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      A T Cell-Inducing Influenza Vaccine for the Elderly: Safety and Immunogenicity of MVA-NP+M1 in Adults Aged over 50 Years

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          Abstract

          Background

          Current influenza vaccines have reduced immunogenicity and are of uncertain efficacy in older adults. We assessed the safety and immunogenicity of MVA-NP+M1, a viral-vectored influenza vaccine designed to boost memory T cell responses, in a group of older adults.

          Methods

          Thirty volunteers (aged 50–85) received a single intramuscular injection of MVA-NP+M1 at a dose of 1·5×10 8 plaque forming units (pfu). Safety and immunogenicity were assessed over a period of one year. The frequency of T cells specific for nucleoprotein (NP) and matrix protein 1 (M1) was determined by interferon-gamma (IFN-γ) ELISpot, and their phenotypic and functional properties were characterized by polychromatic flow cytometry. In a subset of M1-specific CD8 + T cells, T cell receptor (TCR) gene expression was evaluated using an unbiased molecular approach.

          Results

          Vaccination with MVA-NP+M1 was well tolerated. ELISpot responses were boosted significantly above baseline following vaccination. Increases were detected in both CD4 + and CD8 + T cell subsets. Clonality studies indicated that MVA-NP+M1 expanded pre-existing memory CD8 + T cells, which displayed a predominant CD27 +CD45RO +CD57 CCR7 phenotype both before and after vaccination.

          Conclusions

          MVA-NP+M1 is safe and immunogenic in older adults. Unlike seasonal influenza vaccination, the immune responses generated by MVA-NP+M1 are similar between younger and older individuals. A T cell-inducing vaccine such as MVA-NP+M1 may therefore provide a way to circumvent the immunosenescence that impairs routine influenza vaccination.

          Trial Registration

          ClinicalTrials.gov NCT00942071

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          Most cited references19

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          IMGT unique numbering for immunoglobulin and T cell receptor variable domains and Ig superfamily V-like domains.

          IMGT, the international ImMunoGeneTics database (http://imgt.cines.fr) is a high quality integrated information system specializing in immunoglobulins (IG), T cell receptors (TR) and major histocompatibility complex (MHC) of human and other vertebrates. IMGT provides a common access to expertly annotated data on the genome, proteome, genetics and structure of the IG and TR, based on the IMGT Scientific chart and IMGT-ONTOLOGY. The IMGT unique numbering defined for the IG and TR variable regions and domains of all jawed vertebrates has allowed a redefinition of the limits of the framework (FR-IMGT) and complementarity determining regions (CDR-IMGT), leading, for the first time, to a standardized description of mutations, allelic polymorphisms, 2D representations (Colliers de Perles) and 3D structures, whatever the antigen receptor, the chain type, or the species. The IMGT numbering has been extended to the V-like domain and is, therefore, highly valuable for comparative analysis and evolution studies of proteins belonging to the IG superfamily.
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            Mortality benefits of influenza vaccination in elderly people: an ongoing controversy.

            Influenza vaccination policy in most high-income countries attempts to reduce the mortality burden of influenza by targeting people aged at least 65 years for vaccination. However, the effectiveness of this strategy is under debate. Although placebo-controlled randomised trials show influenza vaccine is effective in younger adults, few trials have included elderly people, and especially those aged at least 70 years, the age-group that accounts for three-quarters of all influenza-related deaths. Recent excess mortality studies were unable to confirm a decline in influenza-related mortality since 1980, even as vaccination coverage increased from 15% to 65%. Paradoxically, whereas those studies attribute about 5% of all winter deaths to influenza, many cohort studies report a 50% reduction in the total risk of death in winter--a benefit ten times greater than the estimated influenza mortality burden. New studies, however, have shown substantial unadjusted selection bias in previous cohort studies. We propose an analytical framework for detecting such residual bias. We conclude that frailty selection bias and use of non-specific endpoints such as all-cause mortality have led cohort studies to greatly exaggerate vaccine benefits. The remaining evidence base is currently insufficient to indicate the magnitude of the mortality benefit, if any, that elderly people derive from the vaccination programme.
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              T cell responses are better correlates of vaccine protection in the elderly.

              It is commonly held that increased risk of influenza in the elderly is due to a decline in the Ab response to influenza vaccination. This study prospectively evaluated the relationship between the development of influenza illness, and serum Ab titers and ex vivo cellular immune responses to influenza vaccination in community dwelling older adults including those with congestive heart failure (CHF). Adults age 60 years and older (90 subjects), and 10 healthy young adult controls received the 2003-04 trivalent inactivated influenza vaccine. Laboratory diagnosed influenza (LDI) was documented in 9 of 90 older adults. Pre- and postvaccination Ab titers did not distinguish between subjects who would subsequently develop influenza illness (LDI subjects) and those who would not (non-LDI subjects). In contrast, PBMC restimulated ex vivo with live influenza virus preparations showed statistically significant differences between LDI and non-LDI subjects. The mean IFN-gamma:IL-10 ratio in influenza A/H3N2-stimulated PBMC was 10-fold lower in LDI vs non-LDI subjects. Pre-and postvaccination granzyme B levels were significantly lower in CHF subjects with LDI compared with subjects without LDI. In non-CHF subjects with LDI, granzyme B levels increased to high levels at the time of influenza infection. In conclusion, measures of the ex vivo cellular immune response to influenza are correlated with protection against influenza while serum Ab responses may be limited as a sole measure of vaccine efficacy in older people. Ex vivo measures of the cell-mediated immune response should be incorporated into evaluation of new vaccines for older adults.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                31 October 2012
                : 7
                : 10
                : e48322
                Affiliations
                [1 ]The Jenner Institute, University of Oxford, Oxford, United Kingdom
                [2 ]Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
                Statens Serum Institute, Denmark
                Author notes

                Competing Interests: SCG and AVSH are named as inventors on patents relating to methods of vaccination, including influenza vaccines: Methods and reagents for vaccination which generate a CD8+ T cell response. 1997 06 07. United States Patent Application 20110159034. Compositions and methods 2007 10 05. United States Patent Application 20100285050. All other authors have declared that no competing interests exist. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

                Conceived and designed the experiments: TL AM DP AVSH SCG. Performed the experiments: RA PL TKB AJS JM KL. Analyzed the data: RA TKB JM Kl DP. Wrote the paper: RA TKB DP SCG.

                Article
                PONE-D-12-19176
                10.1371/journal.pone.0048322
                3485192
                23118984
                6ed50378-7757-474e-a190-0f0805217aa2
                Copyright @ 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 June 2012
                : 24 September 2012
                Page count
                Pages: 10
                Funding
                This work was supported by the United Kingdom National Institute for Health Research Oxford Biomedical Research Centre, a partnership between the University of Oxford and Oxford Radcliffe Hospitals National Health Service Trust. TKB, AJS and TL are supported by the Oxford Martin School. SCG and AVSH are Jenner Institute Investigators. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Biotechnology
                Genetic Engineering
                Genetically Modified Organisms
                Medicine
                Clinical Immunology
                Immune Cells
                T Cells
                Immunity
                Vaccination
                Vaccine Development
                Immune Response
                Geriatrics
                Infectious Diseases
                Viral Diseases
                Influenza

                Uncategorized
                Uncategorized

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