetti
- GlaxoSmithKline (GSK), Preclinical Evidence Generation (PEG), Siena, Italy
- *Correspondence: Francesca Schiavetti,
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29
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Carli G, Farsi A, Bormioli S, Ridolo E, Fassio F, Pucci S, Montevecchi M, Riparbelli M, Cosmi L, Parronchi P, Rossi O. Management of patients with severe asthma: results from a survey among allergists and clinical immunologists of the Central Italy Inter-Regional Section of SIAAIC. Clin Mol Allergy 2021; 19:22. [PMID: 34872572 PMCID: PMC8647303 DOI: 10.1186/s12948-021-00160-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Asthma, and severe asthma in particular, is often managed within a specialized field with allergists and clinical immunologists playing a leading role. In this respect, the National Scientific Society SIAAIC (Società Italiana di Allergologia, Asma ed Immunologia Clinica), structured in Regional and Inter-Regional sections, interviewed a large number of specialists involved in the management of this respiratory disease. Methods A survey entitled “Management of patients with asthma and severe asthma” based on 17 questions was conducted through the SIAAIC newsletter in 2019 thanks to the collaboration between GlaxoSmithKline S.p.A. and the Inter-Regional Section of SIAAIC of Central Italy. Results Fifty-nine allergists and clinical immunologists participated to the survey, and 40 of them completed the entire questionnaire. Almost all of the specialists (88%) reported that asthma control was achieved in above 50% of their patients, even if only one third (32%) actually used validated clinical tools such as asthma control test (ACT). Poor adherence to inhaled therapy was recognized as the main cause of asthma control failure by 60% of respondents, and 2–5 min on average is dedicated to the patient inhaler technique training by two-thirds of the experts (65%). Maintenance and as-needed therapy (SMART/MART) is considered an appropriate approach in only a minority of the patients (25%) by one half of the respondents (52%). A high number of exacerbations despite the maximum inhalation therapy were recognized as highly suspicious of severe asthma. Patients eligible for biological therapies are 3–5% of the patients, and almost all the responders (95%) agreed that patients affected by severe asthma need to be managed in specialized centers with dedicated settings. Biological drugs are generally prescribed after 3–6 months from the initial access to the center, and once started, the follow-up is initially programmed monthly, and then every 3–6 months after the first year of treatment (96% of responders). After phenotyping and severity assessment, comorbidities (urticaria, chronic rhinosinusitis with or without nasal polyps, vasculitis, etc.) are the drivers of choice among the different biological drugs. In the management of severe asthma, general practitioners (GPs) should play a central role in selecting patients and referring them to specialized centers while Scientific Societies should train GPs to appropriately recognize difficult asthma and promote public disease awareness campaigns. Conclusions This survey which collects the point of view of allergists and clinical immunologists from Central Italy highlights that asthma control is still not measured with validated instruments. There is a general consensus that severe asthma should be managed only in dedicated centers and to this aim it is essential to encourage patient selection from a primary care setting and develop disease awareness campaigns for patients.
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Affiliation(s)
- G Carli
- SOS Allergologia ed Immunologia, USL Toscana Centro, Prato, Italy
| | - A Farsi
- SOS Allergologia ed Immunologia, USL Toscana Centro, Prato, Italy
| | - S Bormioli
- Dept. Experimental and Clinical Medicine, University of Florence, Florence, Italy.,SOD Immunoallergologia, AOU Careggi, Florence, Italy
| | - E Ridolo
- Dept. Medicine and Surgery, University of Parma, Parma, Italy
| | - F Fassio
- SOC Allergologia ed Immunologia Clinica, Ospedale San Giovanni di Dio, USL Toscana Centro, Florence, Italy
| | - S Pucci
- OUC Allergologia, PO Civitanova Marche, Civitanova Marche, MC, Italy
| | | | | | - L Cosmi
- Dept. Experimental and Clinical Medicine, University of Florence, Florence, Italy.,SOD Immunologia e Terapie cellulari, AOU Careggi, Florence, Italy
| | - P Parronchi
- Dept. Experimental and Clinical Medicine, University of Florence, Florence, Italy. .,SOD Immunologia e Terapie cellulari, AOU Careggi, Florence, Italy.
| | - O Rossi
- SOD Immunoallergologia, AOU Careggi, Florence, Italy
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30
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Seppala M, Thivichon-Prince B, Xavier GM, Shaffie N, Sangani I, Birjandi AA, Rooney J, Lau JNS, Dhaliwal R, Rossi O, Riaz MA, Stonehouse-Smith D, Wang Y, Papageorgiou SN, Viriot L, Cobourne MT. Gas1 Regulates Patterning of the Murine and Human Dentitions through Sonic Hedgehog. J Dent Res 2021; 101:473-482. [PMID: 34796774 PMCID: PMC8935464 DOI: 10.1177/00220345211049403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mammalian dentition is a serially homogeneous structure that exhibits wide numerical and morphological variation among multiple different species. Patterning of the dentition is achieved through complex reiterative molecular signaling interactions that occur throughout the process of odontogenesis. The secreted signaling molecule Sonic hedgehog (Shh) plays a key role in this process, and the Shh coreceptor growth arrest-specific 1 (Gas1) is expressed in odontogenic mesenchyme and epithelium during multiple stages of tooth development. We show that mice engineered with Gas1 loss-of-function mutation have variation in number, morphology, and size of teeth within their molar dentition. Specifically, supernumerary teeth with variable morphology are present mesial to the first molar with high penetrance, while molar teeth are characterized by the presence of both additional and absent cusps, combined with reduced dimensions and exacerbated by the presence of a supernumerary tooth. We demonstrate that the supernumerary tooth in Gas1 mutant mice arises through proliferation and survival of vestigial tooth germs and that Gas1 function in cranial neural crest cells is essential for the regulation of tooth number, acting to restrict Wnt and downstream FGF signaling in odontogenic epithelium through facilitation of Shh signal transduction. Moreover, regulation of tooth number is independent of the additional Hedgehog coreceptors Cdon and Boc, which are also expressed in multiple regions of the developing tooth germ. Interestingly, further reduction of Hedgehog pathway activity in Shhtm6Amc hypomorphic mice leads to fusion of the molar field and reduced prevalence of supernumerary teeth in a Gas1 mutant background. Finally, we demonstrate defective coronal morphology and reduced coronal dimensions in the molar dentition of human subjects identified with pathogenic mutations in GAS1 and SHH/GAS1, suggesting that regulation of Hedgehog signaling through GAS1 is also essential for normal patterning of the human dentition.
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Affiliation(s)
- M Seppala
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - B Thivichon-Prince
- Laboratoire de Biologie tissulaire et Ingénierie Thérapeutique (LBTI), UMR CNRS 5305/Université de Lyon 1, IBCP, Lyon, France.,Faculté d'Odontologie, Université de Lyon 1, Université de Lyon, Lyon, France.,Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - G M Xavier
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - N Shaffie
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - I Sangani
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - A A Birjandi
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J Rooney
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J N S Lau
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - R Dhaliwal
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - O Rossi
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - M A Riaz
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - D Stonehouse-Smith
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Y Wang
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - S N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - L Viriot
- Laboratoire de Biologie tissulaire et Ingénierie Thérapeutique (LBTI), UMR CNRS 5305/Université de Lyon 1, IBCP, Lyon, France
| | - M T Cobourne
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Citiulo F, Necchi F, Mancini F, Rossi O, Aruta MG, Gasperini G, Alfini R, Rondini S, Micoli F, Rappuoli R, Saul A, Martin LB. Rationalizing the design of a broad coverage Shigella vaccine based on evaluation of immunological cross-reactivity among S. flexneri serotypes. PLoS Negl Trop Dis 2021; 15:e0009826. [PMID: 34644291 PMCID: PMC8589205 DOI: 10.1371/journal.pntd.0009826] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/12/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
No vaccine to protect against an estimated 238,000 shigellosis deaths per year is widely available. S. sonnei is the most prevalent Shigella, and multiple serotypes of S. flexneri, which change regionally and globally, also cause significant disease. The leading Shigella vaccine strategies are based on the delivery of serotype specific O-antigens. A strategy to minimize the complexity of a broadly-protective Shigella vaccine is to combine components from S. sonnei with S. flexneri serotypes that induce antibodies with maximum cross-reactivity between different serotypes. We used the GMMA-technology to immunize animal models and generate antisera against 14 S. flexneri subtypes from 8 different serotypes that were tested for binding to and bactericidal activity against a panel of 11 S. flexneri bacteria lines. Some immunogens induced broadly cross-reactive antibodies that interacted with most of the S. flexneri in the panel, while others induced antibodies with narrower specificity. Most cross-reactivity could not be assigned to modifications of the O-antigen, by glucose, acetate or phosphoethanolamine, common to several of the S. flexneri serotypes. This allowed us to revisit the current dogma of cross-reactivity among S. flexneri serotypes suggesting that a broadly protective vaccine is feasible with limited number of appropriately selected components. Thus, we rationally designed a 4-component vaccine selecting GMMA from S. sonnei and S. flexneri 1b, 2a and 3a. The resulting formulation was broadly cross-reactive in mice and rabbits, inducing antibodies that killed all S. flexneri serotypes tested. This study provides the framework for a broadly-protective Shigella vaccine which needs to be verified in human trials. A strategy to optimize the composition for a broadly-protective Shigella vaccine is to combine components directed against S. sonnei with S. flexneri serotypes to induce antibody responses with the maximum cross-reactivity between different serotypes. Based on mouse and rabbit immunogenicity, we selected 4 GMMA-immunogens, derived from S. sonnei and S. flexneri 1b, 2a and 3a, able to induce antibodies that were broadly bactericidal against most epidemiologically significant S. flexneri strains in mice and rabbits. This was not predicted on the basis of O-antigen modifications conferring serotype or group specificities and allowed revisiting the dogma of cross-protection among S. flexneri serotypes. Overall, this study provides a framework for the rational design of a broadly-protective vaccine that will be evaluated in upcoming human vaccine trials. It also tackles a key issue regarding Shigella vaccine development that is balancing a sufficient number of antigenic components in the vaccine to provide adequate coverage of serotype diversity while minimizing complexity.
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Affiliation(s)
- Francesco Citiulo
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
- * E-mail:
| | - Francesca Necchi
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | - Francesca Mancini
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | | | | | - Renzo Alfini
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | | | - Francesca Micoli
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | | | - Allan Saul
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
| | - Laura B. Martin
- GSK Vaccines Institute for Global Health S.r.l. (GVGH), Siena, Italy
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32
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Frenck RW, Conti V, Ferruzzi P, Ndiaye AG, Parker S, McNeal MM, Dickey M, Granada JP, Cilio GL, De Ryck I, Necchi F, Suvarnapunya AE, Rossi O, Acquaviva A, Chandrasekaran L, Clarkson KA, Auerbach J, Marchetti E, Kaminski RW, Micoli F, Rappuoli R, Saul A, Martin LB, Podda A. Efficacy, safety, and immunogenicity of the Shigella sonnei 1790GAHB GMMA candidate vaccine: Results from a phase 2b randomized, placebo-controlled challenge study in adults. EClinicalMedicine 2021; 39:101076. [PMID: 34430837 PMCID: PMC8367798 DOI: 10.1016/j.eclinm.2021.101076] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Shigellosis accounts for substantial morbidity and mortality worldwide and is the second most common cause of moderate and severe diarrhoea in children. METHODS This phase 2b study (NCT03527173), conducted between August 2018 and November 2019, evaluated vaccine efficacy (VE), safety, and immunogenicity of a Shigella sonnei GMMA candidate vaccine (1790GAHB) in adults, using a S. sonnei 53 G controlled human infection model. Participants (randomized 1:1) received two doses of 1790GAHB or placebo (GAHB-Placebo), at day (D) 1 and D29, and an oral challenge of S. sonnei 53 G at D57. VE was evaluated using several endpoints, reflecting different case definitions of shigellosis. For the primary endpoint, the success criterion was a lower limit of the 90% confidence interval >0. FINDINGS Thirty-six and 35 participants received 1790GAHB or placebo, respectively; 33 and 29 were challenged, 15 and 12 developed shigellosis. VE was not demonstrated for any endpoint. Adverse events were more frequent in 1790GAHB versus placebo recipients post-vaccination. Anti-S. sonnei lipopolysaccharide (LPS) IgG responses increased at D29 and remained stable through D57 in group 1790GAHB; no increase was shown in placebo recipients. INTERPRETATION 1790GAHB had an acceptable safety profile and induced anti-LPS IgG responses but did not demonstrate clinical efficacy against shigellosis. Baseline/pre-challenge antibody levels were higher in participants who did not develop shigellosis post-challenge, suggesting a role of anti-LPS IgG antibodies in clinical protection, although not fully elucidated in this study. For further vaccine development an increased S. sonnei O-antigen content is likely needed to enhance anti-LPS immune responses. FUNDING GlaxoSmithKline Biologicals SA, Bill and Melinda Gates Foundation.
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Affiliation(s)
- Robert W. Frenck
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | | | | | - Susan Parker
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Monica Malone McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Michelle Dickey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | | | | | | | | | - Akamol E. Suvarnapunya
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Lakshmi Chandrasekaran
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | - Kristen A. Clarkson
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | | | | | - Robert W. Kaminski
- Department of Diarrheal Disease Research, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States
| | | | - Rino Rappuoli
- GSK Vaccines Institute for Global Health, Siena, Italy
- GSK, Siena, Italy
| | - Allan Saul
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
- Corresponding author at: GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100 Siena, Italy.
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33
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Mancini F, Micoli F, Necchi F, Pizza M, Berlanda Scorza F, Rossi O. GMMA-Based Vaccines: The Known and The Unknown. Front Immunol 2021; 12:715393. [PMID: 34413858 PMCID: PMC8368434 DOI: 10.3389/fimmu.2021.715393] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Generalized Modules for Membrane Antigens (GMMA) are outer membrane vesicles derived from Gram-negative bacteria engineered to provide an over-vesiculating phenotype, which represent an attractive platform for the design of affordable vaccines. GMMA can be further genetically manipulated to modulate the risk of systemic reactogenicity and to act as delivery system for heterologous polysaccharide or protein antigens. GMMA are able to induce strong immunogenicity and protection in animal challenge models, and to be well-tolerated and immunogenic in clinical studies. The high immunogenicity could be ascribed to their particulate size, to their ability to present to the immune system multiple antigens in a natural conformation which mimics the bacterial environment, as well as to their intrinsic self-adjuvanticity. However, GMMA mechanism of action and the role in adjuvanticity are still unclear and need further investigation. In this review, we discuss progresses in the development of the GMMA vaccine platform, highlighting successful applications and identifying knowledge gaps and potential challenges.
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Affiliation(s)
- Francesca Mancini
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Francesca Micoli
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Francesca Necchi
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | - Mariagrazia Pizza
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
| | | | - Omar Rossi
- GlaxoSmithKline (GSK) Vaccines Institute for Global Health (GVGH), Siena, Italy
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34
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Kanvatirth P, Rossi O, Restif O, Blacklaws BA, Tonks P, Grant AJ, Mastroeni P. Dual role of splenic mononuclear and polymorphonuclear cells in the outcome of ciprofloxacin treatment of Salmonella enterica infections. J Antimicrob Chemother 2021; 75:2914-2918. [PMID: 32613238 DOI: 10.1093/jac/dkaa249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To determine the immune cell populations associated with Salmonella enterica serovar Typhimurium before and after ciprofloxacin treatment using a murine model of systemic infection. The effect of depletion of immune cells associating with Salmonella on treatment outcome was also determined. METHODS We infected mice with a Salmonella enterica serovar Typhimurium strain expressing GFP and used multicolour flow cytometry to identify splenic immune cell populations associating with GFP-positive Salmonella before and after treatment with ciprofloxacin. This was followed by depletion of different immune cell populations using antibodies and liposomes. RESULTS Our results identified CD11b+CD11chi/lo (dendritic cells/macrophages) and Ly6G+CD11b+ (neutrophils) leucocytes as the main host cell populations that are associated with Salmonella after ciprofloxacin treatment. We therefore proceeded to test the effects of depletion of such populations during treatment. We show that depletion of Ly6G+CD11b+ populations resulted in an increase in the number of viable bacterial cells in the spleen at the end of ciprofloxacin treatment. Conversely, treatment with clodronate liposomes during antimicrobial treatment, which depleted the CD11b+CD11chi/lo populations, resulted in lower numbers of viable bacteria in the tissues. CONCLUSIONS Our study identified host cells where Salmonella bacteria persist during ciprofloxacin treatment and revealed a dual and opposing effect of removal of Ly6G+CD11b+ and CD11b+CD11chi/lo host cells on the efficacy of antimicrobial treatment. This suggests a dichotomy in the role of these populations in clearance/persistence of Salmonella during antimicrobial treatment.
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Affiliation(s)
- P Kanvatirth
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - O Rossi
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - O Restif
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - B A Blacklaws
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - P Tonks
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - A J Grant
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - P Mastroeni
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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35
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Micoli F, Rossi O, Conti V, Launay O, Sciré AS, Aruta MG, Nakakana UN, Marchetti E, Rappuoli R, Saul A, Martin LB, Necchi F, Podda A. Antibodies Elicited by the Shigella sonnei GMMA Vaccine in Adults Trigger Complement-Mediated Serum Bactericidal Activity: Results From a Phase 1 Dose Escalation Trial Followed by a Booster Extension. Front Immunol 2021; 12:671325. [PMID: 34017343 PMCID: PMC8129577 DOI: 10.3389/fimmu.2021.671325] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 01/05/2023] Open
Abstract
Shigella is the second most deadly diarrheal disease among children under five years of age, after rotavirus, with high morbidity and mortality in developing countries. Currently, no vaccine is widely available, and the increasing levels of multidrug resistance make Shigella a high priority for vaccine development. The single-component candidate vaccine against Shigella sonnei (1790GAHB), developed using the GMMA technology, contains the O antigen (OAg) portion of lipopolysaccharide (LPS) as active moiety. The vaccine was well tolerated and immunogenic in early-phase clinical trials. In a phase 1 placebo-controlled dose escalation trial in France (NCT02017899), three doses of five different vaccine formulations (0.06/1, 0.3/5, 1.5/25, 3/50, 6/100 µg of OAg/protein) were administered to healthy adults. In the phase 1 extension trial (NCT03089879), conducted 2–3 years following the parent study, primed individuals who had undetectable antibody levels before the primary series received a 1790GAHB booster dose (1.5/25 µg OAg/protein). Controls were unprimed participants immunized with one 1790GAHB dose. The current analysis assessed the functionality of sera collected from both studies using a high-throughput luminescence-based serum bactericidal activity (SBA) assay optimized for testing human sera. Antibodies with complement-mediated bactericidal activity were detected in vaccinees but not in placebo recipients. SBA titers increased with OAg dose, with a persistent response up to six months after the primary vaccination with at least 1.5/25 µg of OAg/protein. The booster dose induced a strong increase of SBA titers in most primed participants. Correlation between SBA titers and anti-S. sonnei LPS serum immunoglobulin G levels was observed. Results suggest that GMMA is a promising OAg delivery system for the generation of functional antibody responses and persistent immunological memory.
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Affiliation(s)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,Inserm CIC 1417, F-CRIN I-REIVAC, Paris, France
| | | | | | | | | | - Rino Rappuoli
- GSK Vaccines Institute for Global Health, Siena, Italy
| | - Allan Saul
- GSK Vaccines Institute for Global Health, Siena, Italy
| | | | | | - Audino Podda
- GSK Vaccines Institute for Global Health, Siena, Italy
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36
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Palmieri E, Arato V, Oldrini D, Ricchetti B, Aruta MG, Pansegrau W, Marchi S, Giusti F, Ferlenghi I, Rossi O, Alfini R, Giannelli C, Gasperini G, Necchi F, Micoli F. Stability of Outer Membrane Vesicles-Based Vaccines, Identifying the Most Appropriate Methods to Detect Changes in Vaccine Potency. Vaccines (Basel) 2021; 9:229. [PMID: 33800727 PMCID: PMC7998687 DOI: 10.3390/vaccines9030229] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 01/15/2023] Open
Abstract
Ensuring the stability of vaccines is crucial to successfully performing global immunization programs. Outer Membrane Vesicles (OMV) are receiving great attention as vaccine platforms. OMV are complex molecules and few data have been collected so far on their stability. OMV produced by bacteria, genetically modified to increase their spontaneous release, simplifying their production, are also known as Generalized Modules for Membrane Antigens (GMMA). We have performed accelerated stability studies on GMMA from different pathogens and verified the ability of physico-chemical and immunological methods to detect possible changes. High-temperature conditions (100 °C for 40 min) did not affect GMMA stability and immunogenicity in mice, in contrast to the effect of milder temperatures for a longer period of time (37 °C or 50 °C for 4 weeks). We identified critical quality attributes to monitor during stability assessment that could impact vaccine efficacy. In particular, specific recognition of antigens by monoclonal antibodies through competitive ELISA assays may replace in vivo tests for the potency assessment of GMMA-based vaccines.
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Affiliation(s)
- Elena Palmieri
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Vanessa Arato
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Davide Oldrini
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Beatrice Ricchetti
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Maria Grazia Aruta
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Werner Pansegrau
- GSK, Via Fiorentina 1, 53100 Siena, Italy; (W.P.); (S.M.); (F.G.); (I.F.)
| | - Sara Marchi
- GSK, Via Fiorentina 1, 53100 Siena, Italy; (W.P.); (S.M.); (F.G.); (I.F.)
| | - Fabiola Giusti
- GSK, Via Fiorentina 1, 53100 Siena, Italy; (W.P.); (S.M.); (F.G.); (I.F.)
| | - Ilaria Ferlenghi
- GSK, Via Fiorentina 1, 53100 Siena, Italy; (W.P.); (S.M.); (F.G.); (I.F.)
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Carlo Giannelli
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Gianmarco Gasperini
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Via Fiorentina 1, 53100 Siena, Italy; (E.P.); (V.A.); (D.O.); (B.R.); (M.G.A.); (O.R.); (R.A.); (C.G.); (G.G.); (F.N.)
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Mancini F, Gasperini G, Rossi O, Aruta MG, Raso MM, Alfini R, Biagini M, Necchi F, Micoli F. Dissecting the contribution of O-Antigen and proteins to the immunogenicity of Shigella sonnei generalized modules for membrane antigens (GMMA). Sci Rep 2021; 11:906. [PMID: 33441861 PMCID: PMC7806729 DOI: 10.1038/s41598-020-80421-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/11/2020] [Indexed: 01/11/2023] Open
Abstract
GMMA are exosomes released from engineered Gram-negative bacteria resembling the composition of outer membranes. We applied the GMMA technology for the development of an O-Antigen (OAg) based vaccine against Shigella sonnei, the most epidemiologically relevant cause of shigellosis. S. sonnei OAg has been identified as a key antigen for protective immunity, and GMMA are able to induce anti-OAg-specific IgG response in animal models and healthy adults. The contribution of protein-specific antibodies induced upon vaccination with GMMA has never been fully elucidated. Anti-protein antibodies are induced in mice upon immunization with either OAg-negative and OAg-positive GMMA. Here we demonstrated that OAg chains shield the bacteria from anti-protein antibody binding and therefore anti-OAg antibodies were the main drivers of bactericidal activity against OAg-positive bacteria. Interestingly, antibodies that are not targeting the OAg are functional against OAg-negative bacteria. The immunodominant protein antigens were identified by proteomic analysis. Our study confirms a critical role of the OAg on the immune response induced by S. sonnei GMMA. However, little is known about OAg length and density regulation during infection and, therefore, protein exposure. Hence, the presence of protein antigens on S. sonnei GMMA represents an added value for GMMA vaccines compared to other OAg-based formulations.
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Affiliation(s)
- Francesca Mancini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Gianmarco Gasperini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Maria Grazia Aruta
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Maria Michelina Raso
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Renzo Alfini
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | | | - Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy
| | - Francesca Micoli
- GSK Vaccines Institute for Global Health (GVGH), via Fiorentina 1, 53100, Siena, Italy.
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38
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Rossi O, Aruta MG, Acquaviva A, Mancini F, Micoli F, Necchi F. Characterization of Competitive ELISA and Formulated Alhydrogel Competitive ELISA (FAcE) for Direct Quantification of Active Ingredients in GMMA-Based Vaccines. Methods Protoc 2020; 3:mps3030062. [PMID: 32878036 PMCID: PMC7563494 DOI: 10.3390/mps3030062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022] Open
Abstract
Generalized modules for membrane antigens (GMMA) represent a technology particularly attractive for designing affordable vaccines against Gram-negative bacteria. We explored such technology for the development of O-antigen-based vaccines against Shigella and nontyphoidal Salmonella. Adsorption of GMMA on Alhydrogel was required for abrogation of pyrogenicity in rabbits, and Shigella sonnei GMMA on Alhydrogel was well tolerated and immunogenic in humans. Quantification of key antigens in formulated vaccines was fundamental for release and to check stability overtime. Traditionally, the direct quantification of antigens adsorbed on aluminum salts has been challenging, and the quantification of each active ingredient in multicomponent formulated vaccines has been even more complicated. To directly quantify each active ingredient and unbound drug substances in formulated vaccines, we developed the Formulated Alhydrogel competitive ELISA (FAcE) and the competitive ELISA method, respectively. The methods were both fully characterized, assessing specificity, repeatability, intermediate precision, and accuracy, for S. sonnei OAg quantification, both in a single component or multicomponent GMMA formulation also containing S. flexneri GMMA. The developed immunological methods allowed us to fully characterize Shigella GMMA drug products, supporting their preclinical and clinical development. The same methods, already extended to GMMA from nontyphoidal Salmonella and Neisseria meningitidis, could be potentially extended to any antigen formulated on Alhydrogel.
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Rossi O, Vlazaki M, Kanvatirth P, Restif O, Mastroeni P. Within-host spatiotemporal dynamic of systemic salmonellosis: Ways to track infection, reaction to vaccination and antimicrobial treatment. J Microbiol Methods 2020; 176:106008. [PMID: 32707153 DOI: 10.1016/j.mimet.2020.106008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022]
Abstract
During the last two decades our understanding of the complex in vivo host-pathogen interactions has increased due to technical improvements and new research tools. The rapid advancement of molecular biology, flow cytometry and microscopy techniques, combined with mathematical modelling, have empowered in-depth studies of systemic bacterial infections across scales from single molecules, to cells, to organs and systems to reach the whole organism level. By tracking subpopulations of bacteria in vivo using molecular or fluorescent tags, it has been possible to reconstruct the spread of infection within and between organs, allowing unprecedented quantification of the effects of antimicrobial treatment and vaccination. This review illustrates recent advances in the study of heterogeneous traits of the infection process and illustrate approaches to investigate the reciprocal interactions between antimicrobial treatments, bacterial growth/death as well as inter- and intra-organ spread. We also discuss how vaccines impact the in vivo behaviour of bacteria and how these findings can guide vaccine design and rational antimicrobial treatment.
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Affiliation(s)
- Omar Rossi
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK.
| | - Myrto Vlazaki
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Panchali Kanvatirth
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Olivier Restif
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK
| | - Pietro Mastroeni
- University of Cambridge, Department of Veterinary Medicine, Madingley Road, CB3 0ES Cambridge, UK.
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Rossi O, Citiulo F, Mancini F. Outer membrane vesicles: moving within the intricate labyrinth of assays that can predict risks of reactogenicity in humans. Hum Vaccin Immunother 2020; 17:601-613. [PMID: 32687736 PMCID: PMC7899674 DOI: 10.1080/21645515.2020.1780092] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Outer membrane vesicles (OMV) are exosomes naturally released from the surface of Gram-negative bacteria. Since the ’80s, OMVs have been proposed as powerful vaccine platforms due to their intrinsic self-adjuvanticity and ability to present multiple antigens in natural conformation. However, the presence of several pathogen-associated molecular patterns (PAMPs), especially lipid A, has raised concerns about potential systemic reactogenicity in humans. Recently, chemical and genetic approaches allowed to efficiently modulate the balance between reactogenicity and immunogenicity for the use of OMV in humans. Several assays (monocyte activation test, rabbit pyrogenicity test, limulus amebocyte lysate, human transfectant cells, and toxicology studies) were developed to test, with highly predictive potential, the risk of reactogenicity in humans before moving to clinical use. In this review, we provide a historical perspective on how different assays were and can be used to successfully evaluate systemic reactogenicity during clinical development and after licensure.
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Affiliation(s)
- Omar Rossi
- GSK Vaccines Institute for Global Health S.r.l (GVGH) , Siena, Italy
| | - Francesco Citiulo
- GSK Vaccines Institute for Global Health S.r.l (GVGH) , Siena, Italy
| | - Francesca Mancini
- GSK Vaccines Institute for Global Health S.r.l (GVGH) , Siena, Italy
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Vlazaki M, Rossi O, Price DJ, McLean C, Grant AJ, Mastroeni P, Restif O. A data-based mathematical modelling study to quantify the effects of ciprofloxacin and ampicillin on the within-host dynamics of Salmonella enterica during treatment and relapse. J R Soc Interface 2020; 17:20200299. [PMID: 32634369 DOI: 10.1098/rsif.2020.0299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Antibiotic therapy has drastically reduced the mortality and sequelae of bacterial infections. From naturally occurring to chemically synthesized, different classes of antibiotics have been successfully used without detailed knowledge of how they affect bacterial dynamics in vivo. However, a proportion of patients receiving antimicrobial therapy develop recrudescent infections post-treatment. Relapsing infections are attributable to incomplete clearance of bacterial populations following antibiotic administration; the metabolic profile of this antibiotic-recalcitrant bacterial subpopulation, the spatio-temporal context of its emergence and the variance of antibiotic-bacterial interactions in vivo remain unclear. Here, we develop and apply a mechanistic mathematical model to data from a study comparing the effects of ciprofloxacin and ampicillin on the within-host dynamics of Salmonella enterica serovar Typhimurium in murine infections. Using the inferential capacity of our model, we show that the antibiotic-recalcitrant bacteria following ampicillin, but not ciprofloxacin, treatment belong to a non-replicating phenotype. Aligning with previous studies, we independently estimate that the lymphoid tissues and spleen are important reservoirs of non-replicating bacteria. Finally, we predict that post-treatment, the progenitors of the non-growing and growing bacterial populations replicate and die at different rates. Ultimately, the liver, spleen and mesenteric lymph nodes are all repopulated by progenitors of the previously non-growing phenotype in ampicillin-treated mice.
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Affiliation(s)
- Myrto Vlazaki
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Omar Rossi
- GSK Vaccines Institute for Global Health, Via Fiorentina 1, 53100 Siena, Italy
| | - David J Price
- Centre of Epidemiology and Biostatistics, University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.,The Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Callum McLean
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Andrew J Grant
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Pietro Mastroeni
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Olivier Restif
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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Tonacci A, Nettis E, Asero R, Rossi O, Tontini C, Gangemi S. Omalizumab retreatment in patients with chronic spontaneous urticaria: a systematic review of published evidence. Eur Ann Allergy Clin Immunol 2020; 52:100-103. [PMID: 32108461 DOI: 10.23822/eurannaci.1764-1489.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary A systematic review of the current literature on retreatment with omalizumab of patients with relapsing chronic spontaneous urticaria was performed. Published evidence shows that retreatment is safe and clinically effective, and that time to complete clinical response reduces as the number of retreatments increases.
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Affiliation(s)
- A Tonacci
- Institute of Clinical Physiology-National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - E Nettis
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - R Asero
- Allergology Clinic, Clinica San Carlo, Paderno Dugnano, Milan, Italy
| | - O Rossi
- ImmunoAllergology Unit, Careggi University Hospital of Florence, Florence, Italy
| | - C Tontini
- Allergy Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - S Gangemi
- School and Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Quinzi V, Rossi O, Paglia L, Marzo G, Caprioglio A. Paediatric Orthodontics Part 2: Periodontal effects of maxillary expansion. Eur J Paediatr Dent 2019; 20:164-166. [PMID: 31246096 DOI: 10.23804/ejpd.2019.20.02.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Both rapid and slow maxillary expansion protocols may produce different effects on the palatal suture, on the periodontium, and on alveolar anatomy such as lateral flexion of the alveolar processes, root resorption, bone fenestration and the anchorage teeth can show different degrees of inclination and dislocation. In order to reduce these side effects, maxillary expansion devices anchored to deciduous teeth or miniscrew-supported appliances should beconsidered.
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Affiliation(s)
- V Quinzi
- Section of Orthodontics, Department of Life, Health and Environmental Sciences University of L'Aquila, L'Aquila, Italy
| | - O Rossi
- Section of Orthodontics, Dept. of Medicine and Surgery, University of Insubria, Varese, Italy
| | - L Paglia
- Head Department of Paediatric Dentistry Istituto Stomatologico Italiano (ISI), Milan, Italy
| | - G Marzo
- Section of Orthodontics, Department of Life, Health and Environmental Sciences University of L'Aquila, L'Aquila, Italy
| | - A Caprioglio
- Section of Orthodontics, Dept. of Medicine and Surgery, University of Insubria, Varese, Italy
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Necchi F, Carducci M, Pisoni I, Rossi O, Saul A, Rondini S. Development of FAcE (Formulated Alhydrogel competitive ELISA) method for direct quantification of OAg present in Shigella sonnei GMMA-based vaccine and its optimization using Design of Experiments approach. J Immunol Methods 2019; 471:11-17. [PMID: 31039338 DOI: 10.1016/j.jim.2019.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/03/2019] [Accepted: 04/25/2019] [Indexed: 12/28/2022]
Abstract
Many formulated vaccines, including 1790GAHB Shigella sonnei GMMA-based vaccine, contain Alhydrogel (aluminum hydroxide), consequently the antigen content must be determined in the formulated final vaccine product, as required by regulatory authorities. The direct quantification of antigens adsorbed on aluminum salts is difficult, and antigens may need to be extracted using laborious and often ineffective desorption procedures. To directly quantify the sugar vaccine target in the LPS of 1790GAHB, we have developed a new FAcE (Formulated Alhydrogel competitive ELISA) method. FAcE is an immunoassay based on the competition between S. sonnei LPS, coated on the ELISA plate, and the LPS in formulated S. sonnei GMMA, in binding a specific monoclonal antibody. To optimize the method, which is as easy to perform as a standard ELISA, we have applied a Design of Experiments (DOE) approach. A model was found to define the significant assay variables and to predict their impact on the output responses. Results obtained using the DOE optimized FAcE assay showed that the method is sensitive (0.02 μg/mL lower detection limit), precise, reproducible and can accurately quantify independently formulated drug products, making it a useful tool in routine tests of Alhydrogel-based vaccines. We are currently using this method to determine S. sonnei vaccine potency, stability and lot-to-lot variations, and are broadening its applicability to quantify active ingredients of other Alhydrogel GMMA-vaccines and in multivalent vaccines formulations.
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Affiliation(s)
- Francesca Necchi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Ivan Pisoni
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Allan Saul
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy
| | - Simona Rondini
- GSK Vaccines Institute for Global Health (GVGH) S.r.l., Siena, Italy.
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Biagioni B, Vitiello G, Bormioli S, Tarrini D, Lombardi C, Rossi O, Parronchi P. Migrants and allergy: a new view of the atopic march. Eur Ann Allergy Clin Immunol 2019; 51:100-114. [DOI: 10.23822/eurannaci.1764-1489.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- B. Biagioni
- Dipartimento di Medicina Sperimentale e Clinica, Universita degli Studi di Firenze, Firenze, Italy
| | - G. Vitiello
- Dipartimento di Medicina Sperimentale e Clinica, Universita degli Studi di Firenze, Firenze, Italy
| | - S. Bormioli
- Dipartimento di Medicina Sperimentale e Clinica, Universita degli Studi di Firenze, Firenze, Italy
| | - D. Tarrini
- Dipartimento di Medicina Sperimentale e Clinica, Universita degli Studi di Firenze, Firenze, Italy
| | - C. Lombardi
- Unita Dipartimentale di Allergologia-Immunologia Clinica e Pneumologia, Fondazione Poliambulanza, Brescia, Italy
| | - O. Rossi
- SOD Immunoallergologia, AOU-Careggi, Firenze, Italy
| | - P. Parronchi
- Dipartimento di Medicina Sperimentale e Clinica, Universita degli Studi di Firenze, Firenze, Italy
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Rossi O, Coward C, Goh YS, Claassens JWC, MacLennan CA, Verbeek SJ, Mastroeni P. The essential role of complement in antibody-mediated resistance to Salmonella. Immunology 2019; 156:69-73. [PMID: 30179254 PMCID: PMC6283648 DOI: 10.1111/imm.13000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/05/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022] Open
Abstract
Vaccines can serve as essential tools to prevent bacterial diseases via the induction of long-lasting IgG responses. The efficacy of such vaccines depends on the effector mechanisms triggered by IgG. The complement system and Fc-gamma receptors (FcγRs) can potentially play a crucial role in IgG-mediated immunity against bacterial diseases. However, their relative importance in vivo is unclear, and has been the object of controversy and debate. In this brief study, we have used gene-targeted mice lacking either FcγRI, II, II and IV or the C3 complement component as well as a novel mouse strain lacking both C3 and FcγRs to conclusively show the essential role of complement in antibody-mediated host resistance to Salmonella enterica systemic infection. By comparing the effect of IgG2a antibodies against Salmonella O-antigen in gene-targeted mice, we demonstrate that the complement system is essential for the IgG-mediated reduction of bacterial numbers in the tissues.
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Affiliation(s)
- Omar Rossi
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
- Present address:
GSK Vaccines Institute for Global HealthSienaItaly
| | - Chris Coward
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
- Present address:
Summit TherapeuticsAbingdonUK
| | - Yun Shan Goh
- Singapore Immunology NetworkAgency for Science, Tecnology and ResearchSingaporeSingapore
| | - Jill W. C. Claassens
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
| | | | - Sjef J. Verbeek
- Department of Human GeneticsLeiden University Medical CenterLeidenThe Netherlands
- Present address:
Department of Biomedical EngineeringToin University of YokohamaYokohamaJapan
| | - Pietro Mastroeni
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
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Rossi O, Dybowski R, Maskell DJ, Grant AJ, Restif O, Mastroeni P. Within-host spatiotemporal dynamics of systemic Salmonella infection during and after antimicrobial treatment. J Antimicrob Chemother 2018; 72:3390-3397. [PMID: 28962012 PMCID: PMC5890750 DOI: 10.1093/jac/dkx294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/20/2017] [Indexed: 01/23/2023] Open
Abstract
Objectives We determined the interactions between efficacy of antibiotic treatment, pathogen growth rates and between-organ spread during systemic Salmonella infections. Methods We infected mice with isogenic molecularly tagged subpopulations of either a fast-growing WT or a slow-growing ΔaroC Salmonella strain. We monitored viable bacterial numbers and fluctuations in the proportions of each bacterial subpopulation in spleen, liver, blood and mesenteric lymph nodes (MLNs) before, during and after the cessation of treatment with ampicillin and ciprofloxacin. Results Both antimicrobials induced a reduction in viable bacterial numbers in the spleen, liver and blood. This reduction was biphasic in infections with fast-growing bacteria, with a rapid initial reduction followed by a phase of lower effect. Conversely, a slow and gradual reduction of the bacterial load was seen in infections with the slow-growing strain, indicating a positive correlation between bacterial net growth rates and the efficacy of ampicillin and ciprofloxacin. The viable numbers of either bacterial strain remained constant in MLNs throughout the treatment with a relapse of the infection with WT bacteria occurring after cessation of the treatment. The frequency of each tagged bacterial subpopulation was similar in the spleen and liver, but different from that of the MLNs before, during and after treatment. Conclusions In Salmonella infections, bacterial growth rates correlate with treatment efficacy. MLNs are a site with a bacterial population structure different to those of the spleen and liver and where the total viable bacterial load remains largely unaffected by antimicrobials, but can resume growth after cessation of treatment.
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Affiliation(s)
- O Rossi
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - R Dybowski
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - D J Maskell
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - A J Grant
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - O Restif
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
| | - P Mastroeni
- University of Cambridge, Department of Veterinary Medicine, Cambridge, UK
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Braido F, Baiardini I, Scichilone N, Musarra A, Menoni S, Ridolo E, Gani F, Pravettoni V, Colombo G, Crivellaro M, Senna GE, Fumagalli F, Rossi O, Canonica GW. Illness perception, mood and coping strategies in allergic rhinitis: are there differences among ARIA classes of severity? Rhinology 2017; 52:66-71. [PMID: 24618631 DOI: 10.4193/rhino13.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was designed to assess if illness perception, mood state and coping strategies differ according to allergic rhinitis (AR) persistence and severity. METHODS Illness perception, mood profiles, coping behaviors and rhinitis symptoms were assessed by means of validated tools inpatients classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines. RESULTS Two hundred and thirty-one patients underwent data analysis. No difference in age, sex, socio-economic status, smoking habits was detected comparing patients according to AR severity, duration or 4 ARIA classes. Patients with intermittent AR reported higher scores than those with persistent AR in confusion-bewilderment of Profile of Mood States (POMS); patients with moderate/severe rhinitis had significantly higher scores than those with mild rhinitis in TSSS, Identity and Consequences. No differences were detected in all assessed outcomes in the 4 ARIA classes. CONCLUSIONS The patient's perspective about AR is independent of persistence and severity of symptoms. This may explain why AR remains under-diagnosed and under-treated, even in its most severe forms. Self-management plans should consider the patient's perspective.
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Rossi O, Grant AJ, Mastroeni P. Effect of in vivo neutralization of tumor necrosis alpha on the efficacy of antibiotic treatment in systemic Salmonella enterica infections. Pathog Dis 2017; 75:ftx002. [PMID: 28087648 PMCID: PMC5353993 DOI: 10.1093/femspd/ftx002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/13/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023] Open
Abstract
Immunity can co-operate with antibiotics, but can also antagonize drug efficacy by segregating the bacteria to areas of the body that are less accessible to antimicrobials, and by selecting for subpopulations with low division rates that are often difficult to eradicate. We studied the effect of an anti-inflammatory/immunosuppressive anti-TNFα treatment, which accelerates bacterial growth in the tissues and inhibits or reverses the formation of granulomas, on the efficacy of ampicillin and ciprofloxacin during a systemic Salmonella enterica infection of the mouse. The anti-TNFα treatment neither precluded nor enhanced the efficacy of antibiotic treatment. However, the anti-TNFα treatment rendered the animals susceptible to the rapid relapse of the infection seen after cessation of the antibiotic treatment. Reactivation of an established infection, due to late administration of anti-TNFα antibodies, could be successfully controlled by antibiotics, but full clearance of the bacterial load from the tissues was not achieved. We conclude that the lack of TNFα does not preclude the efficacy of antibiotic treatment and must be monitored with care due to post-treatment relapses. Combinations of anti-cytokine compounds and antibiotic molecules may not be the best way to treat persistent infections with intracellular bacteria like Salmonella.
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Affiliation(s)
- Omar Rossi
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
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Ridolo E, Caminati M, Martignago I, Melli V, Salvottini C, Rossi O, Dama A, Schiappoli M, Bovo C, Incorvaia C, Senna G. Allergic rhinitis: pharmacotherapy in pregnancy and old age. Expert Rev Clin Pharmacol 2016; 9:1081-9. [PMID: 27177184 DOI: 10.1080/17512433.2016.1189324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Allergic rhinitis (AR) affects 20-30% of women in reproductive age and may worsen during pregnancy. About 10% of the elderly suffer from AR, and it could be under-diagnosed in these patients. Many drugs are currently available, however AR treatment during pregnancy and old age represents a challenging issue. AREAS COVERED A review of the literature on the topic has been performed. Expert commentary: In pregnancy, drug avoidance should be carefully balanced with the need for AR optimal control. Topical drugs are suggested as a first approach. The safety and tolerability profile of second-generation antihistamines is well supported. If allergen immunotherapy (AIT) is ongoing and well tolerated, there is no reason for stopping it. AIT initiation in pregnancy is not recommended. For elderly patients, no specific concerns have been highlighted regarding topical treatments, except from nasal decongestionants. Second generation antihistamines are generally well tolerated. Old age should not preclude AIT.
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Affiliation(s)
- E Ridolo
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - M Caminati
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - I Martignago
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - V Melli
- a Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - C Salvottini
- c Department of Molecular Medicine , University of Pavia , Pavia , Italy
| | - O Rossi
- d Allergy Unit , Azienda Ospedaliera Universitaria Careggi , Firenze , Italy
| | - A Dama
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - M Schiappoli
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
| | - C Bovo
- e Medical Direction , Verona University Hospital , Verona , Italy
| | - C Incorvaia
- f Allergy/Pulmonary Rehabilitation , ICP Hospital , Milano , Italy
| | - G Senna
- b Allergy Unit and Asthma Center , Verona University Hospital , Verona , Italy
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