Induction of a dwarf phenotype with IBH1 may enable increased production of plant-made pharmaceuticals in plant factory conditions

Year-round production in a contained, environmentally controlled 'plant factory' may provide a cost-effective method to produce pharmaceuticals and other high-value products. However, cost-effective production may require substantial modification of the host plant phenotype; for example, using dwarf plants can enable the growth of more plants in a given volume by allowing more plants per shelf and enabling more shelves to be stacked vertically. We show here that the expression of the chimeric repressor for Arabidopsis AtIBH1 (P35S:AtIBH1SRDX) in transgenic tobacco plants (Nicotiana tabacum) induces a dwarf phenotype, with reduced cell size. We estimate that, in a given volume of cultivation space, we can grow five times more AtIBH1SRDX plants than wild-type plants. Although, the AtIBH1SRDX plants also showed reduced biomass compared with wild-type plants, they produced about four times more biomass per unit of cultivation volume. To test whether the dwarf phenotype affects the production of recombinant proteins, we expressed the genes for anti-hepatitis B virus antibodies (anti-HBs) in tobacco plants and found that the production of anti-HBs per unit fresh weight did not significantly differ between wild-type and AtIBH1SRDX plants. These data indicate that P35S:AtIBH1SRDX plants produced about fourfold more antibody per unit of cultivation volume, compared with wild type. Our results indicate that AtIBH1SRDX provides a useful tool for the modification of plant phenotype for cost-effective production of high-value products by stably transformed plants in plant factory conditions.

HCV antigen testing for the diagnosis of hepatitis C infection: a cost-efficient algorithm

BACKGROUND

In North America, diagnosis of active hepatitis C virus (HCV) infection is currently performed using RNA testing which is highly sensitive and specific but is associated with three major limitations: lability of RNA molecules, higher costs, and longer turn-around time as compared with commercially-available HCV core antigen testing. In the current study, a new HCV core antigen assay product was evaluated for the diagnosis of HCV infection and its cost reducing potential.

METHODS

Ninety plasma specimens positive for HCV RNA along with 25 negative HCV specimens were used for HCV antigen assay. Twenty-four specimens positive for a panel of agents were used for possible cross-reactivity. Sixty-four HCV antibody-positive specimens with negative HCV RNA and indeterminate HCV immunoblot results were also employed.

RESULTS

In the first group, 78/90 (86.6%) tested positive for HCV antigen with regression analysis showing no significant deviation from linearity. None of the prenatal specimens tested positive for HCV antigen. Non-specific reactions were not observed. In the HCV antibody-indeterminate group, only 2/64 (3.1%) were antigen positive. In the last group, none of the HCV antibody very-low-positive specimens tested positive for HCV antigen. Both inter- and intra-run reproducibility of 100% were noted. The cost analysis showed a minimum of 52.13% reduction in costs associated with qualitative RNA testing.

CONCLUSIONS

Considering the complexity of HCV infection diagnosis and the significant cost and turn-around time burden it imposes on clinical laboratories, HCV antigen testing seems an attractive adjunct to the current battery of laboratory diagnosis that demands more attention.

Hepatitis B vaccine antibody response and the risk of clinical AIDS or death

BACKGROUND

Whether seroresponse to a vaccine such as hepatitis B virus (HBV) vaccine can provide a measure of the functional immune status of HIV-infected persons is unknown.This study evaluated the relationship between HBV vaccine seroresponses and progression to clinical AIDS or death.

METHODS AND FINDINGS

From a large HIV cohort, we evaluated those who received HBV vaccine only after HIV diagnosis and had anti-HBs determination 1-12 months after the last vaccine dose. Non-response and positive response were defined as anti-HBs <10 and ≥ 10 IU/L, respectively. Participants were followed from date of last vaccination to clinical AIDS, death, or last visit. Univariate and multivariable risk of progression to clinical AIDS or death were evaluated with Cox regression models. A total of 795 participants vaccinated from 1986-2010 were included, of which 41% were responders. During 3,872 person-years of observation, 122 AIDS or death events occurred (53% after 1995). Twenty-two percent of non-responders experienced clinical AIDS or death compared with 5% of responders (p<0.001). Non-response to HBV vaccine was associated with a greater than 2-fold increased risk of clinical AIDS or death (HR 2.47; 95% CI, 1.38-4.43) compared with a positive response, after adjusting for CD4 count, HIV viral load, HAART use, and delayed type hypersensitivity skin test responses (an in vivo marker of cell-mediated immunity). This association remained evident among those with CD4 count ≥ 500 cells/mm³ (HR 3.40; 95% CI, 1.39-8.32).

CONCLUSIONS

HBV vaccine responses may have utility in assessing functional immune status and risk stratificating HIV-infected individuals, including those with CD4 count ≥ 500 cells/mm³.

Induction of multispecific Th-1 type immune response against HCV in mice by protein immunization using CpG and Montanide ISA 720 as adjuvants

Recent studies demonstrate that Th1-type immune responses against a broad spectrum of hepatitis C virus (HCV) gene products are crucial to the resolution of acute HCV infection. We investigated new vaccine approaches to augment the strength of HCV-specific Th1-type immune responses. ELISPOT assay revealed that single or multiple protein immunization using both CpG ODN and Montanide ISA 720 as adjuvants induced much stronger IFN-gamma-producing Th1 responses against core, NS3 and NS5b targets than did the formulation without these adjuvants. Protein vaccination using CpG ODN and Montanide ISA 720 as adjuvants also greatly enhanced humoral responses to HCV core, E1/E2 and NS3. When specific IgG isotypes were assayed, protein immunization using CpG ODN and Montanide ISA 720 as adjuvants produced higher titers of IgG2a dominant antibodies than did protein immunization alone, indicating a more Th1-biased pathway. This increase in IgG2a is consistent with the induction of Th1 cells secreting IFN-gamma demonstrated by ELISPOT assay. In conclusion, protein immunization using CpG ODN and Montanide ISA 720 as adjuvants greatly enhanced cellular (Th1 type) as well as humoral immune responses against HCV in Balb/c mice. The use of adjuvants appears critical to the induction of Th1 immune responses during HCV vaccination with recombinant proteins.

Construction and characterization of the chimeric antibody 8C11 to the hepatitis E virus

Homodimers of the truncated hepatitis E virus (HEV) capsid proteins, E2 and p239, were conformed to model the dominant antigenic determinants of HEV. Using E2 as an immunogen, two neutralizing monoclonal antibodies (mAbs), namely 8C11 and 8H3, were produced. We constructed a mouse-human chimeric antibody derived from 8C11 and its expression in Chinese hamster ovary (CHO) cells. cDNAs encoding variable regions of heavy and light chains were isolated from hybridoma cells and inserted into mammalian expression vectors containing cDNA of human gamma-1 and kappa constant regions, respectively. The vectors were then cotransfected into CHO cells, and a stable cell line was established. Results from indirect enzyme-linked immunosorbent assay (ELISA) and Western blot analysis showed that the chimeric antibody was assembled correctly to the native IgG molecule and could be secreted from the cells. Similar to the original mAb, the expressed chimeric antibody displayed HEV antigen-binding activity and an enhancement effect on 8H3 binding to HEV antigen. The chimeric antibody could specifically inhibit the binding of p239 to HepG2 cells and compete with HEV IgG in positive serum by antibody-competitive ELISA. The chimeric antibody is expected to be less immunogenic in human and more suitable for antibody therapy of hepatitis E.

Engineering of N-glycosylation of hepatitis C virus envelope protein E2 enhances T cell responses for DNA immunization

N-linked oligosaccharides are known to be important in modulating immunogenicity of some viral proteins. However, the roles of N-glycans of hepatitis C virus (HCV) E2 envelope glycoprotein in specific cellular immune responses remain elusive. Previous studies showed that the epitopes aa481-500 and aa551-570 of E2 might be important for immunoreactivity and that the binding site of E2 for hCD81 is located at aa480-493 and aa544-551 within the E2 protein. Here, we made plasmids containing genes encoding either wild type or mutant E2 proteins in which N-glycosylation sites (N560NT and N576ST) close to these important regions were mutated separately or in combination. The immunogenicities of wild type E2 and three mutated E2 proteins were analyzed in BALB/c mice using DNA vaccination. The E2-M2 mutant (at N576ST) significantly enhanced (compared to control) E2-specific CTL activity (P<0.05), expression of IFN-gamma (P<0.05) and suppression of tumor growth (P<0.05). Also, high IgG2a/IgG1 ratios were elicited in a Th1-type response. These results indicate that engineering of the N-glycosylation site N576ST of HCV E2 protein enhances specific cellular immune responses, providing insights into the development of E2-based DNA vaccines with enhanced immunogenicity.

A truncated ORF2 protein contains the most immunogenic site on ORF2: antibody responses to non-vaccine sequences following challenge of vaccinated and non-vaccinated macaques with hepatitis E virus

A candidate hepatitis E vaccine is composed of amino acids (aa) 112-607 of the 660-aa protein encoded by open reading frame 2 (ORF2) of hepatitis E virus (HEV). We have studied the antibody response to vaccine-associated epitopes and to epitopes excluded from the vaccine to determine if important epitopes were omitted from the vaccine and if antibody responses to these regions could be used to differentiate between infection and vaccination. ELISAs were developed based on genotype 1 ORF2 peptides, containing aa 112-607 (vaccine), 458-607 (minimum neutralization site), 1-111 (N-terminus) and 607-660 (C-terminus), as well as on ORF3 peptides, containing aa 1-123 (complete) and 91-123 (C-terminus). All naive macaques infected with HEV genotype 1, 2, 3 or 4 produced antibodies to all ORF2 peptides. Anti-ORF3 was detected in both monkeys infected with genotype 1 virus and in one of two infected with genotype 2 virus. These antibody responses were considerably weaker than those directed against the neutralization site. In contrast, vaccinated animals that were challenged with HEV had a diminished or absent immune response to the peptides not included in the vaccine. Thus, only minor epitopes were excluded from the vaccine; they had limited utility for distinguishing between vaccination and infection.

TLR agonists as vaccine adjuvants: comparison of CpG ODN and Resiquimod (R-848)

TLR ligands that mimic pathogen associated molecular patterns and activate immune cells via Toll-like receptors (TLRs) are being developed for use in humans as therapy against a variety of diseases as well as vaccine adjuvants. These include imidazoquinoline compounds such as Imiquimod and Resiquimod (R-848) that bind to TLR7 and 8, as well as CpG oligodeoxynucleotides (CpG ODN) that bind to TLR9. This study was aimed at comparing CpG ODN and R-848 for their potential use as vaccine adjuvants and to determine whether there are additive or synergistic effects when they are used together. Using HBsAg as a model antigen in mice, we show CpG ODN to be superior to R-848 for augmenting both humoral and cell mediated immune responses.

Pregnant women as a sentinel population to target and implement hepatitis B virus (HBV) vaccine coverage: a three-year survey in Palermo, Sicily

Hepatitis B virus (HBV) vaccine coverage was assessed using serologic patterns of infection (HBsAg, anti HBc) and vaccine-induced immunity (isolated anti HBs) among 3318 pregnant women attending the Obstetrical Unit of the University Hospital in Palermo who were screened over 3 years (2001-2003). Three thousand and eight of them (90.6%) were born in Sicily, whereas 310 (9.4%) were immigrants from non-EU countries. The overall prevalence of HBsAg was 1.1%, and it was significantly higher among immigrant than indigenous women (4.2% versus 0.8%; OR 5.26; p < 0.0001). Serologic evidence of past HBV infection (anti HBc) also was significantly higher in immigrants than in Sicilian women (24.5% versus 5.2%, respectively). Women aged 17-21 in our study were in cohorts that had been targeted since 1991 for mandatory HBV vaccination at age 12. In this targeted age group, 74.2% of the Sicilian women had isolated anti HBs, compared to only 15.0% among immigrants. The results suggest the need to improve HBV immunization of Sicilian adolescents and especially to implement active surveillance and to launch an HBV immunization programme that targets immigrants to Sicily.

A comparison of responsiveness to hepatitis B vaccination in patients on hemodialysis and peritoneal dialysis

The doses of hepatitis B vaccine given to peritoneal dialysis (PD) patients are currently based on responsiveness data from hemodialysis (HD) patients. To determine whether the doses are also appropriate from PD patients, we did a head-to-head comparison of short-term and 2-year responses to hepatitis B vaccination of HD patients and PD patients. We evaluated serum titers of the antibody to hepatitis B surface antigen (anti-HBs) after the patients had completed a course of four consecutive intramuscular vaccinations (40 microg of Engerix-B administered into the deltoid muscle at 0, 1, 2, and 6 months) in 69 dialysis patients (47 HD and 22 PD patients) who were both hepatitis B surface antigen (HBsAg) and anti-HBs negative. No patients had received a hepatitis B vaccination prior to the study. There was no significant difference in response to hepatitis B vaccination between the HD and PD groups (78.7% versus 77.3%, p=0.33). The seroconversion rate defined as anti-HBs > or = 10IU/L was influenced only by age (p=0.011). There was also no significant difference in responsiveness between the HD and PD groups (60% versus 50%, p=0.41) at a 2-year follow-up. We conclude that doses of HBV vaccine being used for HD patients are also appropriate for PD patients and a booster dose of vaccine is required to maintain seroprotection for those who lost protecting anti-HBs.

A non-living nasal influenza vaccine can induce major humoral and cellular immune responses in humans without the need for adjuvants

Twenty-eight healthy adult volunteers were immunized intranasally with an inactivated whole-virus influenza vaccine based on the strain A/New Caledonia/20/99 (H1N1), either in saline or mixed with formaldehyde-inactivated Bordetella pertussis as a mucosal adjuvant, or in a thixotropic vehicle with mucoadhesive properties. After four doses, all groups of vaccinees developed significant IgG- and IgA-antibody responses, measured by ELISA, in respectively serum and nasal secretions. None of the volunteers had demonstrable hemagglutination inhibition (HAI) antibodies in serum before being immunized, whereas more than 80% of them reached HAI titers>or=40, considered protective, after immunizations. In addition, cellular immune responses, measured as significant increases in CD4+ T-cell proliferation and granzyme B-producing cytotoxic T-cells, were detected against the vaccine strain as well as against heterologous virus strains (H3N2). However, no additive effect on these responses could be demonstrated with use of B. pertussis or the thixotropic substance in the present vaccines. It appeared, actually, that the mucoadhesive vehicle containing the thixotropic substance was less efficient than were the two other formulations. An influenza vaccine made as a simple particulate formulation of inactivated virus, and given repeatedly onto the nasal mucosa, may thus be an attractive alternative to currently available vaccines.

Immunogenicity and tolerability of intradermal administration of an HCV E1-based vaccine candidate in healthy volunteers and patients with resolved or ongoing chronic HCV infection

The tolerability and immunogenicity of intradermal injections of a candidate HCV vaccine, based on the E1 protein of the hepatitis C virus (HCV), was examined in an exploratory study in healthy volunteers, in subjects with a history of resolved HCV infection, and in patients suffering from therapy-resistant chronic HCV. Sub-epidermal injection of three doses of 4 microg of non-adjuvanted E1 vaccine induced much weaker humoral and cellular immune responses in healthy subjects and chronic HCV patients than the intramuscular administration of 20 microg E1 formulated on alum. However, in three subjects who cleared HCV infection, intradermal administration of this low dose of E1 induced rapid and clear anamnestic responses. These data demonstrate that E1-specific immune responses can be induced in resolving HCV infections and that memory (B and T) cells can be restimulated with suboptimal doses of E1 antigen.

[Effects of cytokines on the immunogenic properties of hepatitis A vaccine]

Cytokines were found, in experiments with guinea pigs, to have a stimulating action on the immunogenic potency of hepatitis A vaccine (Hep-A-in-Vac). The most pronounced effects were produced by rhIL-1b, rhTNF-alpha, thymosin-a1, the "neothym" hybrid protein and immunophan. Injections of cytokines as of adjuvants stimulated the formation of antibodies titers that exceeded 2-10-fold those observed in control animals immunized by Hep-A-in-Vac alone. Immunization of guinea pigs made alongside with injections of the above cytokines ensured a 100% seroconversion in animals after the administration of drugs was completed. The number of seropositive animals in the control group was 75-89%.

Alterations in the immune system of children from mothers treated with immunosuppressive agents during pregnancy

Many of the immunosuppressive drugs that are used during pregnancy can cross the placental barrier and enter the foetal circulation, with a possible impact on the foetal immune system. We have evaluated the immune function of children born from mothers treated with immunosuppressants for connective tissue diseases. A total of nine babies, whose six mothers had been taking cyclosporine A (two), azathioprine (one) and dexamethasone (three) during pregnancy, together with 14 babies from mothers with similar diseases but who had not been treated (controls) were investigated. Complete blood count, IgA, IgG, IgM, IgG subclasses, and lymphocyte subpopulations were determined in all cases. Moreover, serum levels of anti-HBsAg and presence of autoantibodies (ANA, ENA) were also evaluated. Patients were tested at a mean age of 11 months (range, 1-17). Only a minor proportion of our patients displayed low values for age (mainly, IgA and IgG2), but none of the parameters tested resulted significantly different in patients than in controls. All children responded satisfactorily to hepatitis B vaccination. Although our results are preliminary, we conclude that prenatal exposure to immunosuppressive drugs does not have a profound effect to the developing immune system. More data and a longer follow-up are needed to confirm these results.

Efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant for hepatitis B virus in patients with HIV infection

Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) is a cytokine with a potential vaccine adjuvant activity. It is also known that human immunodeficiency virus (HIV) infected patients often show poor immunologic responses to immunization. We examined whether the use of GM-CSF could augment the immunologic response to recombinant vaccine against the hepatitis B virus (HBV) in 80 HIV infected patients (18-35 years old). They received a double dose (40 microg) of recombinant HBV vaccine IM at 0, 1 and 6 months and were randomized to receive either concurrent 20 microg of GM-CSF (n=40) or placebo IM (n=40) with the first vaccine dose. A significant increase in the seroconversion rate was observed after the second vaccine dose in the GM-CSF group (62% GM-CSF versus 30% control group P<0.0074). The average anti-HBs titers measured on days 28, 60 and 210 were 40.3; 366.5 and 644.8 milli-international units per milliliter (mIU/ml), respectively, in the GM-CSF group, and 62.4; 166.4 and 375.0 mIU/ml, respectively, in the control group, with significant differences at 60 and 210 days (P<0.01). There were no significant differences between CD4/CD8 cells, viral load, risk factors, age, sex and the serological responses to the HBV vaccine. This study suggests that GM-CSF increases the immunogenicity of recombinant HBV vaccine in HIV infected individuals.

Antibody titres after primary and booster vaccination of infants and young children with a virosomal hepatitis A vaccine (Epaxal)

To evaluate the immunogenicity and tolerability of Epaxal in infants and children, 30 infants (aged 6-7 months) and 30 children (aged 5-7 years) received a single intramuscular dose of the aluminium-free virosomal hepatitis A virus (HAV) vaccine Epaxal and a booster dose after 12 months. Anti-HAV antibody titres were measured at baseline (before injection), at 1 and 12 months after primary vaccination, and 1 month after the booster vaccination. Sixteen evaluable infants had maternal anti-HAV antibodies at baseline. Complete seroprotection (titre >/= 20 mIU/ml) was achieved by all infants and children at Month 1 and at Month 12. Additionally, all subjects showed a strong antibody response to booster vaccination. In infants without maternal anti-HAV antibodies, the response was four-fold higher than in those with maternal anti-HAV antibodies. Both doses of Epaxal were well tolerated. These preliminary data suggest that Epaxal is an effective hepatitis A vaccine for children and infants from 6 months of age.

DNA vaccination in utero: a new approach to induce protective immunity in the newborn

Infectious diseases are the primary cause of neonatal morbidity and mortality in people, resulting in millions of deaths every year. Infection of the newborn with some of the pathogens involved, such as herpes simplex virus (HSV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), human cytomegalovirus (HCMV) or group B Streptococcus sp. (GBS), usually occurs at the end of pregnancy, during birth or by breast feeding. Therefore, active immunization of the fetus might represent an effective approach to reduce the high risk of neonatal diseases. We recently showed that DNA immunization in utero within the third trimester of gestation induced strong humoral and cell-mediated immune responses in immunized fetal lambs. Here, we demonstrate that fetal immunization was safe and did not affect fetal gestation, neonatal viability, or significantly alter blood leukocyte populations. In utero immunization resulted in the induction of protective mucosal immunity and immune memory in the newborn lamb. Furthermore, there was no evidence that in utero DNA immunization induced immune tolerance. Our results also indicate that the uptake and expression of the plasmid DNA already occurred within the epithelium of the oral cavity. This correlates with our previous findings that local immune responses were found exclusively in the retropharyngeal lymph nodes draining the oral cavity.

[Baculovirus expression of two human recombinant neutralizing IgG monoclonal antibodies to hepatitis A virus]

OBJECTIVE

To develop human recombinant neutralizing IgG monoclonal antibodies to hepatitis A virus (HAV) by baculovirus expression system.

METHODS

The heavy and light chain genes of two human-derived neutralizing Fab antibodies to HAV were cloned into baculovirus expression vector Pac-kappa-Fc and Pac-L-Fc, and further expressed in insect cells as IgG antibodies. The IgG products were purified and well characterized.

RESULTS

The baculovirus expressed McAb HAFc16 fully retained the specificity of binding to hepatitis A virus and the competition with mouse anti-hepatitis A virus McAb using ELISA. The viral neutralization assay in vitro demonstrated the retention of antibody function after expression of the human antibody in insect cells. The other expressed antibody HAFc78 also has the neutralizing activity but it is directed against different epitopes of HAV when compared with HAFc16.

CONCLUSION

The recombinant baculovirus/insect cells expressed human neutralizing IgG antibodies to hepatitis A virus retained all biological functions specific for hepatitis A virus. The results provided the possibility of using these antibodies to rapidly protect high risk or early exposure populations from hepatitis A virus infection.

Hepatitis B immunisation induces higher antibody and memory Th2 responses in new-borns than in adults

New-borns raise limited antibody responses to most T cell-dependent antigens but little is known about neonatal T lymphocyte responses to vaccines. In this study, we compared the immune response induced by the hepatitis B vaccine in new-borns and nai;ve adults. Infants produced markedly higher serum anti-hepatitis B surface (HBs) antibody titres than adults. This was not associated with greater HBs Ag-specific Th2 cytokine responses but with lower primary IFN-gamma responses. At 1 year, the infant memory response to HBs Ag was characterised by higher Th2 responses than those of adults. We conclude that neonatal antibody and T cell responses to hepatitis B vaccine differ from those induced in adults.

Response to hepatitis-B vaccination in healthy homosexual individuals: retrospective case control study

The aim of the study was to compare the responses of homosexual men (HM) receiving a standard course of recombinant hepatitis B vaccine with those of healthcare workers vaccinated in the same hospital over the same period. Boosters for inadequate responders and repeat courses for non-responders were given. Forty of 61 (75.4%) of HM completing full follow-up were successfully vaccinated, compared with 128 of 129 (99.2%) female and 94 of 96 (97.9%) male health care workers (P<0.001). The response to hepatitis-B vaccination in healthy homosexual men is poor and significantly lower than healthcare workers vaccinated and followed up according to the same protocol.

Antibody responsiveness during immunization and challenge of genetically modified antibody responder mice with murine hepatitis virus 3

The aim of this study was to evaluate some immunological patterns involved in natural and acquired resistance against MHV3 using the original model of genetically modified lines of mice selected for high (HIII) and low (LIII) antibody responsiveness. As previously shown, a lower pre-existing anti-MHV antibody level was found in susceptible HIII mice as compared to resistant LIII mice. Mortality rates of the F1 (H x L) hybrids and F2 and backcross segregants reflected co-dominance of both characters and the survivors had higher preexisting anti-MHV antibody titers. The present data show that both lines had the potential to synthesize antibodies and that the resistance acquired by the susceptible HIII mice paralleled the antibody synthesis. Nevertheless, higher antibody titers were necessary to confer resistance in HIII mice than in LIII ones. When compared to uvMHV3, a single immunization with a related infectious MHV strain induced a higher antibody synthesis and led the HIII mice to resist the MHV3 challenge. A direct correlation between the antibody level and resistance to infection was always observed in HIII mice. Although mounting a Th2 response as indicated by IgG1 responses, they were also able to readily synthesize large amounts of IgG2a antibodies after immunization or during infection, reflecting a Th1 response. The transfer of anti-MHV antibodies to susceptible HIII mice was capable of conferring resistance to MHV3, providing the antibodies were present before virus infection and in large amounts. The resistance and the survival time of these animals increased with the level of antibody administered. If these direct and clear data suggest that HIII mice can acquire resistance through antibodies, the basis of the resistance of the resistant LIII mice may rely on mechanisms less dependent on antibodies.

The immunopathogenesis of hepatitis C virus infection

The outcome of HCV infection is determined by the interaction between the virus and the host immune system. The persistence of infection in most HCV-infected individuals, despite the presence of HCV-directed antibodies, suggests that such antibodies fail to induce viral clearance. Patients with self-limited hepatitis C have evidence of a polyclonal, multispecific CD8+ T-cell response along with a coordinated CD4+ T-cell response that is associated with eradication of HCV infection. Cytokines are produced both locally within the liver and systemically and may play an important role in controlling viral replication and contributing to hepatocellular damage through amplification of a nonspecific immune response. In most patients, the humoral, cellular immune, and cytokine response seem insufficient to eradicate infection. In its attempt to clear the virus from the liver, the immune system contributes to the hepatocellular injury seem in most chronically infected patients. A better understanding of the host's immune response may provide further insight on the pathogenetic mechanisms involved in development of chronic hepatitis and aid the development of better therapeutic strategies.

Generation of infectious and transmissible virions from a GB virus B full-length consensus clone in tamarins

The strong similarity between GB virus B (GBV-B) and hepatitis C virus (HCV) makes tamarins infected by GBV-B an acceptable surrogate animal model for HCV infection. Even more attractive, for drug discovery purposes, is the idea of constructing chimeric viruses by inserting HCV genes of interest into a GBV-B genome frame. To accomplish this, infectious cDNA clones of both viruses must be available. The characterization of several HCV molecular clones capable of infecting chimpanzees has been published, whereas only one infectious GBV-B clone inducing hepatitis in tamarins has been reported so far. Here we describe the infection of tamarins by intrahepatic injection of RNA transcribed from a genomic GBV-B clone (FL-3) and transmission of the disease from infected to naive tamarins via serum inoculation. The disease resulting from both direct and secondary infection was characterized for viral RNA titre and hepatitis parameters as well as for viral RNA distribution in the hepatic tissue. Host humoral immune response to GBV-B antigens was also monitored. The progression of the disease was compared to that induced by intravenous injection of different amounts of the non-recombinant virus.

A randomized study of a flexible booster dosing regimen of VAQTA in adults: safety, tolerability, and immunogenicity

BACKGROUND

VAQTA (hepatitis A vaccine inactivated, Merck & Co., Inc., West Point, PA) is licensed for use in healthy adults in a two-dose schedule at 0 and 6 months.

OBJECTIVE

to determine whether the responses to a booster dose of VAQTA administered to adults 12 or 18 months after the first dose were similar to the response when the booster dose was administered 6 months after the first dose.

METHODS

healthy adults were randomized to receive 50-U of VAQTA at 6 (Group I), 12 (Group II), or 18 months (Group III) following receipt of Dose 1 on Day 0. Blood samples were collected immediately prior to Doses 1 and 2 and then, 4 weeks following Dose 2. Seropositivity rates (SPRs), geometric mean titers (GMTs) in milli-international units per milliliter (mIU/ml) and booster response rates (BRRs) were compared among treatment groups. Safety data were collected on Vaccination Report Cards.

RESULTS

no serious adverse experiences were reported, and the vaccine was well-tolerated by subjects in the three treatment groups. One month following the booster dose, SPRs and GMTs for Groups I, II, and III, respectively, were, 100% (102/102) and 6726.4 mIU/ml; 97.9% (93/95) and 4863.8 mIU/ml; 100% (86/86) and 6068.3 mIU/ml. The BRRs were 88.2% (Group I), 90.2% (Group II) and 94.2% (Group III).

CONCLUSION

responses to the booster dose were comparable regardless of the timing (i.e. 6, 12, or 18 months following Dose 1). Flexibility in the timing of the booster dose of VAQTA in adults would allow the vaccination schedule to be the same for adults, adolescents, and children and may increase the likelihood that adults receive the booster dose.

Comparative immunogenicity and safety of two dosing schedules of a combined hepatitis A and B vaccine in healthy adolescent volunteers: an open, randomised study

An open, randomised study was undertaken to demonstrate the equivalence in immunogenicity and to determine the reactogenicity and safety of two dosing schedules (0, 6 or 0, 12 month) of an adult formulation of a combined hepatitis A and B vaccine containing 720 EL.U. of inactivated hepatitis A antigen and 20 microg of hepatitis B surface antigen (Twinrix, SmithKline Beecham Biologicals, Belgium) in 240 healthy volunteers aged 12-15 years. The vaccine was well tolerated when administered using either vaccination schedule. At month 7, 98.1% of subjects completing the 0, 6 month vaccination schedule were seroprotected against hepatitis B (anti-hepatitis B surface antigen (anti-HBs) > or =10 mIU/ml) and 100% were seropositive for anti-hepatitis A virus (anti-HAV) antibodies (i.e., > or =33 mIU/ml). The corresponding geometric mean titres (GMTs) were 2791 mIU/ml for anti-HBs and 5992 mIU/ml for anti-HAV antibodies. At month 13, 97% of subjects assigned to the 0, 12 month vaccination schedule were protected against hepatitis B and 99% were seropositive for anti-HAV antibodies. The corresponding GMTs were 4340 and 8472 mIU/ml, respectively. A combined response (i.e., subjects, who were seropositive for anti-HAV antibodies and seroprotected for anti-HBs antibodies) was achieved in 98% of subjects vaccinated according to the 0, 6 month interval and in 96% of subjects vaccinated using the 0, 12 month schedule. The reactogenicity of both vaccination schedules was also equivalent. The results thus show that the combined hepatitis A and B vaccine can be administered using flexible vaccination intervals, which make it suitable for use in large-scale hepatitis immunisation programmes.

A prospective, randomized, comparative US trial of a combination hepatitis A and B vaccine (Twinrix) with corresponding monovalent vaccines (Havrix and Engerix-B) in adults

In an open, randomized, multicenter, controlled clinical trial in the US, 773 adults were administered either a combination hepatitis vaccine (Twinrix: 720 EL.U inactivated hepatitis A antigen and 20 mcg recombinant hepatitis B surface antigen per milliliter) on a 0, 1, 6 month schedule or corresponding monovalent vaccines concurrently (Havrix, 1440 EL.U/ml of hepatitis A antigen at 0, 6 months and Engerix-B, 20 mcg of hepatitis B surface antigen at 0, 1, 6 months). Non-inferiority testing for the primary endpoint, severe soreness, and equivalence testing for the secondary endpoints, anti-HAV seroconversion and anti-HBs seroprotection, showed that safety and immunogenicity were comparable in the two groups.

Oral administration of hepatitis E virus-like particles induces a systemic and mucosal immune response in mice

We evaluated the potential of recombinant hepatitis E virus (rHEV) virus-like particles (VLPs) as an oral immunogen by analyzing the response of serum IgM, IgG, and IgA and fecal IgA in mice after oral administration. The capsid proteins of HEV with its N-terminal 111 amino acids truncated were expressed with a recombinant baculovirus in insect cells, where the capsid proteins self-assembled into VLPs. Mice were orally inoculated four times with purified rHEV VLPs in concentrations ranging from 10 to 100 microg without adjuvant. Serum IgM response was obtained with as little as 10 microg of the VLPs, and the level reached its maximum in all mice groups within 2 weeks after the first administration. Serum IgG was detected by 4 weeks post-immunization (p.i.) in the majority of mice given doses of 50 and 100 microg and continuously increased at least until the 10 week mark. Serum IgA was also detected by 4 weeks p.i. in the majority of mice given doses of 50 and 100 microg, and the level reached the maximum at 8 weeks p.i. Furthermore, the maximum level of intestinal IgA responses was detected in the groups of mice receiving 50 and 100 microg rHEV VLPs at 8 weeks p.i. All these antibody responses were obtained without a mucosal adjuvant. We therefore concluded that oral immunization of rHEV VLPs is capable of inducing systemic as well as intestinal antibody responses. Furthermore, serum IgG and fecal IgA thus induced were reactive to the native HEV antigen, as determined by Western blot assays and antigen-capture ELISA.

Vaccination against hepatitis A in children aged 12 to 24 months [corrected]

BACKGROUND

Current hepatitis A vaccines are either licensed for children >2 years of age, as in the U.S. or Chile, or >1 year of age, as in Europe and other parts of the world. Recent recommendations for immunization against hepatitis A have included routine vaccination of children in areas or regions of higher endemicity. However, data on hepatitis A vaccination in toddlers aged between 1 and 2 years are scarce.

METHODS

This open clinical study investigated the reactogenicity and immunogenicity of two doses (0, 6-month schedule) of an inactivated hepatitis A vaccine (Havrix pediatric, Glaxco SmithKline Biologicals, Rixensart, Belgium) in 120 seronegative children aged 12-24 months.

RESULTS

Pain at the injection site and irritability were the most frequently reported local and general symptoms, respectively. No serious adverse events related to the study vaccine were reported. One month after the first dose, all but one subject had antibodies against hepatitis A with a GMT of 159 mIU/mL. After the booster dose, all had antibodies with a GMT of 2,939 mIU/mL.

CONCLUSIONS

Our data show that the inactivated hepatitis A vaccine was well tolerated by these toddlers and that the vaccine elicits a good immune response.

A randomised comparison of two inactivated hepatitis A vaccines, Avaxim and Vaqta, given as a booster to subjects primed with Avaxim

To investigate whether Vaqta may be used as a booster in subjects primed with Avaxim, 127 adults primed 6 months previously with Avaxim were randomised to receive either Vaqta or Avaxim as a booster. Prior to the booster all subjects were seropositive. Geometric mean antibody titres increased from 496 to 7262 mIU/mL 1 month after receiving Vaqta as a booster and from 325 to 5131 mIU/mL 1 month after receiving Avaxim as a booster. Both vaccines were well tolerated; 20.3% of subjects receiving Vaqta experienced a local reaction, compared to 39.7% of those receiving Avaxim. Systemic reactions were reported by 15.6% of those receiving Vaqta and 14.3% of those receiving Avaxim. Vaqta may be used as a booster in subjects primed with Avaxim.

Immunopathogenesis of hepatitis C viral infection: Th1/Th2 responses and the role of cytokines

Hepatitis C virus is a common cause of hepatocellular injury that is associated with complex and vigorous immunologic mechanisms. Both humoral and cell-mediated immune responses participate in the host defense against hepatitis C viral infection, but there is increasing recognition of the roles played by the cell-mediated response, and in particular the cytokine system, in the immunopathogenesis of chronic hepatitis C. The cell-mediated response depends on cytotoxic and helper T-cell activity, and functions through the actions of cytokines to regulate macrophages, natural killer cells, and antiviral cellular proteins. Cytokines produced in the liver are essential in defending the host against hepatitis C invasion, but they have also been implicated in the hepatocellular injury seen in the majority of chronically infected patients. Cytokines are thought to be involved in the pathogenesis of hepatitis C under conditions where the virus can mutate effectively and evade T-cell immune defense mechanisms. Persistent infection upsets the balance between immunostimulatory and inhibitory cytokines which can prolong inflammation and lead to necrosis, fibrosis, and chronic liver disease.

Characterization of hepatitis C virus core-specific immune responses primed in rhesus macaques by a nonclassical ISCOM vaccine

Current therapies for the treatment of hepatitis C virus (HCV) infection are only effective in a restricted number of patients. Cellular immune responses, particularly those mediated by CD8(+) CTLs, are thought to play a role in the control of infection and the response to antiviral therapies. Because the Core protein is the most conserved HCV protein among genotypes, we evaluated the ability of a Core prototype vaccine to prime cellular immune responses in rhesus macaques. Since there are serious concerns about using a genetic vaccine encoding for Core, this vaccine was a nonclassical ISCOM formulation in which the Core protein was adsorbed onto (not entrapped within) the ISCOMATRIX, resulting in approximately 1-microm particulates (as opposed to 40 nm for classical ISCOM formulations). We report that this Core-ISCOM prototype vaccine primed strong CD4(+) and CD8(+) T cell responses. Using intracellular staining for cytokines, we show that in immunized animals 0.30-0.71 and 0.32-2.21% of the circulating CD8(+) and CD4(+) T cells, respectively, were specific for naturally processed HCV Core peptides. Furthermore, this vaccine elicited a Th0-type response and induced a high titer of Abs against Core and long-lived cellular immune responses. Finally, we provide evidence that Core-ISCOM could serve as an adjuvant for the HCV envelope protein E1E2. Thus, these data provide evidence that Core-ISCOM is effective at inducing cellular and humoral immune responses in nonhuman primates.

[Human Fab antibodies derived from phage display library neutralize hepatitis A virus in vitro]

OBJECTIVE

Development of recombinant human monoclonal antibody to hepatitis A virus as a emergent measure for prevention of hepatitis A virus infection.

METHODS

Human neutralizing monoclonal antibody Fab fragments to HAV have been developed by using phage display technique. The heavy and light chains of human IgG Fab genes were amplified from a HAV patient in convalescent stage. The combinatorial phage antibody library was established by inserting both heavy and light chains of Fab genes into phage mid-vector pComb3 and followed by help phage infection after 4 rounds of panning with purified HAV as coated antigen.

RESULTS

The human Fab fragments to HAV were selected and expressed in bacteria.

CONCLUSIONS

The specific binding of Fab antibodies to HAV were demonstrated by their reaction with HAV antigen in ELISA. These results provide the basis for further development of a neutralizing recombinant human whole IgG molecule and hold promise for future use in the prophylaxis of HAV infection.

CpG DNA overcomes hyporesponsiveness to hepatitis B vaccine in orangutans

Oligonucleotides containing immunostimulatory CpG motifs (CpG ODN) have been shown to be potent Th1-type adjuvants for augmenting antigen-specific responses in mice against hepatitis B surface antigen (HBsAg). The hepatitis B virus (HBV) infects only humans and great apes and appears to exist among wild chimpanzees and orangutans. An outbreak of HBV among orangutans being rehabilitated for re-introduction to the jungle caused the death of several animals. A prophylactic vaccination program revealed that orangutans are quite hypo-responsive to a current commercial vaccine compared to results obtained previously in humans and chimpanzees. Addition of CpG ODN to hepatitis B vaccine greatly increased the seroconversion rate and the titers of antibody against HBsAg (anti-HBs). This is the first demonstration of CpG DNA in a great ape and the results have important implications for the vaccination of humans against HBV and other diseases.

Hepatitis A vaccine administration: comparison between jet-injector and needle injection

INTRODUCTION

Type A hepatitis virus (HAV) is a serious health problem throughout the world and can be spread via fecal-oral contact. Both immune globulin and an HAV vaccine provide protection, but the vaccine gives complete protection. Efficacy of methods of vaccination in relation to the formation of anti-HAV antibodies is unclear; thus, this study seeks to determine if significant differences exist between the syringe as compared to the jet injection technique. The purpose of this study was to compare in a randomized trial Biojet jet-injection system to a needle-syringe method. To determine if a significant difference between these two methods in seroconversion rates or geometric mean titers of anti HAV antibody occurs at day 15, 30, and 210 days after vaccination.

METHOD

Anti-HAV IgG(-) adult hospital employees were randomized to receive 1440 EL.U of hepatitis a vaccine (HAVRIX(R)) in 2 doses by either needle or jet-injector (Biojector(R)) system at month 0 and 6. HAV seroconversion titer results were measured by the Boehringer-Mannheim method.

RESULTS/DISCUSSION

A higher proportion of persons who received HAV vaccine via the Biojector(R) seroconverted with anti-HAV level >/=20 mIU at day 15, 30, and month 7 when compared with a needle injection.Side-effect profiles reported by participants in both methods were below those identified in current published and insert information, but the Biojector(R) had greater local reactivity in all categories when compared to the needle method.

Hepatitis A virus-specific humoral and cellular immune responses following immunization with a formalin-inactivated hepatitis A vaccine

To evaluate proliferative T cell responses elicited by a formalin-inactivated HAV vaccine, we immunized 10 subjects with an inactivated HAV vaccine, and measured HAV antibody titers and HAV-specific T cell proliferation. gamma-Interferon production by PBMC's was evaluated in selected subjects. By week 30, seroconversion (geometric mean titer=2299 mIU/ml), and HAV-specific proliferation was detected in all subjects. HAV also induced gamma-interferon in the three subjects studied. These data indicate that the inactivated HAV vaccine induces proliferative T cell responses in addition to HAV antibody. This may be important for protection against hepatitis A, and suggests that recall memory for HAV antigen is elicited by the vaccine.

Safety, immunogenicity and antibody persistence of an inactivated hepatitis A vaccine in 4 to 15 year old children

Among 277 healthy Venezuelan children, aged between 4 and 15 years, who were screened for hepatitis A virus (HAV) antibodies, 118 seronegative children were enrolled in an open study. Each child received one dose of the Pasteur Mérieux Connaught inactivated hepatitis A vaccine (AVAXIM¿trade mark omitted¿, 160 antigen units), followed by a booster dose 24 weeks later. All seronegative subjects seroconverted 2 weeks after immunisation (antibody titres greater, similar20 mIU/ml), and antibody titres were still over greater, similar20 mIU/ml after 24 weeks, at the moment of the booster dose. The anti-HAV antibody geometric mean titre (GMT), as measured by a modified radio-immunoassay (HAVAB(R), Abbott Laboratories, North Chicago, IL, USA), was 73.7 mIU/ml, 2 weeks after the first dose. Four weeks after the booster, the GMT value reached 6999 mIU/ml, representing a 29.6-fold rise from pre-booster levels. One year after the booster dose, the GMT value was 1673 mIU/ml in the 92 subjects who provided blood samples at this time, all of whom were still seroconverted ( greater, similar20 mIU/ml). No serious adverse event related to the vaccination occurred during the study. No immediate systemic reaction occurred. Local reactions were reported by 9.3% of subjects who received the primary injection and 5.5% of those given the booster dose. The systemic reactions were mainly fever and myalgia reported over the 7 days following the injection by 3.4% of subjects after the first dose and 5.5% of subjects after the booster dose. A clinically significant elevation of serum transaminase from pre-immunisation levels was noted in one subject (AST level 2.2 times the upper normal limit) 2 weeks after the first injection, although this was not associated with any clinical signs of impaired liver function. This trial demonstrated that AVAXIM¿trade mark omitted¿ containing 160 antigen units is safe and highly immunogenic in healthy children aged between 4 and 15 years, and could be included in the childhood vaccination schedule to control infection in areas endemic for hepatitis A.

Inactivated hepatitis A vaccine in Chinese patients with chronic hepatitis B infection

BACKGROUND

Hepatitis B (HBV)-infected patients have a higher morbidity and mortality when super-infected by hepatitis A (HAV).

AIM

To evaluate the immunogenicity and safety of a commercial inactivated HAV vaccine in Chinese patients with chronic HBV infection.

METHODS

Sixty-five HBV-infected patients (30 carriers, 22 chronic hepatitis, 13 cirrhosis), who were seronegative for HAV, received a dose of 1440 ELISA units of HAV vaccine at weeks 0 and 24. Twenty-eight healthy individuals aged 18-57 years, who were seronegative for both HBV and HAV infection, also received the same vaccination regimen. Seroconversion was defined as an anti-HAV titre >/= 33 mIU/mL.

RESULTS

The seroconversion rates for the HBV-infected patients at weeks 2, 4 and 24 were 72, 91 and 80%, respectively. The corresponding geometric mean titres (GMTs) were 103, 311 and 123 mIU/mL. In the healthy control group the seroconversion rates were 86, 93 and 89% at weeks 2, 4 and 24. The corresponding GMTs were 112, 158 and 250 mIU/mL. There was no difference in the seroconversion rates between the two groups, but healthy controls had a significantly higher GMT at week 24 (P=0.04). Side-effects were more common in HBV patients.

CONCLUSION

The HAV vaccine is equally efficacious in patients with chronic HBV infection.

Concurrent administration of inactivated hepatitis A vaccine with immune globulin in healthy adults

301 healthy adult volunteers were randomized to one of three treatment groups: inactivated hepatitis A vaccine alone; inactivated hepatitis A vaccine with immune globulin (Ig) concurrently; or Ig alone. The first two treatment groups received a second dose of hepatitis A vaccine at week 24. Anti-HAV was measured 4, 8, 12, 24 and 28 weeks after the primary immunization. When comparing subjects receiving inactivated hepatitis A vaccine alone to those receiving vaccine and Ig, the seropositivity rates were not significantly different at 4, 8, 12 and 28 weeks, but at week 24 the seropositivity rate was lower in the group receiving both vaccine and Ig compared to the group receiving vaccine alone (92.0% compared to 97.0%). At weeks 8, 12 and 24 the geometric mean titers (GMTs) were significantly lower for subjects receiving both vaccine and Ig. The GMTs were not significantly different after the second dose of vaccine. At all time points, the lower serum antibody concentrations observed in subjects receiving both inactivated hepatitis A vaccine and Ig were nevertheless substantially higher than the cutoff for assay seropositivity and much higher than after Ig alone; these differences are therefore clinically insignificant.

[Detection of the nucleic acids of hepatitis B and C viruses and human immunodeficiency virus for the biological screening of blood donations. Viral Hepatitis and Retrovirus Working Groups and Subgroup for Molecular Biology Applied to Transfusion Virology of the French Blood Transfusion Society]

Direct viral DNA or RNA detection by genomic amplification methods should contribute to the improvement of blood supply safety by reducing the pre-seroconversion window period. However, nucleic acid testing may not eliminate virus transmission from window period donations. Moreover, the virus subtype diversity has to be taken into account for the choice of nucleic amplification assays. Technology for nucleic acid testing has not been developed to be implemented in blood screening laboratories. The limitations of these procedures are mainly linked to the difficulties related to the automation of sample processing and to the possibilities of cross contamination of samples due to the high sensitivity of amplification methods. The extreme complexity of nucleic acid testing for single donation screening (development of an on-site automated high-throughput instrumentation, training, specialized facilities for sample processing, amplification and detection...) and its high cost mean that strategies using amplification testing of pooled samples should be developed.

Solid phase synthesis and immunogenicity of a VP3 peptide from hepatitis A virus

The synthesis of a peptide belonging to the VP3 capsid protein of Hepatitis A virus has been accomplished by the continuous flow Fmoc-polyamide solid phase method. The use of methoxytrimethylbenzenesulphonyl (Mtr) and pentamethylchromansulphonyl (Pmc) as arginine side-chain protecting groups in the presence of tryptophan without lateral protection or protected with t-Boc is discussed. The synthetic VP3 peptide has been administered to mice in different forms: (i) free, (ii) coupled to keyhole limpet hemocyanin, (iii) encapsulated in multilamellar (MLV) liposomes, and (iv) incorporated to a tetrameric branched lysine core. The immune response induced by these preparation is reported.

Assembly of hepatitis delta virus-like empty particles in yeast

Large delta antigen (L-HDAg) of hepatitis delta virus (HDV) and small-form hepatitis B surface antigen (HBsAg) of helper hepatitis B virus have previously been shown to be the minimum components for the assembly of HDV-like particles in mammalian cells. Extending from this finding, we coexpressed L-HDAg and small HBsAg in Saccharomyces cerevisiae to study their assembly in yeast cells. The assembly of virus particles from L-HDAg and HBsAg in yeast was demonstrated by their coexistence in the same isopycnic fractions and by the coimmunoprecipitation of L-HDAg with HBsAg using an antibody against HBsAg (anti-HBs). Furthermore, after purification by affinity chromatography with anti-HBs, HDV-like particles with size and morphology similar to those derived from mammalian cells could be visualized by electron microscopy. Mice immunized with yeast-derived HDV-like particles simultaneously acquired antibodies against HBsAg and HDAg, indicating that both viral proteins are antigenic. The results indicated that S. cerevisiae could serve as a host for the assembly of HDV-like empty particles. This system may be useful in investigating cellular processes involved in HDV assembly and in producing ample amount of HDV-like particles for structural and immunological studies.

Antibodies to the hepatitis B e antigen (HBeAg) can be induced in HBeAg-transgenic mice by adoptive transfer of a specific T-helper 2 cell clone

Production of antibody to hepatitis B e antigen (HBeAg); i.e., anti-HBe antibody,) in HBeAg-transgenic mice is believed to be mediated by T-helper 2 (Th2) cells. Injection of an HBeAg-specific Th2 clone into HBeAg-transgenic H-2k mice induced anti-HBe antibody production, confirming the function of Th2 cells in this model system.

Immunogenicity and protectivity of a new liposomal hepatitis A vaccine

In this study we investigated a new liposomal hepatitis A vaccine (Epaxal) developed by the Swiss Serum and Vaccine Institute clinically and immunologically using a one dose priming schedule and a booster injection after 1 year. This vaccine contains formalin inactivated hepatitis A virus particles attached to phospholipid vesicles together with influenza virus haemagglutinin. Two doses of the vaccine were administered at months 0 and 12 in 117 volunteers. Blood samples were drawn at days-7, 14 and 28 and after 6, 12 and 13 months, local and systemic reactions were monitored by means of questionnaires. Immunogenicity was evaluated as usual by the determination of anti-HAV from the collected sera using the ELISA technique. In order to evaluate the protective efficacy of the vaccine induced antibodies a sample of 25 sera mainly from vaccinees showing low ELISA titres was additionally analysed by means of a virus NT. The vaccine was excellently tolerable and highly immunogenic. Seroconversion evaluated by ELISA was 97 and 99%, respectively, 14 and 28 days after the first dose and 100% after the second dose. NT titres were well correlated with ELISA titres and showed similar seroconversion rates even in the early phase of immunization. The results of this study show that with two doses of the liposomal hepatitis A vaccine administered at months 0 and 12 early protection within 14 days and long lasting immunity can be achieved.

Further evaluation of the safety and protective efficacy of live attenuated hepatitis A vaccine (H2-strain) in humans

A study on the possibility of transmission of live hepatitis A vaccine (H2-strain) from vaccinees to nonvaccinees was conducted. As a result, no seroconversion was found among 87 seronegative nonvaccinees, who had a close contact with their 141 subcutaneously vaccinated classmates nor was it found among 101 seronegative children administered the vaccine orally. The above fundings suggest that by losing the ability to be transmitted orally the vaccine virus may result in a decreasing possibility of dissemination among contacts. A 4-year study on the protective efficacy of the H2-strain vaccine was done at 11 primary schools starting at 1991 in Shaoxing County. Since then, there has been no hepatitis A reported among 18102 cumulative person-years in the vaccination group, while 495 cases occurred among 242168 cumulative person-years in the control groups. A large scale vaccination with a cumulative vaccination coverage of 89.45% was carried out in Jiaojiang City among children 1-15 years old. Hepatitis A in this age group in the city, which had 12-87 cases per annum with an average of 32 for 8 years before vaccination, decreased drastically to 0-1 cases after vaccination. The protective efficacy of H2-strain vaccine proved to be satisfactory.

DNA inoculation with a plasmid vector carrying the hepatitis E virus structural protein gene induces immune response in mice

The plasmid construct, pJHEV, containing the full-length open reading frame 2 (ORF-2) of hepatitis E virus (HEV) gene, expresses the HEV structural protein ORF-2 in Cos-7 cells under the control of a hCMV promoter. No ORF-2 protein could be detected in Cos-7 cells transfected with either vector alone or with a vector containing the ORF-2 of HEV in the incorrect orientation. The successful construct was further tested in BALB/c (H-2d) mice for the induction of an ORF-2 specific immune response. Intramuscular (i.m.) immunization of mice pretreated 24 h earlier with bupivacaine with the naked DNA construct elicited a humoral immune response in 80% and 100% of two separate groups of mice, respectively. No anti-ORF-2 responses were observed in mice immunized with the vector only. Sera from mice injected with pJHEV specifically recognized HEV ORF-2 structural protein expressed in recombinant baculovirus in an enzyme-linked-immunosorbent assay (ELISA) and Western blot. Anti-ORF-2 serum titers peaked at ca 1:5000 in the ELISA and 1:1000 in the Western blot. These titers have remained constant for over 12 months after the last boost of pJHEV. To our knowledge, this is the first report of the use of DNA-based immunization for the generation of an immune response to a HEV structural protein.

Humoral immune response to the hypervariable region of hepatitis C virus differs between genotypes 1b and 2a

Antibody to the hypervariable region (HVR) of HCV is thought to have neutralizing activity. The HCV genotype is known to affect the clinical course of infection. The antibody response to HVR and its relationship to the virologic and clinical characteristics were investigated in 21 patients with chronic hepatitis C. HVRs amplified by polymerase chain reaction from serum HCV were expressed as glutathione S-transferase fusion proteins. From 8 to 34 clones per serum sample were obtained (375 clones total), and the anti-HVR antibody in serum was assessed by Western blot. Both the incidence of fusion proteins positive for anti-HVR antibody and the activity of antibody were significantly higher in 6 patients with genotype 2a than in 15 patients with genotype 1b. This result suggests that the quantity of humoral response to HVR affects the clinical outcome of infection with these two HCV genotypes.

Long-term persistence of anti-HAV antibodies following active immunization with hepatitis A vaccine

Seventy-one anti-hepatitis A virus (HAV) negative volunteers were immunized against hepatitis A. An inactivated hepatitis A vaccine (HAVRIX, SmithKline Beecham), derived from tissue cell cultures, at single doses of 720 ELISA units was used following a schedule of vaccinations at month 0.1 and 6. The vaccines were tested for the presence of HAV antibodies 1 month after each vaccination and then after 2, 3, 4 and 5 years. The annual decrease of anti-HAV titres was 25%. Five years after vaccination a protective antibody titre, varying between 20 and 5200 mIU ml-1, could be demonstrated in all 47 retested volunteers with a geometric mean titre (GMT) of 442 mIU ml-1. Levels of anti-HAV-antibodies following active immunization were significantly higher in female volunteers. This could be consistently demonstrated throughout the observation period. Based on these data the antibody persistence was calculated over time. GMTs at protective levels higher than 20 mIU ml-1 can be expected to persist for at least 15 years.

[Protection of adolescents against hepatitis A]

In Croatia, hepatitis A is still a considerable public health problem which, however, can be efficiently solved by vaccination. The study of vaccine immunogenicity and reactivity was performed in a random sample of 88 high school seniors, mean age 209 +/- 6.4 month (17 years and 5 months), from Ivanić-Grad and surrounding countyside. All the children were immunized by HAV sorbate SSW inactivated vaccine, manufactured by Sächsisches Serumwerk GmbH, Dresden. One 1-ml dose of the vaccine contains at least 720 units of inactivated HAV, MRC 5 strain, grown on human diploid cells and adsorbed on 0.95 mg aluminium hydroxide gel. The vaccine was administered intramuscularly, according to the scheme 0, 30, 60. Postvaccinal reactions were followed for 3 days after each dose and were observed in four (4.6%) children. A month after last dose (day 90), a 100% seroconversion was found. In 84 (95.5%) children, the level of antibodies exceeded 100 IU/L, one (1.1%) child had 80 IU/L, two (2.3%) children had 50 IU/L, one (1.1%) child had only 20 IU/L.