Ebola vaccine

Ebola vaccine candidates against Ebola have been developed in the decade prior to 2014,[1] but none have yet been approved for clinical use in humans.[2][3][4] Several promising vaccine candidates have been shown to protect nonhuman primates (usually macaques) against lethal infection.[5][6][7] These include replication-deficient adenovirus vectors, replication-competent vesicular stomatitis (VSV) and human parainfluenza (HPIV-3) vectors, and virus-like nanoparticle preparations. Conventional trials to study efficacy by exposure of humans to the pathogen after immunization are obviously not feasible in this case. For such situations, the FDA has established the "Animal Efficacy Rule" allowing licensure to be approved on the basis of animal model studies that replicate human disease, combined with evidence of safety and a potentially potent immune response (antibodies in the blood) from humans given the vaccine. Clinical trials involve the administration of the vaccine to healthy human subjects to evaluate the immune response, identify any side effects and determine the appropriate dosage.[8]

Vaccines in development and in use

Summary table

Vaccine Associated organisations Status
Chimp adenovirus 3 vectored glycoprotein (cAd3-EBO Z) GSK & NIAID Phase III Feb. 2016[9]
rVSV vectored glycoprotein (VSV-EBOV) Newlink Genetics & Merck in use (flare ups/ West Africa)[10][11]
Human adenovirus 5 vectored 2014 glycoprotein insert BIT & CanSino Phase I complete [12]
Adenovirus 26 vectored glycoprotein / MVA-BN (Ad26.ZEBOV/ MVA-BN) Johnson & Johnson Phase I complete April, 2016 [13][14]
HPIV-3 vectored glycoprotein Ministry of Health (Russia) Phase I planned [15]
Rabies vectored glycoprotein Thomas Jefferson University & NIAID Non-human primate challenge complete[16]
Purified glycoprotein Protein Sciences NHP challenge initiated [17]
Ebola ∆VP30 H2O2 treated University of Wisconsin Non-human primate challenge complete [18]

cAd3-EBO Z

Ebola virions
For more details on this topic, see cAd3-ZEBOV.

In September 2014, two Phase 1 clinical trials began for the vaccine cAd3-EBO Z, which is based on an attenuated version of a chimpanzee adenovirus (cAd3) that has been genetically altered so that it is unable to replicate in humans.[19] The cAd3 vector has a DNA fragment insert that encodes the Ebola virus glycoprotein, which is expressed on the virion surface and is critical for attachment to host cells and catalysis of membrane fusion.[20] It was developed by NIAID in collaboration with Okairos, now a division of GlaxoSmithKline. For the trial designated VRC 20, 20 volunteers were recruited by the NIAID in Bethesda, Maryland, while three dose-specific groups of 20 volunteers each were recruited for trial EBL01 by University of Oxford, U.K. Initial results were released in November 2014; all 20 volunteers developed antibodies against Ebola and there were no significant concerns raised about safety.[21][22] In December 2014, University of Oxford expanded the trial to include a booster vaccine based on MVA-BN, a strain of Modified vaccinia Ankara, developed by Bavarian Nordic, to investigate whether it can help increase immune responses further.[23][24] The trial which has enrolled a total of 60 volunteers will see 30 volunteers vaccinated with the booster vaccine. As of April 2015, Phase 3 trial with a single dose of cAd3-EBO Z begins in Sierra Leone after a successful Phase 2 study in West Africa countries.[25][26]

rVSV-EBOV

For more details on this topic, see VSV-EBOV.

A vaccine based on the vesicular stomatitis virus which was genetically modified to express a surface glycoprotein of Zaire Ebola virus, called VSV-EBOV, has been developed by the Public Health Agency of Canada, with development subsequently taken over by Merck Inc.[27] In October 2014, the Wellcome Trust, who was also one of the biggest UK founder,[28] announced the start of multiple trials in healthy volunteers in Europe, Gabon, Kenya, and the USA.[29] The vaccine was proven safe at multiple sites in North America, Europe, and Africa,but several volunteers at one trial site in Geneva, Switzerland, developed vaccine-related arthritis after about 2 weeks, and about 20%-30% of volunteers at reporting sites developed low-grade post-vaccine fever, which resolved within a day or two. Other common side-effects were pain at the site of injection, myalgia, and fatigue.[30] The trial was temporarily halted in December 2014 due to possible adverse effects, but subsequently resumed.[31] As of April 2015, a Phase 3 trial with a single dose of VSV-EBOV began in Liberia after a successful Phase 2 study in the West Africa country.[25] On 31 July 2015, preliminary results of a Phase 3 trial in Guinea indicated that the vaccine appears to be "highly efficacious and safe."[32] The trial used a ring vaccination protocol that first vaccinated all the closest contacts of new cases of Ebola infection either immediately or after 21 days. Because of the demonstrated efficacy of immediate vaccination, all recipients will now be immunized immediately.[33][34] Ring vaccination is the method used in the program to eradicate smallpox in the 1970s. The trial will continue to assess whether the vaccine is effective in creating herd immunity to Ebola virus infection.[35]

Ad26.ZEBOV/ MVA-BN

Johnson & Johnson has developed an Ebola vaccine at its Janssen Pharmaceutica Company. The regimen consists of two vaccine components (first vaccine as prime, followed by a second vaccine as boost)[36] that are based on AdVac technology from Crucell Holland B.V., which is part of Janssen, and the MVA-BN technology from Bavarian Nordic. The Ad26.ZEBOV is derived from human adenovirus serotype 26 (Ad26) expressing the Ebola virus Mayinga variant glycoprotein while the second component MVA-BN is the Modified Vaccinia Virus Ankara - Bavarian Nordic (MVA-BN) Filo-vector.[37] This product commenced Phase 1 clinical trial at the Jenner Institute in Oxford during January 2015.[38][39] The preliminary data indicated the prime-boost vaccine regimen elicited temporary immunologic response in the volunteers as expected from vaccination. The Phase 2 trial enrolled 612 adult volunteers and commenced in July 2015 in United Kingdom and France. A second Phase 2 trial, involving 1,200 volunteers, has been initiated in Africa [36] with the first trial commenced in Sierra Leone in October 2015.[40]

Ebola GP vaccine

Recombinant formation plasmids

At the 8th Vaccine and ISV Conference in Philadelphia on 27−28 October 2014, Novavax Inc. reported the development in a "few weeks" of a glycoprotein (GP) nanoparticle Ebola virus (EBOV GP) vaccine using their proprietary recombinant technology. A recombinant protein is a protein whose code is carried by recombinant DNA. The vaccine is based on the newly published genetic sequence[41] of the 2014 Guinea Ebola (Makona) strain that is responsible for the current Ebola disease epidemic in West Africa. In animal studies, a useful immune response was induced, and was found to be enhanced ten to a hundred-fold by the company's "Matrix-M" immunologic adjuvant. A study of the response of non-human primate to the vaccine had been initiated. As of February 2015, Novavax had completed 2 primate studies on baboons and macaques and had initiated a Phase 1 clinical trial in Australia. The Lipid nanoparticle (LNP)-encapsulated siRNAs rapidly adapted to target the Makona outbreak strain of EBOV are able to protect 100% of rhesus monkeys against lethal challenge when treatment was initiated at 3 days postexposure while animals were viremic and clinically ill.[42] The top line Phase 1 human trial results showed that the adjuvanted Ebola GP Vaccine was highly immunogenic at all dose levels.

Nasal vaccine

On November 5, 2014, the Houston Chronicle reported that a research team at the University of Texas-Austin was developing a nasal spray Ebola vaccine, which the team had been working on for seven years.[43] The team reported in 2014 that in the nonhuman primate studies it conducted, the vaccine had more efficacy when delivered via nasal spray than by injection.[44] As of early November 2014 further development by the team appeared unlikely due to lack of funding.[43][45]

Vaxart tablet

Vaxart Inc. is developing a vaccine technology in the form of a temperature-stable tablet which may offer advantages such as reduced cold chain requirement, and rapid and scalable manufacturing. In January 2015, Vaxart announced that it had secured funding to develop its Ebola vaccine to Phase 1 trial.[46]

Novel recombinant adenovirus type-5 vector-based Ebola vaccine

In late 2014 and early 2015, a double-blind, randomized Phase 1 trial was conducted in the Jiangsu Province of China; the trial examined a vaccine that contains glycoproteins of the 2014 strain, rather than those of the 1976 strain. The trial found signals of efficacy and raised no significant safety concerns.[47]

Vesicular Stomatitis Virus vaccine

A study published in Science during March 2015 demonstrates that vaccination with a weakened form of the Ebola virus provides some measure of protection to non-human primates. This study was conducted in accordance with a protocol approved by an Institutional Animal Care and Use Committee of the National Institutes of Health.[48] The new vaccine relies on a strain of Ebola called EBOVΔVP30, which is unable to replicate.[49]

Clinical trials in West Africa

In January 2015, Marie-Paule Kieny, the WHO's assistant director-general of health systems and innovation, announced that the vaccines cAd3-EBO Z and VSV-EBOV had demonstrated acceptable safety profiles during early testing and would soon progress to large-scale trials in Liberia, Sierra Leone and Guinea. The trials would involve up to 27,000 people and comprise 3 groups - members of the first two groups would receive the two candidate vaccines, while the third group will receive a placebo.[50] Both vaccines have since successfully completed the Phase 2 studies. The large scale Phase 3 studies have begun as of April 2015 in Liberia and Sierra Leone,[25][26] and in Guinea in March 2016.[34]

In addition, a medical anthropologist at Université de Montréal, has been working in Guinea and raised further questions about safety in the ring trial after spending time in April at one of the Ebola treatment units where trial participants are taken if they become ill, the centre in Coyah, about 50 km from the capital of Conakry.[30]

U.S. national stockpile

Credit Suisse has estimated that the U.S. government will eventually provide over $1 billion in contracts to companies to develop medicine and vaccines for Ebola virus disease. Congress passed a law in 2004 that funds a national stockpile of vaccines and medicine for possible outbreaks of disease. A number of companies are developing Ebola vaccines: GlaxoSmithKline, NewLink Genetics, Johnson & Johnson and Bavarian Nordic. Another company, Emergent BioSolutions, is a contestant for manufacturing new doses of ZMapp, a drug for Ebola virus disease treatment originally developed by Mapp Biopharmaceutical. Supplies of ZMapp ran out in October 2014.[51][52]

See also

References

  1. ↑ Richardson JS, Dekker JD, Croyle MA, Kobinger GP (June 2010). "Recent advances in Ebolavirus vaccine development". Human Vaccines (open access). 6 (6): 439–49. doi:10.4161/hv.6.6.11097. PMID 20671437.
  2. ↑ "Statement on the WHO Consultation on potential Ebola therapies and vaccines". WHO. 5 September 2014. Retrieved 1 October 2014.
  3. ↑ "2014 Ebola Outbreak in West Africa". U.S. Food and Drug Administration. Retrieved 1 Oct 2014.
  4. ↑ Alison P. Galvani with three others (21 August 2014). "Ebola Vaccination: If Not Now, When?". Annals of Internal Medicine. 161 (10): 749–50. doi:10.7326/M14-1904. PMC 4316820Freely accessible. PMID 25141813.
  5. ↑ Hoenen T, Groseth A, Feldmann H (July 2012). "Current Ebola vaccines". Expert Opin Biol Ther. 12 (7): 859–72. doi:10.1517/14712598.2012.685152. PMC 3422127Freely accessible. PMID 22559078.
  6. ↑ Peterson AT, Bauer JT, Mills JN (2004). "Ecologic and Geographic Distribution of Filovirus Disease". Emerging Infectious Diseases. 10 (1): 40–47. doi:10.3201/eid1001.030125. PMC 3322747Freely accessible. PMID 15078595.
  7. ↑ Fausther-Bovendo H, Mulangu S, Sullivan NJ (June 2012). "Ebolavirus vaccines for humans and apes". Curr Opin Virol. 2 (3): 324–29. doi:10.1016/j.coviro.2012.04.003. PMC 3397659Freely accessible. PMID 22560007.
  8. ↑ Pavot, Vincent (1 December 2016). "Ebola virus vaccines: Where do we stand?". Clinical Immunology. 173: 44–49. doi:10.1016/j.clim.2016.10.016. PMID 27910805.
  9. ↑ Pavot, Vincent (1 December 2016). "Ebola virus vaccines: Where do we stand?". Clinical Immunology. 173: 44–49. doi:10.1016/j.clim.2016.10.016. PMID 27910805.
  10. ↑ "WHO coordinating vaccination of contacts to contain Ebola flare-up in Guinea". World Health Organization. WHO.int. Retrieved 20 July 2016.
  11. ↑ "Vaccines alliance signs $5 million advance deal for Merck's Ebola shot". Reuters. 20 January 2016. Retrieved 20 July 2016.
  12. ↑ Zhu, Feng-Cai; Hou, Li-Hua; Li, Jing-Xin; Wu, Shi-Po; Liu, Pei; Zhang, Gui-Rong; Hu, Yue-Mei; Meng, Fan-Yue; Xu, Jun-Jie; Tang, Rong; Zhang, Jin-Long; Wang, Wen-Juan; Duan, Lei; Chu, Kai; Liang, Qi; Hu, Jia-Lei; Luo, Li; Zhu, Tao; Wang, Jun-Zhi; Chen, Wei (6 June 2015). "Safety and immunogenicity of a novel recombinant adenovirus type-5 vector-based Ebola vaccine in healthy adults in China: preliminary report of a randomised, double-blind, placebo-controlled, phase 1 trial". The Lancet. 385 (9984): 2272. doi:10.1016/S0140-6736(15)60553-0.
  13. ↑ "A Safety and Immunogenicity Study of Heterologous Prime-Boost Ebola Vaccine Regimens in Healthy Participants - Full Text View - ClinicalTrials.gov". clinicaltrials.gov. Retrieved 20 July 2016.
  14. ↑ "Safety and immunogenicity of novel adenovirus type 26– and modified vaccinia ankara–vectored ebola vaccines: A randomized clinical trial". JAMA. 315 (15): 1610–1623. 19 April 2016. doi:10.1001/jama.2016.4218. ISSN 0098-7484. Retrieved 20 July 2016.Subscription required
  15. ↑ "Ebola vaccines, therapies, and diagnostics". 6 July 2015. Retrieved 10 September 2015.
  16. ↑ Blaney, Joseph E.; Marzi, Andrea; Willet, Mallory; Papaneri, Amy B.; Wirblich, Christoph; Feldmann, Friederike; Holbrook, Michael; Jahrling, Peter; Feldmann, Heinz; Schnell, Matthias J. (30 May 2015). "Antibody Quality and Protection from Lethal Ebola Virus Challenge in Nonhuman Primates Immunized with Rabies Virus Based Bivalent Vaccine". PLoS Pathogens. 9 (5): e1003389. doi:10.1371/journal.ppat.1003389. PMC 3667758Freely accessible. PMID 23737747.
  17. ↑ "CT lab hopes to stop spread of Ebola". 3 March 2015. Retrieved 10 September 2015.
  18. ↑ Marzi, A.; Halfmann, P.; Hill-Batorski, L.; Feldmann, F.; Shupert, W. L.; Neumann, G.; Feldmann, H.; Kawaoka, Y. (24 April 2015). "An Ebola whole-virus vaccine is protective in nonhuman primates". Science. 348 (6233): 439–42. doi:10.1126/science.aaa4919. PMC 4565490Freely accessible. PMID 25814063.
  19. ↑ Vaccine Research Center, NIAID (29 September 2014). "Ebola Vaccine Clinical Development Overview (presentation)" (PDF). Retrieved 21 October 2014.
  20. ↑ "Partnership for Research on Ebola Vaccines in Liberia (PREVAIL)". 24 June 2015. Retrieved 10 September 2015.
  21. ↑ Ledgerwood, Julie E.; DeZure, Adam D.; Stanley, Daphne A.; Novik, Laura; Enama, Mary E.; Berkowitz, Nina M.; Hu, Zonghui; Joshi, Gyan; Ploquin, Aurélie; Sitar, Sandra; Gordon, Ingelise J.; Plummer, Sarah A.; Holman, LaSonji A.; Hendel, Cynthia S.; Yamshchikov, Galina; Roman, Francois; Nicosia, Alfredo; Colloca, Stefano; Cortese, Riccardo; Bailer, Robert T.; Schwartz, Richard M.; Roederer, Mario; Mascola, John R.; Koup, Richard A.; Sullivan, Nancy J.; Graham, Barney S. (26 November 2014). "Chimpanzee Adenovirus Vector Ebola Vaccine — Preliminary Report". New England Journal of Medicine: 150126054808000. doi:10.1056/NEJMoa1410863. PMID 25426834.
  22. ↑ Stanley DA, Honko AN, Asiedu C, Trefry JC, Lau-Kilby AW, Johnson JC, Hensley L, Ammendola V, Abbate A, Grazioli F, Foulds KE, Cheng C, Wang L, Donaldson MM, Colloca S, Folgori A, Roederer M, Nabel GJ, Mascola J, Nicosia A, Cortese R, Koup RA, Sullivan NJ (2014). "Chimpanzee adenovirus vaccine generates acute and durable protective immunity against ebolavirus challenge". Nat. Med. 20 (10): 1126–9. doi:10.1038/nm.3702. PMID 25194571.
  23. ↑ "A Study to Assess New Ebola Vaccines, cAd3-EBO Z and MVA-BN® Filo". 18 June 2015. Retrieved 10 September 2015.
  24. ↑ University of Oxfod (4 December 2014). "Booster Ebola vaccine enters first trials at Oxford University". Retrieved 7 December 2014.
  25. 1 2 3 NIH Press Release (26 March 2015). "Ebola test vaccines appear safe in Phase 2 Liberian clinical trial".
  26. 1 2 CDC Press Release (14 April 2015). "Ebola vaccine trial begins in Sierra Leone".
  27. ↑ "Canadian Ebola vaccine development taken over by Merck". CBC. 24 November 2014. Retrieved 25 November 2014.
  28. ↑ Henao-Restrepo, Ana Maria (2015). "Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial.". The Lancet. 386.9996 (2015): 857-866.
  29. ↑ "Multiple trials of VSV Ebola vaccine accelerated by international collaborative" (Press release). Wellcome Trust. Retrieved 29 October 2014.
  30. 1 2 Shuchman, Miriam (2015). "Ebola Vaccine Trial in West Africa Faces Criticism". The Lancet. 385.9981 (2015): 1933-4 – via ProQuest.
  31. ↑ "WHO Director-General opens high-level meeting on Ebola vaccines". World Health Organization. Retrieved 10 January 2015.
  32. ↑ Henao-Restrepo, Ana Maria; et al. (31 July 2015). "Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial" (PDF). Lancet. 15 (9996): 61117–5. doi:10.1016/S0140-6736(15)61117-5.
  33. ↑ "Ebola update (93): Positive vaccine trial results". ProMED mail. International Society for Infectious Diseases. Retrieved 2 August 2015.
  34. 1 2 "WHO coordinating vaccination of contacts to contain Ebola flare-up in Guinea". World Health Organization. March 2016. Retrieved 2016-05-14.
  35. ↑ "World on the verge of an effective Ebola vaccine" (Press release). World Health Organization. 31 July 2015.
  36. 1 2 Press Release (15 July 2015). "Bavarian Nordic announces that the Oxford Vaccines Group has initiated a Phase 2 study of the Ebola prime-boost vaccine regimen combining MVA-BN Filo and Janssen's Advac technology". Bavarian Nordic. Retrieved 16 July 2015.
  37. ↑ "A Safety and Immunogenicity Study of Heterologous Prime-Boost Ebola Vaccine Regimens in Healthy Participants". 23 July 2015. Retrieved 15 October 2015.
  38. ↑ Walsh, Fergus (6 January 2015). "Ebola: New vaccine trial begins". BBC News. Retrieved 6 January 2015.
  39. ↑ "Johnson & Johnson Announces Major Commitment to Speed Ebola Vaccine Development and Significantly Expand Production". Johnson & Johnson. Retrieved 6 January 2015.
  40. ↑ Hirschler, Ben (9 October 2015). "J&J starts vaccine trial in Sierra Leone, even as Ebola fades". Reuters. Retrieved 15 October 2015.
  41. ↑ Gire SK, Goba A, Andersen KG, Sealfon RS, Park DJ, Kanneh L, Jalloh S, Momoh M, Fullah M, Dudas G, Wohl S, Moses LM, Yozwiak NL, Winnicki S, Matranga CB, Malboeuf CM, Qu J, Gladden AD, Schaffner SF, Yang X, Jiang PP, Nekoui M, Colubri A, Coomber MR, Fonnie M, Moigboi A, Gbakie M, Kamara FK, Tucker V, Konuwa E, Saffa S, Sellu J, Jalloh AA, Kovoma A, Koninga J, Mustapha I, Kargbo K, Foday M, Yillah M, Kanneh F, Robert W, Massally JL, Chapman SB, Bochicchio J, Murphy C, Nusbaum C, Young S, Birren BW, Grant DS, Scheiffelin JS, Lander ES, Happi C, Gevao SM, Gnirke A, Rambaut A, Garry RF, Khan SH, Sabeti PC (September 2014). "Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak". Science. 345 (6202): 1369–72. doi:10.1126/science.1259657. PMC 4431643Freely accessible. PMID 25214632.
  42. ↑ Thi, Emily (2015). "Lipid nanoparticle siRNA treatment of Ebola-virus-Makona-infected nonhuman primates.". Nature. 521.7552 (2015): 362-365 – via GoogleScholar.
  43. 1 2 Ackerman, Todd (5 November 2014). "UT nasal spray vaccine for Ebola effective in monkeys". Houston Chronicle. Retrieved 13 November 2014.
  44. ↑ Choi, Jin Huk; Jonsson-Schmunk, Kristina; Qiu, Xiangguo; Shedlock, Devon J.; Strong, Jim; Xu, Jason X.; Michie, Kelly L.; Audet, Jonathan; Fernando, Lisa; Myers, Mark J.; Weiner, David; Bajrovic, Irnela; Tran, Lilian Q.; Wong, Gary; Bello, Alexander; Kobinger, Gary P.; Schafer, Stephen C.; Croyle, Maria A. (14 November 2014). "A Single Dose Respiratory Recombinant Adenovirus-Based Vaccine Provides Long-Term Protection for Non-Human Primates from Lethal Ebola Infection". Molecular Pharmaceutics. 12 (8): 141114080030002. doi:10.1021/mp500646d.
  45. ↑ Stanton, Dan (12 November 2014). "Ebola nasal vaccine under threat as funding runs dry". in-PharmaTechnologist. Crawley, Sussex, United Kingdom: William Reed Business Media. Retrieved 13 November 2014.
  46. ↑ "Vaxart Completes Financing to Fund Expanding Development Portfolio". Vaxart.
  47. ↑ Zhu, Feng-Cai; et al. (24 March 2015). "Safety and immunogenicity of a novel recombinant adenovirus type-5 vector-based Ebola vaccine in healthy adults in China: preliminary report of a randomised, double-blind, placebo-controlled, Phase 1 trial". The Lancet. 385 (9984): 2272. doi:10.1016/S0140-6736(15)60553-0.
  48. ↑ Marzi, Andrea (2015). "Vesicular Stomatitis Virus--Based Vaccines against Lassa and Ebola Viruses.". Emerging Infectious Diseases. 21: 305–307 – via EBSCO Wilson Science Fulltext Select.
  49. ↑ Marzi, A.; Halfmann, P.; Hill-Batorski, L.; Feldmann, F.; Shupert, W. L.; Neumann, G.; Feldmann, H.; Kawaoka, Y. (24 March 2015). "An Ebola whole-virus vaccine is protective in nonhuman primates". Science. 348 (6233): 439–42. doi:10.1126/science.aaa4919. PMC 4565490Freely accessible. PMID 25814063.
  50. ↑ "UK leads promising Ebola vaccine trial Pharmaceutical company looking into largescale manufacturing if trials are successful.". Ars Technica. Retrieved 10 January 2015.
  51. ↑ Rooney, Ben (28 October 2014). "Ebola: The making of a $1 billion drug". CNN Money. Retrieved 19 November 2014.
  52. ↑ Gantz, Sarah (20 October 2014). "Emergent BioSolutions among three under consideration for Ebola drug manufacturing". Baltimore Business Journal. Retrieved 13 November 2014.

Further reading

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