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Confronting the avian influenza threat: vaccine development for a potential pandemic.

Sporadic human infection with avian influenza viruses has raised concern that reassortment between human and avian subtypes could generate viruses of pandemic potential. Vaccination is the principal means to combat the impact of influenza. During an influenza pandemic the immune status of the population would differ from that which exists during interpandemic periods. An emerging pandemic virus will create a surge in worldwide vaccine demand and new approaches in immunisation strategies may be needed to ensure optimum protection of unprimed individuals when vaccine antigen may be limited. The manufacture of vaccines from pathogenic avian influenza viruses by traditional methods is not feasible for safety reasons as well as technical issues. Strategies adopted to overcome these issues include the use of reverse genetic systems to generate reassortant strains, the use of baculovirus-expressed haemagglutinin or related non-pathogenic avian influenza strains, and the use of adjuvants to enhance immunogenicity. In clinical trials, conventional surface-antigen influenza virus vaccines produced from avian viruses have proved poorly immunogenic in immunologically naive populations. Adjuvanted or whole-virus preparations may improve immunogenicity and allow sparing of antigen.

Animals↗

ALVAC-HIV vaccines: clinical trial experience focusing on progress in vaccine development.

A decade of clinical trial experience with the preventive use of ALVAC-HIV (Aventis Pasteur) has revealed important information on the safety and immunogenicity of HIV vaccines in general. The ability to induce mucosal immune responses and the feasibility of assessing those responses with a systemically delivered HIV vaccine was recently shown with ALVAC-HIV. A critical advance for the HIV vaccine field was the reported direct relationship between cellular immune responses to ALVAC-HIV vaccine in human leukocyte antigen (HLA) B27 and HLA B57 carriers, alleles linked with a favorable HIV prognosis in the setting of natural infection. Other advances include the use of ALVAC-HIV as a heterologous viral boost to enhance cellular responses to an adenovirus-HIV vaccine. All of these observations have important implications for the future of HIV vaccines and need to be considered in the design of the next generation of products.

AIDS Vaccines↗

Applying the concepts of financial options to stimulate vaccine development.

Stimulating research and development for neglected diseases (such as tuberculosis, malaria and AIDS) has proven difficult. We offer an alternative approach to stimulating research into neglected diseases based on the concept of a financial call option. Our Call Options for Vaccines (COV) model allows the purchaser to make payments during the early stages of development in exchange for reduced future prices. We conclude with a discussion of possible risks and benefits.

Drug Design↗

Antigen discovery and tuberculosis vaccine development in the post-genomic era.

For a number of years, a major effort has been put into the identification of candidate molecules for inclusion in a novel vaccine against tuberculosis. Various techniques have been exploited and have resulted in the identification of immunologically important antigens such as the immunodominant antigens ESAT-6 and antigen 85A/B. Today, the availability of the total nucleotide sequence of the Mycobacterium tuberculosis genome enables a post-genomic antigen discovery approach based on denotation and screening of complete protein families containing immunodominant molecules. One group of genes sharing properties with ESAT-6 constitute what has been called the esat-6 gene family. The genes have 10-35% homology to esat-6, are approximately the same size and share genomic organization. The data accumulated so far demonstrate that these molecules are immunodominant antigens strongly recognized in human TB patients and with the potential for a novel TB vaccine.

Antigens, Bacterial↗