1
|
Spring MD, Sousa JC, Li Q, Darko CA, Morrison MN, Marcsisin SR, Mills KT, Potter BM, Paolino KM, Twomey PS, Moon JE, Tosh DM, Cicatelli SB, Froude JW, Pybus BS, Oliver TG, McCarthy WF, Waters NC, Smith PL, Reichard GA, Bennett JW. Determination of Cytochrome P450 Isoenzyme 2D6 (CYP2D6) Genotypes and Pharmacogenomic Impact on Primaquine Metabolism in an Active-Duty US Military Population. J Infect Dis 2020; 220:1761-1770. [PMID: 31549155 PMCID: PMC6804407 DOI: 10.1093/infdis/jiz386] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/24/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Plasmodium vivax malaria requires a 2-week course of primaquine (PQ) for radical cure. Evidence suggests that the hepatic isoenzyme cytochrome P450 2D6 (CYP2D6) is the key enzyme required to convert PQ into its active metabolite. Methods CYP2D6 genotypes and phenotypes of 550 service personnel were determined, and the pharmacokinetics (PK) of a 30-mg oral dose of PQ was measured in 45 volunteers. Blood and urine samples were collected, with PQ and metabolites were measured using ultraperformance liquid chromatography with mass spectrometry. Results Seventy-six CYP2D6 genotypes were characterized for 530 service personnel. Of the 515 personnel for whom a single phenotype was predicted, 58% had a normal metabolizer (NM) phenotype, 35% had an intermediate metabolizer (IM) phenotype, 5% had a poor metabolizer (PM) phenotype, and 2% had an ultrametabolizer phenotype. The median PQ area under the concentration time curve from 0 to ∞ was lower for the NM phenotype as compared to the IM or PM phenotypes. The novel 5,6-ortho-quinone was detected in urine but not plasma from all personnel with the NM phenotype. Conclusion The plasma PK profile suggests PQ metabolism is decreased in personnel with the IM or PM phenotypes as compared to those with the NM phenotype. The finding of 5,6-ortho-quinone, the stable surrogate for the unstable 5-hydroxyprimaquine metabolite, almost exclusively in personnel with the NM phenotype, compared with sporadic or no production in those with the IM or PM phenotypes, provides further evidence for the role of CYP2D6 in radical cure. Clinical Trials Registration NCT02960568.
Collapse
Affiliation(s)
- Michele D Spring
- Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Silver Spring
| | | | - Qigui Li
- Experimental Therapeutics Branch, Silver Spring
| | | | | | | | | | | | - Kristopher M Paolino
- Division of Infectious Disease, SUNY Upstate Medical University, Syracuse, New York
| | - Patrick S Twomey
- Licensing and Early Development-Oncology, Genentech, South San Francisco, California
| | | | - Donna M Tosh
- Clinical Operations, Government and Public Health Solutions, ICON, Hinckley, Ohio
| | | | - Jeffrey W Froude
- Vaccines/Therapeutics Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia
| | | | | | - William F McCarthy
- U. S. Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Norman C Waters
- Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Jason W Bennett
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences, Silver Spring.,Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring
| |
Collapse
|
2
|
Spring MD, Sousa JC, Li Q, Darko CA, Morrison MN, Marcsisin SR, Mills KT, Potter BM, Paolino KM, Twomey PS, Moon JE, Tosh DM, Cicatelli SB, Froude JW, Pybus BS, Oliver TG, Mccarthy WF, Waters NC, Smith PL, Reichard GA, Bennett JW. Corrigendum to: Determination of Cytochrome P450 Isoenzyme 2D6 (CYP2D6) Genotypes and Pharmacogenomic Impact on Primaquine Metabolism in an Active-Duty US Military Population. J Infect Dis 2019; 221:1204. [PMID: 31773155 PMCID: PMC7075415 DOI: 10.1093/infdis/jiz599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michele D Spring
- Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.,The Henry M. Jackson Foundation for the Advancement of Military Medicine
| | | | - Qigui Li
- Experimental Therapeutics Branch
| | | | | | | | | | | | - Kristopher M Paolino
- Division of Infectious Disease, SUNY Upstate Medical University, Syracuse, New York
| | - Patrick S Twomey
- Licensing and Early Development-Oncology, Genentech, South San Francisco, California
| | | | - Donna M Tosh
- Clinical Operations, Government and Public Health Solutions, ICON, Hinckley, Ohio
| | | | - Jeffrey W Froude
- Vaccines/Therapeutics Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia
| | | | - Thomas G Oliver
- Clinical Pharamacology Division, Uniformed Services University of the Health Sciences
| | - William F Mccarthy
- U. S. Army Medical Materiel Development Activity, Fort Detrick, Maryland
| | - Norman C Waters
- Department of Bacterial and Parasitic Diseases, US Army Medical Directorate of the Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Jason W Bennett
- Infectious Diseases Division, Department of Medicine, Uniformed Services University of the Health Sciences.,Bacterial Diseases Branch, Walter Reed Army Institute of Research
| |
Collapse
|
3
|
Gallovic MD, Schully KL, Bell MG, Elberson MA, Palmer JR, Darko CA, Bachelder EM, Wyslouzil BE, Keane-Myers AM, Ainslie KM. Acetalated Dextran Microparticulate Vaccine Formulated via Coaxial Electrospray Preserves Toxin Neutralization and Enhances Murine Survival Following Inhalational Bacillus Anthracis Exposure. Adv Healthc Mater 2016; 5:2617-2627. [PMID: 27594343 DOI: 10.1002/adhm.201600642] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 06/17/2016] [Revised: 07/20/2016] [Indexed: 12/30/2022]
Abstract
Subunit formulations are regarded as the safest type of vaccine, but they often contain a protein-based antigen that can result in significant challenges, such as preserving antigenicity during formulation and administration. Many studies have demonstrated that encapsulation of protein antigens in polymeric microparticles (MPs) via emulsion techniques results in total IgG antibody titers comparable to alum formulations, however, the antibodies themselves are non-neutralizing. To address this issue, a coaxial electrohydrodynamic spraying (electrospray) technique is used to formulate a microparticulate-based subunit anthrax vaccine under conditions that minimize recombinant protective antigen (rPA) exposure to harsh solvents and high shear stress. rPA and the adjuvant resiquimod are encapsulated either in separate or the same acetalated dextran MPs. Using a murine model, the electrospray formulations lead to higher IgG2a subtype titers as well as comparable total IgG antibody titers and toxin neutralization relative to the FDA-approved vaccine (BioThrax). BioThrax provides no protection against a lethal inhalational challenge of the highly virulent Ames Bacillus anthracis anthrax strain, whereas 50% of the mice vaccinated with separately encapsulated electrospray MPs survive. Overall, this study demonstrates the potential use of electrospray for encapsulating protein antigens in polymeric MPs.
Collapse
Affiliation(s)
- Matthew D. Gallovic
- Department of Chemical and Biomolecular Engineering; College of Engineering; The Ohio State University; Columbus OH 43210 USA
- Division of Molecular Pharmaceutics; Eshelman School of Pharmacy; University of North Carolina; Chapel Hill NC 27599 USA
| | - Kevin L. Schully
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - Matthew G. Bell
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - Margaret A. Elberson
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - John R. Palmer
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - Christian A. Darko
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - Eric M. Bachelder
- Division of Molecular Pharmaceutics; Eshelman School of Pharmacy; University of North Carolina; Chapel Hill NC 27599 USA
| | - Barbara E. Wyslouzil
- Department of Chemical and Biomolecular Engineering; College of Engineering; The Ohio State University; Columbus OH 43210 USA
- Department of Chemistry and Biochemistry; College of Arts and Sciences; The Ohio State University; Columbus OH 43210 USA
| | - Andrea M. Keane-Myers
- Vaccine and Medical Countermeasures Department; Biological Defense Research Directorate; Naval Medical Research Center; Fort Detrick MD 20910 USA
| | - Kristy M. Ainslie
- Division of Molecular Pharmaceutics; Eshelman School of Pharmacy; University of North Carolina; Chapel Hill NC 27599 USA
| |
Collapse
|
4
|
Heppner DG, Kester KE, Ockenhouse CF, Tornieporth N, Ofori O, Lyon JA, Stewart VA, Dubois P, Lanar DE, Krzych U, Moris P, Angov E, Cummings JF, Leach A, Hall BT, Dutta S, Schwenk R, Hillier C, Barbosa A, Ware LA, Nair L, Darko CA, Withers MR, Ogutu B, Polhemus ME, Fukuda M, Pichyangkul S, Gettyacamin M, Diggs C, Soisson L, Milman J, Dubois MC, Garçon N, Tucker K, Wittes J, Plowe CV, Thera MA, Duombo OK, Pau MG, Goudsmit J, Ballou WR, Cohen J. Towards an RTS,S-based, multi-stage, multi-antigen vaccine against falciparum malaria: progress at the Walter Reed Army Institute of Research. Vaccine 2005; 23:2243-50. [PMID: 15755604 DOI: 10.1016/j.vaccine.2005.01.142] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The goal of the Malaria Vaccine Program at the Walter Reed Army Institute of Research (WRAIR) is to develop a licensed multi-antigen, multi-stage vaccine against Plasmodium falciparum able to prevent all symptomatic manifestations of malaria by preventing parasitemia. A secondary goal is to limit disease in vaccinees that do develop malaria. Malaria prevention will be achieved by inducing humoral and cellular immunity against the pre-erythrocytic circumsporozoite protein (CSP) and the liver stage antigen-1 (LSA-1). The strategy to limit disease will target immune responses against one or more blood stage antigens, merozoite surface protein-1 (MSP-1) and apical merozoite antigen-1 (AMA-1). The induction of T- and B-cell memory to achieve a sustained vaccine response may additionally require immunization with an adenovirus vector such as adenovirus serotype 35. RTS,S, a CSP-derived antigen developed by GlaxoSmithKline Biologicals in collaboration with the Walter Reed Army Institute of Research over the past 17 years, is the cornerstone of our program. RTS,S formulated in AS02A (a GSK proprietary formulation) is the only vaccine candidate shown in field trials to prevent malaria and, in one instance, to limit disease severity. Our vaccine development plan requires proof of an individual antigen's efficacy in a Phase 2 laboratory challenge or field trial prior to its integration into an RTS,S-based, multi-antigen vaccine. Progress has been accelerated through extensive partnerships with industrial, academic, governmental, and non-governmental organizations. Recent safety, immunogenicity, and efficacy trials in the US and Africa are presented, as well as plans for the development of a multi-antigen vaccine.
Collapse
Affiliation(s)
- D Gray Heppner
- Walter Reed Army Institute of Research, Department of Immunology, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Darko CA, Angov E, Collins WE, Bergmann-Leitner ES, Girouard AS, Hitt SL, McBride JS, Diggs CL, Holder AA, Long CA, Barnwell JW, Lyon JA. The clinical-grade 42-kilodalton fragment of merozoite surface protein 1 of Plasmodium falciparum strain FVO expressed in Escherichia coli protects Aotus nancymai against challenge with homologous erythrocytic-stage parasites. Infect Immun 2005; 73:287-97. [PMID: 15618165 PMCID: PMC538964 DOI: 10.1128/iai.73.1.287-297.2005] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 42-kDa fragment from the C terminus of major merozoite surface protein 1 (MSP1) is among the leading malaria vaccine candidates that target infection by asexual erythrocytic-stage malaria parasites. The MSP1(42) gene fragment from the Vietnam-Oak Knoll (FVO) strain of Plasmodium falciparum was expressed as a soluble protein in Escherichia coli and purified according to good manufacturing practices. This clinical-grade recombinant protein retained some important elements of correct structure, as it was reactive with several functional, conformation-dependent monoclonal antibodies raised against P. falciparum malaria parasites, it induced antibodies (Abs) that were reactive to parasites in immunofluorescent Ab tests, and it induced strong growth and invasion inhibitory antisera in New Zealand White rabbits. The antigen quality was further evaluated by vaccinating Aotus nancymai monkeys and challenging them with homologous P. falciparum FVO erythrocytic-stage malaria parasites. The trial included two control groups, one vaccinated with the sexual-stage-specific antigen of Plasmodium vivax, Pvs25, as a negative control, and the other vaccinated with baculovirus-expressed MSP1(42) (FVO) as a positive control. Enzyme-linked immunosorbent assay (ELISA) Ab titers induced by E. coli MSP1(42) were significantly higher than those induced by the baculovirus-expressed antigen. None of the six monkeys that were vaccinated with the E. coli MSP1(42) antigen required treatment for uncontrolled parasitemia, but two required treatment for anemia. Protective immunity in these monkeys correlated with the ELISA Ab titer against the p19 fragment and the epidermal growth factor (EGF)-like domain 2 fragment of MSP1(42), but not the MSP1(42) protein itself or the EGF-like domain 1 fragment. Soluble MSP1(42) (FVO) expressed in E. coli offers excellent promise as a component of a vaccine against erythrocytic-stage falciparum malaria.
Collapse
Affiliation(s)
- Christian A Darko
- Department of Immunology, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|