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Ma H, Lim TH, Leerapun A, Weltman M, Jia J, Lim YS, Tangkijvanich P, Sukeepaisarnjaroen W, Ji Y, Le Bert N, Li D, Zhang Y, Hamatake R, Tan N, Li C, Strasser SI, Ding H, Yoon JH, Stace NH, Ahmed T, Anderson DE, Yan L, Bertoletti A, Zhu Q, Yuen MF. Therapeutic vaccine BRII-179 restores HBV-specific immune responses in patients with chronic HBV in a phase Ib/IIa study. JHEP Rep 2021; 3:100361. [PMID: 34661089 PMCID: PMC8502773 DOI: 10.1016/j.jhepr.2021.100361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 01/12/2023] Open
Abstract
Background & Aims Functional cure of chronic HBV infection (CHB) without life-long treatment requires the restoration of defective HBV-specific humoral and cellular immunity. Therapeutic vaccines based on the major structural and non-structural proteins have been tested in patients with CHB but have shown scarce immunogenicity. BRII-179, also known as VBI-2601, is a novel formulation comprised of all 3 HBV surface envelope proteins (Pre-S1, Pre-S2, and S). Safety, antiviral activity, and immunogenicity of BRII-179 admixed with co-adjuvant interferon (IFN)-α were assessed in patients with CHB. Method This randomized, open-label, controlled phase Ib/IIa study included 2 dose levels, 20 μg BRII-179 (Part 1, n = 25) and 40 μg BRII-179 (Part 2, n = 24). Patients, virally suppressed under nucleos(t)ide analogue (NA) therapy were randomized 1:2:2 into 3 cohorts in Part 1 and 1:1 into 2 cohorts in Part 2 to receive 4 monthly intramuscular injections of BRII-179 admixed with/without 3 MIU IFN-α. Antibody and cellular responses to HBsAg, as well as evolution of circulating HBsAg were monitored. Results Both 20 μg and 40 μg BRII-179 with/without IFN-α were well tolerated with no severe adverse events. BRII-179 induced anti-HBs responses in >30% patients in all treatment cohorts, however, moderate anti-Pre-S1 or anti-Pre-S2 antibody responses were only observed in patients receiving BRII-179 with IFN-α. BRII-179 also restored S-, Pre-S1-, Pre-S2-specific IFN-γ-producing T-cells in the majority of treated patients. Overall, no notable reduction of HBsAg was observed after BRII-179 treatment. Conclusion In patients with CHB under NA therapy, BRII-179 with/without IFN-α exhibited a good safety profile and induced HBV-specific B- and T-cell immune responses. These data support further clinical evaluation of BRII-179 in combination with other therapies. Clinical Trial Number ACTRN12619001210167. Lay summary BRII-179 is a therapeutic vaccine designed to improve the immune response in patients with chronic hepatitis B. In this study, BRII-179 alone or with a low dose of interferon-α was safe, well tolerated, and induced enhanced HBV-specific antibody and T-cell responses in patients with chronic hepatitis B. However, BRII-179 treatment alone had minimal effect on patient's virological status. The potential of BRII-179 to achieve a functional cure in conjunction with other agents is being evaluated in the clinic.
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Key Words
- AE, adverse event
- ALT, alanine aminotransferase
- Anti-HBs, hepatitis B surface antibody
- BMI, body mass index
- BRII-179
- CHB
- CHB, chronic hepatitis B
- ELISpot, enzyme-linked immune absorbent spot
- HBV, hepatitis B virus
- HBV-specific immune response
- HBeAg, hepatitis B e antigen
- HBsAg, hepatitis B surface antigen
- IFN-alpha
- IFN-α, interferon-α
- IM, intramuscular
- IU, international units
- NA, nucleos(t)ide analogue
- PBMCs, peripheral blood mononuclear cells
- PEG-IFN-α, pegylated interferon-α
- SAE, serious adverse events
- Th1, T helper type 1
- immunotherapy
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Affiliation(s)
- Haiyan Ma
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | | | | | | | - Jidong Jia
- Beijing Friendship Hospital, Beijing, China
| | - Young-Suk Lim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Yun Ji
- Brii Biosciences Inc. Durham, NC, USA
| | - Nina Le Bert
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Dong Li
- Brii Biosciences Inc. Beijing, PR China
| | - Yao Zhang
- Brii Biosciences Inc. Beijing, PR China
| | | | - Nicole Tan
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | | | | | - Huiguo Ding
- Beijing You 'an Hospital affiliated to Capital Medical University, Beijing, China
| | | | - Nigel H Stace
- Capital & Coast District Health Board, Wellington, New Zealand
| | | | | | - Li Yan
- Brii Biosciences Inc. Durham, NC, USA
| | - Antonio Bertoletti
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Qing Zhu
- Brii Biosciences Inc. Durham, NC, USA
| | - Man-Fung Yuen
- Department of Medicine and State Key Laboratory of Liver Research, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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