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_|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

Giuseppe

Emeritus
Experts: New Bird flu vaccine looks promising
By LINDA A. JOHNSON, Associated Press Writer

The first experimental bird flu vaccine made from lab-grown cells instead of chicken eggs shows promise in blocking the highly lethal virus, scientists report.

The advance is good news not just for preparations in case of a pandemic, but also because it offers a way to make shots for seasonal flu much faster.

That gives health officials crucial extra time to better match annual shots to the flu strains circulating.

It also would reduce dependence on the antiquated system of using millions of eggs to make flu vaccines and could cut production time roughly in half, to as little as 12 weeks, according to maker Baxter International Inc.

Results of mid-stage testing of the Baxter vaccine, Celvapan, showed two shots produced an immune response considered strong enough to protect 76 percent of healthy adults from both the H5N1 Vietnam strain it targets and the related Hong Kong strain; it appeared to protect 45 percent from a third, Indonesian strain.

"I think it is a big leap forward," said Dr. Wilbur Chen, a vaccine researcher at the University of Maryland School of Medicine not involved in the study.

Since the first outbreak in Hong Kong in 1997, more than 240 people in Asia, Europe and Africa have died from bird flu, which kills about two-thirds of people infected.

Nearly all had close contact with poultry, but scientists worry bird flu could mutate to a form easily spread among people, who have no natural immunity. Many experts believe a pandemic will eventually occur.

On Wednesday, Hong Kong health officials ordered the slaughter of all live poultry in street markets due to one of the largest outbreaks of the virus in birds in years.

The United States has stockpiled 23 million doses of egg-based human bird flu vaccine made by three companies; some European countries also have such stockpiles and are ordering Baxter's cell-based vaccine.

Other human vaccines ? a few using cells or genetic engineering but most made from eggs ? are being tested in dozens of government and commercial projects. Baxter officials say theirs is the first produced in cells that's been tested in people, and they expect to get a European Union license for Celvapan around year's end.

The results of the company-funded study were reported in Thursday's New England Journal of Medicine.

A total of 275 volunteers in Austria and Singapore got one of four doses.

The best results ? the 76 percent protection ? came from the second-lowest dose.

That dose also proved effective in a final-stage test last year of 550 volunteers in Austria and Germany, according to Dr. Harmut Ehrlich, head of research and development for Baxter's Vienna-based Bioscience unit.

It protected 73 percent of adults under 60 and 74 percent of those over 60 from the Vietnam strain. It was less effective against the Indonesian strain and wasn't tested against the older Hong Kong one.

To measure effectiveness, volunteers' blood is tested to see how well the new antibodies they developed kill the virus.

Dr. William Schaffner, a Vanderbilt University infectious disease specialist, said researchers need to keep working to make a better vaccine but Baxter's got "pretty darn good results" at low doses.

"I'm excited about this, but we have not yet reached the finish line," he said.

In the United States, the Department of Health and Human Services has invested $1.5 billion in research on cell-based seasonal and pandemic flu vaccines.

In the half-century-old egg method, virus samples are injected into hundreds of millions of specialized eggs and incubated. The egg fluids are later harvested, concentrated and purified into the vaccine.

With cell technology, small amounts of virus are put in large fermenting tanks with nutrients and cells derived from monkey kidneys, and the virus multiplies. Then the virus is inactivated, purified and put into vaccine vials.

Two cell culture vaccines for seasonal flu are licensed in Europe, said Marie-Paule Kieny, director of the World Health Organization's vaccine research program. But full development of the technology could still take a few years, she said.

Experts said Baxter's vaccine appears to work better than egg-based ones, but cautioned that lab results from different companies are hard to compare.

Linda Lambert, chief of the respiratory diseases branch at the National Institute of Allergy and Infectious Diseases, said the Baxter vaccine's protection against multiple strains could be important if a pandemic is caused by a strain other than H5N1.

"If another pops up, we'll know what to do," based on what Baxter and other researchers have been learning, she said.
___
AP Medical Writer Maria Cheng in London contributed to this story.
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On the Net:
New England Journal: http://www.nejm.org
U.S. Health and Human Services : http://www.pandemicflu.gov
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http://news.yahoo.com/s/ap/20080611/ap_on_he_me/med_bird_flu_vaccine
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Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

[FROM NEJM]

A Clinical Trial of a Whole-Virus H5N1 Vaccine Derived from Cell Culture

Hartmut J. Ehrlich, M.D., Markus M?ller, M.D., Helen M.L. Oh, M.D., Paul A. Tambyah, M.B., B.S., Christian Joukhadar, M.D., Emanuele Montomoli, Ph.D., Dale Fisher, F.R.A.C.P., Greg Berezuk, M.S., Sandor Fritsch, Ph.D., Alexandra L?w-Baselli, Ph.D., Nina Vartian, Ph.D., Roman Bobrovsky, Ph.D., Borislava G. Pavlova, Ph.D., Eva Maria P?llabauer, M.D., Otfried Kistner, Ph.D., P. Noel Barrett, Ph.D., for the Baxter H5N1 Pandemic Influenza Vaccine Clinical Study Team

ABSTRACT

Background
Widespread infections of avian species with avian influenza H5N1 virus and its limited spread to humans suggest that the virus has the potential to cause a human influenza pandemic.
An urgent need exists for an H5N1 vaccine that is effective against divergent strains of H5N1 virus.

Methods
In a randomized, dose-escalation, phase 1 and 2 study involving six subgroups, we investigated the safety of an H5N1 whole-virus vaccine produced on Vero cell cultures and determined its ability to induce antibodies capable of neutralizing various H5N1 strains.

In two visits 21 days apart, 275 volunteers between the ages of 18 and 45 years received two doses of vaccine that each contained 3.75 ?g, 7.5 ?g, 15 ?g, or 30 ?g of hemagglutinin antigen with alum adjuvant or 7.5 ?g or 15 ?g of hemagglutinin antigen without adjuvant. Serologic analysis was performed at baseline and on days 21 and 42.

Results
The vaccine induced a neutralizing immune response not only against the clade 1 (A/Vietnam/1203/2004) virus strain but also against the clade 2 and 3 strains.

The use of adjuvants did not improve the antibody response.

Maximum responses to the vaccine strain were obtained with formulations containing 7.5 ?g and 15 ?g of hemagglutinin antigen without adjuvant.

Mild pain at the injection site (in 9 to 27% of subjects) and headache (in 6 to 31% of subjects) were the most common adverse events identified for all vaccine formulations.

Conclusions
A two-dose vaccine regimen of either 7.5 ?g or 15 ?g of hemagglutinin antigen without adjuvant induced neutralizing antibodies against diverse H5N1 virus strains in a high percentage of subjects, suggesting that this may be a useful H5N1 vaccine.

(ClinicalTrials.gov number, NCT00349141 [ClinicalTrials.gov] .)


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http://content.nejm.org/cgi/content/full/358/24/2573?query=TOC
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Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

[FROM NEJM - EXCERPT]

Vaccine Preparedness ? Are We Ready for the Next Influenza Pandemic?

Peter F. Wright, M.D.

The quest for a fully immunogenic vaccine against influenza H5N1 viruses has gone on for more than 10 years, since this family of potentially pandemic viruses emerged as a cause of human disease in Hong Kong in 1997.

H5N1 has caused 381 human cases of influenza, with a mortality rate exceeding 60%.

H5 strains have now been found in birds throughout much of the world (though not yet in the Americas), and human illness has occurred in 14 countries throughout Asia and in northern Africa.1

The much-feared rapid spread through and between communities, however, has not occurred.

Aside from small clusters of cases within families, each human case has been associated with close contact with poultry.

The culling of poultry in the face of recognized bird disease has been a major defense strategy since the first outbreak.

Each human infection constitutes an opportunity for genetic modification of the virus through reassortment, mutation, or both ? modifications that could enable the virus to overcome the remaining barrier to a pandemic by gaining the capacity for efficient person-to-person transmission.

The fact that no epidemic has yet occurred has prompted questions about whether H5 viruses face some insurmountable barrier of viral fitness that renders them incapable of causing widespread illness in humans.

Yet all agree that history is a powerful teacher and that future influenza pandemics caused by novel strains are highly probable.

So where do we stand with vaccines against emergent influenza strains?

The preparation of a vaccine against H5 influenza has not proved as simple as adhering to the standard manufacturing techniques used to create yearly influenza vaccines. The H5 strains have had to be modified, since their virulence in chicken eggs causes rapid death of the embryo, precluding the generation of an acceptable antigen yield.

Assays that are used to evaluate potential vaccine efficacy have also had to be modified, since horse erythrocytes have proved more sensitive than the commonly used chicken or turkey cells in measuring responses to the H5 hemagglutinin antigen (HA).

Attempts have been made to standardize a neutralization assay in the hope that it would be a more sensitive reflection of the functional activity of the vaccine.

The difficulties in producing and standardizing conventional H5 vaccines have prompted innovative and extensive examinations of options for improving all influenza vaccines. (...)
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http://content.nejm.org/cgi/content/full/358/24/2540?query=TOC
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Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

the Baxter vax is not new, Austria has a contract,
it is produced in Bohumil, Czechia.
100million doses per year

http://www.meduniqa.at/2877.0.html


this thread:
http://www.flutrackers.com/forum/showthread.php?t=71115
This thread is about the early phases of a clinical trial Baxter has initiated for regulatory approval. Like most of the initial trials, Baxter is using a 2004 isolate from Vietnam. This trial uses Vero (African Green Monkey) cells to grow the virus. The virus was the inactivated and used with and without adjuvent. The positive results are VERY borderline, using a cut-off of a titer of 1/20 instead of the more conventional cut-off of 1/40. This VERY low level is not very reliable, which may account for the lack of a dose response. It also has not been shown to be protective. In the 1918 pandemic, patients had titers above 1/1000 which were still present more than 80 years after infection.
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

On these vax clinical trials, don't they have standardized endpoints?
I don't think I've ever seen them published in the tests... or maybe I just missed them.
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

On these vax clinical trials, don't they have standardized endpoints?
I don't think I've ever seen them published in the tests... or maybe I just missed them.
Most use a titer rof 40 (Baxter used 20).
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

I see they got the response in 76% and 45%; are those considered acceptable numbers? Is the endpoint 100%?
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

I see they got the response in 76% and 45%; are those considered acceptable numbers? Is the endpoint 100%?
They used an unacceptable titer cut-off of 20 and had no dose response. The response is PR (but H5N1 doesn't read press releases).
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

So then, it's the FDA that has a standardized endpoint by which the drugs are approved/disapproved?

If so, is it published or kept secret?
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

So then, it's the FDA that has a standardized endpoint by which the drugs are approved/disapproved?

If so, is it published or kept secret?
Applications are judged (by expert consultants) on safety and efficacy.
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

They used an unacceptable titer cut-off of 20 and had no dose response. The response is PR (but H5N1 doesn't read press releases).
The titration graph in attachment.
 

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Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

isn't usually the max. at ~20 days ?
 
Re: _|PRE-PANDEMIC VACCINES. BAXTER CELLS-BASED VACCINE TRIAL|_

Some additional comments from the Cidrap article:

Pros and cons of whole-virus vaccines
John Treanor, MD, who conducts viral vaccine research at the University of Rochester in New York, called the Baxter report "intensely interesting" on multiple counts, including the use of a whole, wild-type virus and cell culture production. Treanor is a professor of medicine and of microbiology and immunology.

Commenting by e-mail, he said the question of whole-virus versus subunit vaccines has raised an "intriguing discussion." Some data suggest that whole-virus vaccines yield better immune responses than subunit vaccines do in hosts with no previous exposure to the virus (as in a pandemic), which makes some intuitive sense, he said. However, this advantage doesn't hold true with seasonal flu viruses, and there is good evidence that whole-virus vaccines cause more side effects in young children.

Whole-virus vaccines might be easier to make, because they require fewer steps, Treanor said. "On the other hand, most of the current manufacturers don't make whole-virion vaccines, so they would have to significantly change their current process to go back to a whole-virion approach," he added. Given the pros and cons, it's hard to say which approach is better, he said.

"Then the really interesting thing that Baxter has done is to use the wild-type cleavage sequence," Treanor added. He explained that H5 viruses are highly pathogenic in birds because their hemagglutinin (HA) surface protein can be cleaved easily by proteases founds in all bird tissues, permitting the virus to bind to and enter cells. "Viruses that have a highly cleaveable HA must be handled under high containment because of the risk that the virus might escape and cause outbreaks of lethal influenza in chickens?an agricultural nightmare," he said.

The standard approach is to use reverse genetics to replace the amino acid sequence at the HA cleavage site with a sequence from a less pathogenic H5 virus, Treanor said. He added that he's not sure why Baxter chose to use the wild-type sequence, but this approach eliminates the need to use reverse genetics, "and since that requires licensing, maybe that is what they're trying to avoid."

Still a long way to go
Another infectious-disease expert, Michael T. Osterholm, PhD, MPH, welcomed the findings but cautioned that the world is still a long way from having the practical capability to quickly make an effective vaccine in large enough quantities to protect most people in the event of a pandemic.

"I think it's an important step forward in that we're now reporting results from cell culture, but the pandemic clock is ticking, and there remains considerable confusion about what the different serologic results mean in terms of human protection," said Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, which publishes CIDRAP News.

He called Wright's commentary a thoughtful analysis of the state of flu vaccine research, but said, "His comments . . . fail to take into account the supply and manufacturing facility requirements to make vaccines for the next pandemic. Even if we had a vaccine today that was an ideal candidate for use in the next pandemic, the international capacity to make vaccines, package them, and provide all of the syringes, needles, and other vaccine support materials for a worldwide campaign are extremely limited."

For example, he said it now takes up to 3 years or even longer for the delivery and installation of equipment to bottle and fill vaccines

http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/jun1208vaccine-jw.html
 
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