On the basis of epidemiological data demonstrating that the majority of cases of pharyngitis, necrotizing fasciitis, and other invasive streptococcal infections are caused by a limited number of serotypes, this 26-valent vaccine could have significant impact on the overall burden of streptococcal disease.
A multivalent vaccine containing amino-terminal M protein fragments from 26 different serotypes of group A streptococci was constructed by recombinant techniques. The vaccine consisted of four different recombinant proteins that were formulated with alum to contain 400 g of protein per dose. Rabbits were immunized via the intramuscular route at 0, 4, and 16 weeks. Immune sera were assayed for the presence of type-specific antibodies against the individual recombinant M peptides by enzyme-linked immunosorbent assay and for opsonic antibodies by in vitro opsonization tests and indirect bactericidal tests. The 26-valent vaccine was highly immunogenic and elicited fourfold or greater increases in antibody levels against 25 of the 26 serotypes represented in the vaccine. The immune sera were broadly opsonic and were bactericidal against the majority of the 26 different serotypes. Importantly, none of the immune sera cross-reacted with human tissues. Our results indicate that type-specific, protective M protein epitopes can be incorporated into complex, multivalent vaccines designed to elicit broadly protective opsonic antibodies in the absence of tissue-cross-reactive antibodies.Group A streptococcal pharyngitis is one of the most common bacterial infections in school age children. In addition, invasive streptococcal infections afflict thousands of children and adults each year, often resulting in death or significant morbidity (37). Although the incidence of acute rheumatic fever (ARF), a nonsuppurative sequela of streptococcal pharyngitis, has declined in developed countries, the disease is rampant in developing countries (40). Efforts to develop a vaccine that would prevent group A streptococcal infections have been ongoing for more than 8 decades (22,28). New molecular techniques (8) and a better understanding of the biology of group A streptococci (11) have allowed the previous obstacles associated with vaccine development to be overcome.Previous studies have shown that the surface M protein is the major virulence determinant and the major protective antigen of group A streptococci (29). The type specificity of each M protein, of which more than 100 are now known, is largely determined by the epitopes located in the amino-terminal 40 to 50 amino acid residues (3,8,14,27). These regions of M proteins have been shown to evoke antibodies with the greatest bactericidal (protective) activity and are least likely to crossreact with human tissues (2,14,20). Thus, our approach has been to combine small amino-terminal M protein peptides to make multivalent vaccines that would elicit opsonic antibodies against epidemiologically important serotypes of group A streptococci (12,21).In the present study, we constructed a 26-valent M proteinbased vaccine by recombinant technology. The vaccine is composed of four different fusion proteins that contain six or seven M protein fragments linked in tandem. Each component protein of the vaccine was designed to serve as its own carrier, thus obviating the need for unrelated proteins. ...
ROUP A STREPTOCOCCAL INfection and its protean complications continue to cause morbidity and mortality throughout the world. The World Health Organization has estimated that 12 million people have rheumatic heart disease, of whom 400000 die each year. 1 In addition, serious invasive infections, such as bacteremia, streptococcal toxic shock syndrome, and necrotizing fasciitis, plus the more common noninvasive infections, such as pharyngitis and impetigo, produce a significant burden of disease throughout the world. Vaccine prevention of even a fraction of these cases could have a major impact on the health of children and young adults, and potentially reduce the large economic impact of these infections. 2 Efforts to develop a vaccine to prevent group A streptococcal infections have been ongoing for more than 70 years. The surface-expressed M protein is a major protective antigen of group A streptococcus and a frequent
We have previously shown that a hexavalent group A streptococcal M protein-based vaccine evoked bactericidal antibodies after intramuscular injection. In the present study, we show that the hexavalent vaccine formulated with several different mucosal adjuvants and delivered intranasally induced serum and salivary antibodies that protected mice from intranasal challenge infections with virulent group A streptococci. The hexavalent vaccine was formulated with liposomes with or without monophosphorylated lipid A (MPL), cholera toxin B subunit with or without holotoxin, or proteosomes from Neisseria meningitidis outer membrane proteins complexed with lipopolysaccharide from Shigella flexneri. Intranasal immunization with the hexavalent vaccine mixed with these adjuvants resulted in significant levels of antibodies in serum 2 weeks after the final dose. Mean serum antibody titers were equivalent in all groups of mice except those that were immunized with hexavalent protein plus liposomes without MPL, which were significantly lower. Salivary antibodies were also detected in mice that received the vaccine formulated with the four strongest adjuvants. T-cell proliferative assays and cytokine assays using lymphocytes from cervical lymph nodes and spleens from mice immunized with the hexavalent vaccine formulated with proteosomes indicated the presence of hexavalent protein-specific T cells and a Th1-weighted mixed Th1-Th2 cytokine profile. Intranasal immunization with adjuvanted formulations of the hexavalent vaccine resulted in significant levels of protection (80 to 100%) following intranasal challenge infections with type 24 group A streptococci. Our results indicate that intranasal delivery of adjuvanted multivalent M protein vaccines induces protective antibody responses and may provide an alternative to parenteral vaccine formulations.
Streptococcal inhibitor of complement (Sic) is a highly polymorphic extracellular protein made by serotype M1 group A Streptococcus strains that contributes to bacterial persistence in the mammalian upper respiratory tract. New variants of the Sic protein arise very rapidly by positive selection in human populations during M1 epidemics. The human antibody response to Sic was analyzed. Of 636 persons living in diverse localities, 43% had anti-Sic serum antibodies, but only 16.4% had anti-M1 protein serum antibody. Anti-Sic antibody was also present in nasal wash specimens in high frequency. Linear B cell epitope mapping showed that serum antibodies recognized epitopes located in structurally variable regions of Sic and the amino terminal hypervariable region of the M1 protein. Phage display analyses confirmed that the polymorphic regions of Sic are primary targets of host antibodies. These results support the hypothesis that selection of Sic variants occurs on mucosal surfaces by a mechanism that involves acquired host antibody.
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