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adenovirus-vectored vaccine

An Appreciation for Viruses

7 October 2021 by Gertrud U. Rey

by Gertrud U. Rey

EV-D68

Most people associate viruses with illness and suffering. After all, the word “virus” is derived from the Latin word for “poison.” However, considering that the vast majority of viruses cause no illness and are actually beneficial to humans and the planet as a whole, this sentiment is largely misplaced. Let me explain.

The ability of viruses to enter cells by attaching to host cell receptors and releasing their genome into the cell can be exploited for various purposes. For example, viruses can be used as vectors for delivering vaccines, healthy copies of defective genes (i.e., for “gene therapy”), and therapeutic drugs to specific cells.

Several SARS-CoV-2 vaccines, including those made by AstraZeneca and Johnson & Johnson, consist of a “vector virus” (an adenovirus) that contains a gene for the SARS-CoV-2 spike protein. Upon injection into a vaccine recipient, the vector virus should enter cells and serve as a code for host proteins to synthesize the encoded spike protein. Genes that regulate replication of the vector virus are removed to ensure that the vector itself cannot cause an infection in human cells. Other genes not needed for purposes of vaccine delivery are also typically removed to create more room inside the vector for the inserted antigen gene. Adenoviruses are particularly suitable for delivering foreign genes into cells because they have a double-stranded DNA genome that can accommodate segments of foreign DNA and because they infect most cell types without integrating into the host genome. However, poxviruses, retroviruses, vesicular stomatitis virus, and other viruses can also be used for vaccine delivery. As of today, six viral-vectored vaccines have been authorized for use in humans: four SARS-CoV-2 vaccines (two of which were previously described here and here) and two Ebola virus vaccines.

Viruses may also serve as vectors for targeted gene therapy to treat genetic disorders caused by mutations in the sequence of a person’s DNA. By replacing the mutated, non-functional portion of DNA with its healthy counterpart, the function of the defective gene could potentially be restored. Some viruses, like retroviruses, already insert their genetic material into the host genome as part of their replication cycle, making them suitable for delivering such functional genes to target cells. Recent advances in technology may even allow for the delivery of CRISPR-mediated gene editing tools to edit the target genome in the cell by excising the defective gene and replacing it with a functional version. One such targeted therapy aimed at treating genetic muscle disease by specifically targeting muscle cells was recently discussed on TWiV 812. Another exemplary gene therapy method for potentially deleting integrated HIV-1 from the genomes of infected individuals using CRISPR technology was described in a previous post.

A similar vector approach can also be used for cell-specific delivery of therapeutic drugs. For example, replication-incompetent viruses (viruses that have been engineered so they can’t replicate) can be further modified. These modifications may allow the viruses to specifically target dividing tumor cells or cells that display surface proteins that are unique to cancer cells, and deliver chemotherapeutic drugs only to those cells. Alternatively, replication-competent viruses can be manipulated to directly target and kill cancer cells in a mechanism known as oncolytic virotherapy. An example of this mechanism described previously involves a herpes simplex virus engineered to target a receptor that is practically absent in healthy brain cells, but is specifically expressed on glioblastoma multiforme tumor cells. The engineered virus also encodes a gene for a cytokine that increases the effectiveness of oncolytic viruses by recruiting cytotoxic T lymphocytes, which cause the tumor cells to burst. An accumulating body of evidence suggests that the cancer-specific antigens that emerge from burst cancer cells may also trigger additional downstream immune responses, further enhancing the potency of oncolytic viruses.

Considering that we are on the brink of a major antibiotic resistance crisis, viruses may just come to our rescue in this regard as well. Bacteriophages (“phages” for short) are viruses that only infect bacteria, and as it turns out, they can be used to treat pathogenic bacterial infections. There are numerous potential advantages to phage therapy compared to traditional antibiotic therapy. Phages are equally effective against antibiotic-sensitive and antibiotic-resistant bacteria. They are also more specific than antibiotics, and this specificity leads to reduced impact on commensal bacteria, which are typically obliterated by conventional antibiotics. Unlike most antibiotics, phages are capable of disrupting bacterial biofilms, and their use would lead to reduced incidence of opportunistic infections and reduced toxic effects of bacterial infection. Although bacteria can become resistant to phages, phages can likewise evolve to overcome this resistance, making bacterial resistance to phages less of a challenge than their resistance to antibiotics. Furthermore, scientists have found that the efficacy of phage therapy can be improved by combining phages with an antibiotic treatment regimen, or by combining several phages in a “phage cocktail.” In a highly publicized phage therapy success story, infectious disease epidemiologist Steffanie Strathdee describes how she recruited the help of an international team of physicians to cure her husband of a life-threatening multi-drug-resistant Acinetobacter baumanii infection using an intravenous phage therapy cocktail.

Phages can also be used as an alternative energy source by powering the electrodes in batteries. As repeatedly demonstrated by materials scientist Angela Belcher at MIT, biological scaffolds composed of M13 phages that display the negatively charged peptide sequence glutamate-glutamate-alanine-glutamate (E-E-A-E) inevitably attract nickel phosphide molecules, and the resulting nanostructures can be used directly as freestanding negative electrodes in batteries. These “virus batteries” have multiple advantages over traditional batteries. They are more environmentally friendly because they’re made from non-toxic materials. Their synthesis requires relatively little equipment, so they are inexpensive to produce. They are lightweight and flexible and can thus be woven into fabrics, which makes them suitable for military clothing. They also have higher conductivity than conventional lithium-ion batteries, making them extremely useful for portable electronics, medical implants, and various aerospace applications. It is even possible that they could one day be used to power electric cars.

The examples described so far are ones in which people have capitalized on virus functions for the benefit of humans. However, viruses have other benefits that just relate to their natural functions. For instance, phages are also an essential component of our environment, where they help control pests and recycle nutrients. If phages didn’t exist, some bacterial populations would explode and outcompete other populations, causing them to disappear completely. This imbalance would be especially disastrous in the oceans, where microbes make up more than 70% of the total biomass. Phages kill a large portion of oceanic bacteria every day, allowing the organic molecules released from the dead bacterial cells to be recycled as nutrients for other organisms. Perhaps the most important organisms to benefit from these recycled nutrients are microscopic plants called phytoplankton, which produce oxygen by removing carbon dioxide from the atmosphere. In fact, phytoplankton are a crucial element of the global carbon cycle and one of the largest contributors to our atmospheric oxygen. This means that without viruses, we would not have air to breathe.

Viruses are deeply integrated in life on earth, and their functions in sustaining environmental equilibrium and our ongoing survival are too numerous to describe in a single blog post. Moreover, our current appreciation of what can be accomplished using viruses is cursory, at best. Future research will lead to a deeper understanding of how viruses can be utilized to do more good.

[This post was written in honor of Virus Appreciation Day, which occurs annually on October 3]

Filed Under: Basic virology, Gertrud Rey Tagged With: adenovirus-vectored vaccine, bacteriophage, crispr, gene editing, gene therapy, microbe, oncolytic vector, oncolytic virotherapy, phage, phage therapy, phytoplankton, retrovirus, vaccines, vector, viral oncotherapy, virus battery, virus vector

One and Done

4 March 2021 by Gertrud U. Rey

by Gertrud U. Rey

On February 27, 2021, the FDA issued an emergency use authorization for a third SARS-CoV-2 vaccine. The vaccine was developed by Janssen Pharmaceutica, a Belgium-based division of Johnson & Johnson, in collaboration with Beth Israel Deaconess Medical Center in Boston. Perhaps the most exciting feature of this new vaccine is that it only requires one dose to be effective in inducing an immune response.

The vaccine is named Ad26.COV2.S because it consists of a human adenovirus vector, with a DNA genome, into which has been inserted the gene that encodes the full-length SARS-CoV-2 spike protein (pictured). Ad26.COV2.S is similar to AstraZeneca’s vaccine, based on a different adenovirus, and with a slightly different version of spike, which is not yet authorized in the U.S. The notion of using a virus as a vector to deliver vaccines to humans is based on the ability of viruses to enter cells by attaching to host cell receptors and releasing their genome into the cell. Upon injection into a vaccine recipient, the vaccine vector should enter cells and serve as a code for host proteins to synthesize the SARS-CoV-2 spike protein from the inserted gene. Ideally, the spike protein will then act as an antigen to prime the immune system to recognize SARS-CoV-2 if it infects the body at a later time. 

Adenoviruses are particularly suitable as vectors for delivering foreign genes into cells because they have a double-stranded DNA genome that can accommodate relatively large segments of foreign DNA, and because they infect most cell types without integrating into the host genome. However, because of the prevalence of adenovirus infections in humans, most people have adenovirus-specific antibodies that could bind and neutralize these vectors, thus rendering them less effective at stimulating antibodies to the inserted gene product. AstraZeneca circumvented this issue by using an adenovirus of chimpanzee origin that does not normally infect humans. The adenovirus used to make Ad26.COV2.S (Adenovirus 26) is of human origin; however, when tested, most people have very few antibodies that inactivate this adenovirus, compared to antibodies against other adenoviruses. Thus, potential Ad26.COV2.S recipients are less likely to have pre-existing antibodies to the adenovirus vector itself. To optimize Adenovirus 26 for use as a vaccine vector, Janssen investigators deleted the gene that regulates viral replication, thus ensuring that the virus vector cannot cause an infection in human cells.

During infection, the SARS-CoV-2 viral particle fuses with the host cell membrane; a process that is mediated by two main events: 1) a structural rearrangement of the spike protein from its pre-fusion conformation; and, 2) cleavage of the spike protein by a cellular enzyme called furin. Based on the knowledge that the pre-fusion, uncleaved form of spike is more stable and immunogenic, Janssen investigators also inserted two mutations into the spike gene: one that locks the translated spike protein into its pre-fusion conformation, and one that prevents its cleavage by furin.  

The FDA’s decision to issue an emergency use authorization for Ad26.COV2.S was based on safety and efficacy data from an ongoing Phase III clinical trial done in 39,321 participants who received either a single dose of Ad26.COV2.S or a placebo control. The trial was randomized, meaning that participants were randomly assigned to the experimental group receiving the Ad26.COV2.S vaccine, or the control group, so that the only expected differences between the experimental and control groups were the outcome variables studied (safety and efficacy). Randomizing trial participants eliminates unwanted effects that have nothing to do with the variables being analyzed. The trial was also double-blinded, meaning that neither the investigators nor the subjects knew who was receiving a particular treatment. Double-blinding leads to more authentic conclusions because they reduce researcher bias.

The basic findings of the trial were as follows:

  • side effects related to vaccination were mild to moderate; and
  • the vaccine was
    • 66% effective at preventing moderate to severe COVID-19 across all geographic areas and age groups (U.S., South Africa, and six countries in Latin America);
    • 72% effective at preventing moderate to severe COVID-19 across all age groups in the U.S.; 
    • 85% effective at preventing severe disease; and
    • 100% effective at preventing COVID-19-related hospitalization and death as of day 28 after vaccination.

The apparently reduced efficacy of Ad26.COV2.S compared to the Moderna and Pfizer vaccines has led to considerable public skepticism. However, this is an unfair comparison for several reasons. Ad26.COV2.S was tested at a time when more variants were in circulation, including in places where the Moderna/Pfizer vaccines are thought to be less effective against locally circulating variants. Some limited data also suggest that Ad26.COV2.S might protect from asymptomatic infection and may thus prevent transmission from vaccinated individuals to non-vaccinated individuals. Although there is some evidence to suggest that the Pfizer vaccine has a similar effect, no such data exist yet for the Moderna vaccine.

The most critical measure of a vaccine’s efficacy is how well it prevents severe disease, hospitalizations, and deaths, and in this regard, all three vaccines are comparable. Moreover, Ad26.COV2.S has at least two advantages over the Pfizer/Moderna vaccines: 1) it does not require a freezer and can be stored in a refrigerator for up to three months; and, 2) it can be administered in a single dose. This will increase vaccine uptake, because people won’t have to get two shots and/or remember to get the second shot.  It also makes it easier to immunize people with limited access to healthcare, such as the homeless and people living in remote areas. When all these factors are considered together, it is clear that Ad26.COV2.S will be a crucial additional tool in the fight against this pandemic.

Filed Under: Basic virology, Gertrud Rey, Uncategorized Tagged With: adenovirus-vectored vaccine, efficacy, emergency use authorization, FDA, furin, Johnson & Johnson, pre-fusion spike protein, SARS-CoV-2, single dose, spike glycoprotein, spike glycoprotein cleavage, spike protein, vaccine efficacy

The Route Matters

3 September 2020 by Gertrud U. Rey

by Gertrud U. Rey

There are currently 315 therapeutic drugs and 210 vaccine candidates in development to treat or prevent SARS-CoV-2 infection. Many of these vaccines are designed to be administered by injection into the muscle. 

Intramuscular injection of a vaccine antigen typically induces a systemic (serum) immune response that involves the action of IgM and IgG antibodies. IgM antibodies appear first and typically bind very strongly to antigens, to the extent that they often cross-react with other, non-specific antigens. IgG antibodies arise later, are a lot more specific than IgM, and provide the majority of antibody-based immunity against invading pathogens. Intramuscular immunization usually does not induce very high levels of serum IgA, a type of antibody that is more prevalent in mucosal surfaces and represents a first line of defense against invasion by inhaled and ingested pathogens. The role of IgA in the serum is mostly secondary to IgG, in that IgA mediates elimination of pathogens that have breached the mucosal surface.    

Several of the SARS-CoV-2 vaccine candidates currently in clinical trials consist of a replication-deficient adenovirus with an inserted gene that encodes a SARS-CoV-2 antigen. The suitability of adenoviruses as vectors for delivering foreign genes into cells was discussed in a previous post, which summarized preliminary phase I/II clinical trials assessing the safety and efficacy of a chimpanzee adenovirus-vectored replication-deficient SARS-CoV-2 vaccine candidate encoding the full-length SARS-CoV-2 spike protein (AZD1222). The spike protein has been the primary antigenic choice for a number of SARS-CoV-2 vaccine candidates because it mediates binding of the virus to the ACE2 host cell receptor via its receptor-binding domain (RBD), and it also mediates fusion of the viral particle with the host cell membrane via its fusion domain. Both of these spike domains are highly immunogenic and are targeted by neutralizing antibodies, which bind viral antigens, inactivating virus and preventing infection of new cells. However, preliminary results suggest that AZD1222 only protects against SARS-CoV-2 lung infection and pneumonia but doesn’t appear to prevent upper respiratory tract infection and viral shedding.

To mediate fusion of the virus particle to the host cell membrane, the SARS-CoV-2 spike protein undergoes a structural rearrangement from its pre-fusion conformation. Because the pre-fusion form is more immunogenic, vaccines encoding the spike protein often contain a mutation that locks the translated spike protein into this pre-fusion structure. In a recent publication, virologist Michael Diamond and colleagues analyzed the efficacy of an adenovirus-vectored SARS-CoV-2 vaccine candidate and compared its protective effects after intramuscular injection to those after administration by the intranasal route. The vaccine, named ChAd-SARS-CoV-2-S, is similar to AZD1222 except that its spike gene encodes the pre-fusion stabilized spike protein. To assess the antibody responses induced by intramuscular vaccination with ChAd-SARS-CoV-2-S, the authors injected mice with 10 billion viral particles of either ChAd-SARS-CoV-2-S or a control vaccine consisting of the same adenovirus shell, but lacking the spike protein gene insert. They found that one dose of ChAd-SARS-CoV-2-S induced strong serum IgG responses against both the entire spike protein and the RBD, but no IgA responses in the serum or in mucosal lung cells.

While antibodies are an important part of the adaptive immune response, cell-mediated immunity is just as important and at the very least results in activation of white blood cells that destroy ingested microbes and also produces cytotoxic T cells that directly kill infected target cells. During a first exposure to a pathogen, T helper cells typically sense the presence of antigens on the surface of the invading pathogen and release a variety of signals that ultimately stimulate B cells to secrete antibodies to those antigens and also stimulate cytotoxic T cells to kill infected target cells. Analysis of these T cells in mice immunized with one or two doses of intramuscularly administered ChAd-SARS-CoV-2-S revealed that two vaccine doses induced both T helper and cytotoxic T cell responses against the whole spike protein. Collectively, these results suggest that although intramuscular vaccination produces strong systemic adaptive immune responses against SARS-CoV-2, it induces little, if any, mucosal immunity.

To determine whether intramuscular immunization with ChAd-SARS-CoV-2-S protects mice from infection, the authors intentionally infected (“challenged”) immunized mice with SARS-CoV-2. Although a single vaccine dose protected the mice from SARS-CoV-2 infection and lung inflammation, the mice still had high levels of viral RNA in the lung after infection, suggesting that intramuscular administration of the vaccine does not lead to complete protection from infection.  

In an effort to see whether vaccination by the intranasal route provides more complete protection, the authors inoculated mice with a single dose of ChAd-SARS-CoV-2-S or control vaccine through the nose. Analysis of serum samples and mucosal lung cells four weeks after vaccination revealed that recipients of ChAd-SARS-CoV-2-S had high spike- and RBD-specific levels of neutralizing IgG and IgA in both the serum and the lung mucosa, and that the number of B cells producing IgA was about five-fold higher than that of B cells producing IgG. Interestingly, the neutralizing antibodies were also able to inactivate SARS-CoV-2 viruses containing a D614G change in the spike protein, suggesting that ChAd-SARS-CoV-2-S can effectively protect against other circulating SARS-CoV-2 viruses. Intranasal vaccination also induced SARS-CoV-2-specific cytotoxic T cells in the lung mucosa, specifically T cells that produce interferon gamma, an important activator of macrophages and inhibitor of viral replication.

The ideal immune response is “sterilizing” – meaning that it completely protects against a new infection and does not allow the virus to replicate at all. To evaluate the ability of a single intranasal dose of ChAd-SARS-CoV-2-S to induce sterilizing immunity, the authors analyzed immunized and infected mice for serum antibodies produced against the viral NP protein. Because the vaccine does not encode the NP protein, any antibodies produced against this protein would be induced by translation of the NP gene from the challenge virus and active replication of the virus. All of the mice immunized with a single dose of intranasally administered ChAd-SARS-CoV-2-S had very low levels of anti-NP antibodies compared to recipients of the control vaccine, suggesting that ChAd-SARS-CoV-2-S induced strong mucosal immunity that prevented SARS-CoV-2 infection in both the upper and lower respiratory tract. This means that if intranasally immunized mice were to be exposed to SARS-CoV-2, they would not be able to replicate the virus or transmit it to others. 

The study has some notable limitations. First, it is well known that mice can be poor predictors of human disease outcomes. Second, because the mouse ACE2 receptor doesn’t easily bind SARS-CoV-2, the mice were engineered to express the human ACE2 receptor, which added a further artificial variable to an already imperfect model system. Third, it is presently unknown how long the observed immune responses would last. That being said, studies with influenza virus have shown that mucosal immunization through the nose can elicit strong local protective IgA-mediated immune responses. Further, there are clear advantages to intranasal vaccine administration: inoculation is simple, painless, and does not require trained professionals. The adequacy of a single dose would also lead to more widespread compliance. Lastly, a vaccine that prevents viral shedding would be ideal, because in addition to preventing disease in the exposed individual, it would prevent transmission to others. 

None of the SARS-CoV-2 vaccine candidates currently in clinical trials are delivered by the intranasal route. If the results observed in these mouse experiments can be duplicated in humans, ChAd-SARS-CoV-2-S would clearly be superior to other SARS-CoV-2 vaccine candidates. 

Filed Under: Gertrud Rey Tagged With: adenovirus-vectored vaccine, antibodies, IgA, IgG, IgM, infection, intramuscular, intranasal, mucosal immunity, SARS-CoV-2, spike protein, sterilizing immunity, T cells, transmission, vaccine

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by Vincent Racaniello

Earth’s virology Professor
Questions? virology@virology.ws

With David Tuller and
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