Immune Responses to a Recombinant Glycoprotein E Herpes Zoster Vaccine in Adults Aged 50 Years or Older
Anthony L Cunningham, Thomas C Heineman, Himal Lal, Olivier Godeaux, Roman Chlibek, Shinn-Jang Hwang, Janet E McElhaney, Timo Vesikari, Charles Andrews, Won Suk Choi, Meral Esen, Hideyuki Ikematsu, Martina Kovac Choma, Karlis Pauksens, Stéphanie Ravault, Bruno Salaun, Tino F Schwarz, Jan Smetana, Carline Vanden Abeele, Peter Van den Steen, Ilse Vastiau, Lily Yin Weckx, Myron J Levin, ZOE-50/70 Study Group, Anthony L Cunningham, Thomas C Heineman, Himal Lal, Olivier Godeaux, Roman Chlibek, Shinn-Jang Hwang, Janet E McElhaney, Timo Vesikari, Charles Andrews, Won Suk Choi, Meral Esen, Hideyuki Ikematsu, Martina Kovac Choma, Karlis Pauksens, Stéphanie Ravault, Bruno Salaun, Tino F Schwarz, Jan Smetana, Carline Vanden Abeele, Peter Van den Steen, Ilse Vastiau, Lily Yin Weckx, Myron J Levin, ZOE-50/70 Study Group
Abstract
Background: The herpes zoster subunit vaccine (HZ/su), consisting of varicella-zoster virus glycoprotein E (gE) and AS01B Adjuvant System, was highly efficacious in preventing herpes zoster in the ZOE-50 and ZOE-70 trials. We present immunogenicity results from those trials.
Methods: Participants (ZOE-50: ≥50; ZOE-70: ≥70 years of age) received 2 doses of HZ/su or placebo, 2 months apart. Serum anti-gE antibodies and CD4 T cells expressing ≥2 of 4 activation markers assessed (CD42+) after stimulation with gE-peptides were measured in subcohorts for humoral (n = 3293) and cell-mediated (n = 466) immunogenicity.
Results: After vaccination, 97.8% of HZ/su and 2.0% of placebo recipients showed a humoral response. Geometric mean anti-gE antibody concentrations increased 39.1-fold and 8.3-fold over baseline in HZ/su recipients at 1 and 36 months post-dose 2, respectively. A gE-specific CD42+ T-cell response was shown in 93.3% of HZ/su and 0% of placebo recipients. Median CD42+ T-cell frequencies increased 24.6-fold (1 month) and 7.9-fold (36 months) over baseline in HZ/su recipients and remained ≥5.6-fold above baseline in all age groups at 36 months. The proportion of CD4 T cells expressing all 4 activation markers increased over time in all age groups.
Conclusions: Most HZ/su recipients developed robust immune responses persisting for 3 years following vaccination.
Clinical trials registration: NCT01165177; NCT01165229.
Figures
References
- Levin MJ. Licensed vaccines. Zoster vaccine. In: Orenstein WA, Offit PA, eds. Vaccines. 6th ed London: W.B. Saunders, 2013:969–80.
- Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 2014; 4:e004833.
- Lal H, Cunningham AL, Godeaux O et al. ; ZOE-50 Study Group Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med 2015; 372:2087–96.
- Cunningham AL, Lal H, Kovac M et al. ; ZOE-70 Study Group Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med 2016; 375:1019–32.
- Oxman MN, Levin MJ, Johnson GR et al. ; Shingles Prevention Study Group A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271–84.
- Schmader KE, Levin MJ, Gnann JW Jr et al. . Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012; 54:922–8.
- Levin MJ, Oxman MN, Zhang JH et al. ; Veterans Affairs Cooperative Studies Program Shingles Prevention Study Investigators Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. J Infect Dis 2008; 197:825–35.
- Weinberg A, Levin MJ. VZV T cell-mediated immunity. Curr Top Microbiol Immunol 2010; 342:341–57.
- Weinberg A, Lazar AA, Zerbe GO et al. . Influence of age and nature of primary infection on varicella-zoster virus-specific cell-mediated immune responses. J Infect Dis 2010; 201:1024–30.
- Oxman MN, Gershon AA, Poland GA. Zoster vaccine recommendations: the importance of using a clinically valid correlate of protection. Vaccine 2011; 29:3625–7.
- Izurieta HS, Wernecke M, Kelman J et al. . Effectiveness and duration of protection provided by the live-attenuated herpes zoster vaccine in the medicare population ages 65 years and older. Clin Infect Dis 2017; 64:785–93.
- Morrison VA, Johnson GR, Schmader KE et al. ; Shingles Prevention Study Group Long-term persistence of zoster vaccine efficacy. Clin Infect Dis 2015; 60:900–9.
- Tseng HF, Harpaz R, Luo Y et al. . Declining effectiveness of herpes zoster vaccine in adults aged ≥60 years. J Infect Dis 2016; 213:1872–5.
- Dubey L, Steinberg SP, LaRussa P, Oh P, Gershon AA. Western blot analysis of antibody to varicella-zoster virus. J Infect Dis 1988; 157:882–8.
- Arvin AM. Humoral and cellular immunity to varicella-zoster virus: an overview. J Infect Dis 2008; 197(Suppl 2):S58–60.
- Dendouga N, Fochesato M, Lockman L, Mossman S, Giannini SL. Cell-mediated immune responses to a varicella-zoster virus glycoprotein E vaccine using both a TLR agonist and QS21 in mice. Vaccine 2012; 30:3126–35.
- Vafai A. Boosting immune response with a candidate varicella-zoster virus glycoprotein subunit vaccine. Vaccine 1995; 13:1336–8.
- Didierlaurent AM, Collignon C, Bourguignon P et al. . Enhancement of adaptive immunity by the human vaccine adjuvant AS01 depends on activated dendritic cells. J Immunol 2014; 193:1920–30.
- Detienne S, Welsby I, Collignon C et al. . Central role of CD169+lymph node resident macrophages in the adjuvanticity of the QS-21 component of AS01. Sci Rep 2016; 6:39475.
- Coccia M, Collignon C, Hervé C et al. . Cellular and molecular synergy in AS01-adjuvanted vaccines results in an early IFNγ response promoting vaccine immunogenicity. NPJ Vaccines 2017; 2:25.
- Chlibek R, Bayas JM, Collins H et al. . Safety and immunogenicity of an AS01-adjuvanted varicella-zoster virus subunit candidate vaccine against herpes zoster in adults >=50 years of age. J Infect Dis 2013; 208:1953–61.
- Chlibek R, Smetana J, Pauksens K et al. . Safety and immunogenicity of three different formulations of an adjuvanted varicella-zoster virus subunit candidate vaccine in older adults: a phase II, randomized, controlled study. Vaccine 2014; 32:1745–53.
- Leroux-Roels I, Leroux-Roels G, Clement F et al. . A phase 1/2 clinical trial evaluating safety and immunogenicity of a varicella zoster glycoprotein e subunit vaccine candidate in young and older adults. J Infect Dis 2012; 206:1280–90.
- Pauksens K, Volpe S, Schwarz TF et al. . Persistence of immune response to an adjuvanted varicella‐zoster virus subunit candidate vaccine for up to year 9 in older adults. IDWeek2017 San Diego . Accessed 24 February 2018.
- Lal H, Chlibek R, Pauksens K et al. . Persistence of the immune response to an adjuvanted herpes zoster subunit vaccine in healthy older adults: modeling of vaccine-induced immune response, data from a 6-year follow-up study. Open Forum Infect Dis 2015; 2(Suppl 1):abstract 1931.
- Cunningham AL, Heineman T. Vaccine profile of herpes zoster (HZ/su) subunit vaccine. Expert Rev Vaccines 2017; 16:1–10.
- Fochesato M, Dendouga N, Boxus M. Comparative preclinical evaluation of AS01 versus other adjuvant systems in a candidate herpes zoster glycoprotein E subunit vaccine. Hum Vaccin Immunother 2016; 12:2092–5.
- Chlibek R, Pauksens K, Rombo L et al. . Long-term immunogenicity and safety of an investigational herpes zoster subunit vaccine in older adults. Vaccine 2016; 34:863–8.
- Didierlaurent AM, Laupèze B, Di Pasquale A, Hergli N, Collignon C, Garçon N. Adjuvant system AS01: helping to overcome the challenges of modern vaccines. Expert Rev Vaccines 2017; 16:55–63.
- Abendroth A, Kinchington PR, Slobedman B. Varicella zoster virus immune evasion strategies. Curr Top Microbiol Immunol 2010; 342:155–71.
- Berry N, Manoussaka M, Ham C et al. . Role of occult and post-acute phase replication in protective immunity induced with a novel live attenuated SIV vaccine. PLoS Pathog 2016; 12:e1006083.
- Maggioli MF, Palmer MV, Thacker TC et al. . Increased TNF-α/IFN-γ/IL-2 and decreased TNF-α/IFN-γ production by central memory T cells are associated with protective responses against bovine tuberculosis following BCG vaccination. Front Immunol 2016; 7:421.
- Mordmüller B, Surat G, Lagler H et al. . Sterile protection against human malaria by chemoattenuated PfSPZ vaccine. Nature 2017; 542:445–9.
- Srivastava R, Khan AA, Garg S et al. . Human asymptomatic epitopes identified from the herpes simplex virus tegument protein VP13/14 (UL47) preferentially recall polyfunctional effector memory CD44high CD62Llow CD8+ TEM cells and protect humanized HLA-A*02:01 transgenic mice against ocular herpesvirus infection. J Virol 2017; 91:e01793-16.
- Lin L, Finak G, Ushey K et al. . COMPASS identifies T-cell subsets correlated with clinical outcomes. Nat Biotechnol 2015; 33:610–6.
- Gross S, Erdmann M, Haendle I et al. . Twelve-year survival and immune correlates in dendritic cell-vaccinated melanoma patients. JCI Insight 2017; 2:e91438.
- Chattopadhyay PK, Yu J, Roederer M. A live-cell assay to detect antigen-specific CD4+ T cells with diverse cytokine profiles. Nat Med 2005; 11:1113–7.
- Leroux-Roels G, Marchant A, Levy J et al. . Impact of adjuvants on CD4(+) T cell and B cell responses to a protein antigen vaccine: Results from a phase II, randomized, multicenter trial. Clin Immunol 2016; 169:16–27.
- Arvin A, Abendroth A. VZV: immunobiology and host response. In: Arvin A, Roizman B, Mocarski E et al., eds. Human herpesviruses: biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press, 2007:700–12.
- Cunningham AL, Turner RR, Miller AC, Para MF, Merigan TC. Evolution of recurrent herpes simplex lesions. An immunohistologic study. J Clin Invest 1985; 75:226–33.
- Qi Q, Cavanagh MM, Le Saux S et al. . Defective T memory cell differentiation after varicella zoster vaccination in older individuals. PLoS Pathog 2016; 12:e1005892.
- Miller JD, van der Most RG, Akondy RS et al. . Human effector and memory CD8+ T cell responses to smallpox and yellow fever vaccines. Immunity 2008; 28:710–22.
- Li Causi E, Parikh SC, Chudley L et al. . Vaccination expands antigen-specific CD4+ memory T cells and mobilizes bystander central memory T cells. PLoS One 2015; 10:e0136717.
- Sei JJ, Cox KS, Dubey SA et al. . Effector and central memory poly-functional CD4(+) and CD8(+) T cells are boosted upon ZOSTAVAX(®) vaccination. Front Immunol 2015; 6:553.
- Weinberg A, Johnson MJ, Kroehl M, Lang N, Reinhold D, Levin MJ. A comparison of the immunogenicity of a live attenuated herpes zoster vaccine (ZV) and the recombinant gE/AS01B candidate vaccine in older adults. J Immunol 2017; 198(Suppl 1):225.1.
- Patterson-Bartlett J, Levin MJ, Lang N, Schödel FP, Vessey R, Weinberg A. Phenotypic and functional characterization of ex vivo T cell responses to the live attenuated herpes zoster vaccine. Vaccine 2007; 25:7087–93.
- Levin MJ, Schmader KE, Pang L et al. . Cellular and humoral responses to a second dose of herpes zoster vaccine administered 10 years after the first dose among older adults. J Infect Dis 2016; 213:14–22.
- Maue AC, Yager EJ, Swain SL, Woodland DL, Blackman MA, Haynes L. T-cell immunosenescence: lessons learned from mouse models of aging. Trends Immunol 2009; 30:301–5.
- Zhou X, Hopkins JW, Wang C et al. . IL-2 and IL-6 cooperate to enhance the generation of influenza-specific CD8 T cells responding to live influenza virus in aged mice and humans. Oncotarget 2016; 7:39171–83.
- Belshe RB, Heineman TC, Bernstein DI et al. . Correlate of immune protection against HSV-1 genital disease in vaccinated women. J Infect Dis 2014; 209:828–36.
Source: PubMed