Seroconversión frente a primovacunación reforzada contra hepatitis B en niños con cáncer / Seroconversion in response to a reinforced primary hepatitis B vaccination in children with cancer

Introducción: La respuesta inmune a los antígenos de las vacunas está disminuida en los niños con cáncer. El objetivo de este estudio fue evaluar la seroconversión frente a vacuna ADN recombinante contra hepatitis B al momento del inicio de la quimioterapia y/o remisión en niños con cáncer. Pacientes y método: Estudio prospectivo, bicéntrico, controlado, no aleatorizado de niños con diagnóstico reciente de cáncer pareados con niños sanos. Los casos fueron vacunados a tiempo 0, 1 y 6 meses, a dosis de 20 y 40 μg si eran < ó > 10 años, respectivamente, con vacuna ADN recombinante contra hepatitis B, en el momento del diagnóstico en el caso de los tumores sólidos y luego de la remisión en el caso de los tumores hematológicos. El grupo control recibió el mismo esquema, con dosis de 10 o 20 μg respectivamente. Se midieron anticuerpos séricos anti-HBs a los 2, 8 y 12 meses posvacunación. Seroconversión se definió como títulos anti-HBs > 10 mUI/ml al octavo mes. Resultados: Un total de 78 niños con cáncer y 25 controles fueron evaluados con títulos anti-HBs al octavo mes. La tasa de seroconversión fue de 26,9%, en niños con cáncer, sin diferencia por edad, género ni tipo de tumor (p = 0,13; 0,29; y 0,44, respectivamente), y de 100% en el grupo control (p < 0,0001, comparado con los niños con cáncer). En el seguimiento a los 12 meses solo el 31,9% de los niños con cáncer presentaba títulos anti-HBs > 10 mUI/ml. Conclusiones: La vacunación contra hepatitis B con vacuna ADN recombinante, con esquema reforzado de 3 dosis, en el momento del inicio de la quimioterapia y/o remisión provee una respuesta inmune insuficiente en la mayoría de los niños con cáncer. En esta población debieran evaluarse vacunas de tercera generación, con adyuvantes más inmunogénicos, esquemas reforzados a los 0, 1, 2 y 6 meses, medición de títulos de anticuerpos al octavo y duodécimo mes, eventual uso de refuerzos y reevaluación de inmunogenicidad si correspondiese.

Introduction: Immune response against vaccine antigens may be impaired in children with cancer. The aim of this study was to evaluate the seroconversion response against hepatitis B vaccination (HBV) at the time of chemotherapy onset and/or remission in children with cancer. Patients and method: Prospective, two-centre, controlled, non-randomised study conducted on children recently diagnosed with cancer, paired with healthy subjects. Cases received HBV at time 0, 1 and 6 months with DNA recombinant HBV at a dose of 20 and 40 μg if < or > than 10 years of age, respectively, at the time of diagnosis for solids tumours and after the remission in case of haematological tumours. Controls received the same schedule, but at of 10 and 20 μg doses, respectively. HBs antibodies were measured in serum samples obtained at 2, 8 and 12 months post-vaccination. Protective titres were defined as > 10 mIU/ml at 8th month of follow up. Results: A total of 78 children with cancer and 25 healthy controls were analysed at month 8th of follow up. Seroconversion rates in the cancer group reached 26.9%, with no differences by age, gender or type of tumour (P = .13, .29, and .44, respectively). Control group seroconversion was 100% at the 8th month, with P < .0001 compared with the cancer group. At month 12 of follow up, just 31.9% of children with cancer achieved anti-HBs antibodies > 10 mIU/ml. Conclusions: Vaccination against hepatitis B with three doses of DNA recombinant vaccine at an increased concentration, administrated at the time of onset of chemotherapy and/or remission provided an insufficient immune response in a majority of children with cancer. More immunogenic vaccines should be evaluated in this special population, such as a third generation, with more immunogenic adjuvants, enhanced schedules at 0, 1, 2, 6 month, evaluation of antibody titres at month 8 and 12 h to evaluate the need for further booster doses.

Immune response evaluation against leishmaniasis using liposomes containing rLmSTI1 in murine model

Leishmaniasis is a parasitic disease spread by the bite of infected sand flies. Protozoa of the Leishmania species cause leishmaniasis. The protective immunity against leishmaniasis is the cell-mediated immunity [CMI]. LmSTI1 is a candidate for the development of vaccine against cutaneous leishmaniasis [CL]. Liposomes are microscopic vesicles consisting of phospholipid bilayers which enclose aqueous compartments and are used as an immunoadjuvant. The aim of this study was to formulate liposome preparations containing recombinant rLmSTI1 to induce Th1 response in BALB/c mice against infection with L. major. Liposomes containing rLmSTI1 were prepared as dehydration-rehydration vesicles [DRV] and composed of distearoylphosphatidylcholine [DSPC] and cholesterol [CHOL] in a molar ratio of 2:1 [DSPC/CHOL-rLmSTI1]. The average size of liposome formulations was 1.1micro m checked by light microscope and particle size analyzer. DSPC/CHOL-rLmSTI1 [2micro g]; soluble rLmSTI1 [2micro g]; PBS, and a control empty liposome were injected separately subcutaneously [SC] in female BALB/c mice [10 per group], 3 times in three week intervals. The mice were challenged with L. major promastigotes [1.5 X 10[6]] SC to the left footpad and PBS to the right footpad for control at 3 weeks after the last booster. The footpad swellings were measured weekly for 12 weeks. Blood samples were collected on the day before and 12 weeks after challenge to titrate the anti-Leishmania antibodies [IgG total, IgG1 and IgG2a] by ELISA method. The parasite burden in spleen was determined at 15weeks after challenge. The results showed that in the group that received DSPC/CHOL-rLmSTI1, footpad thickness was significantly less; IgG2a titer was higher with very few parasites in the spleen compared to the other groups. The results indicated that encapsulation of rLmSTI1 in liposome seems to be a suitable tool to improve the CMI and rate of protection in murine model of leishmaniasis

Induction of neutralizing antibodies in mice immunized with scorpion toxins detoxified by liposomal entrapment

The possibility of producing neutralizing antibodies against the lethal effects of scorpion toxins was evaluated in the mouse model by immunization with an immunogen devoid of toxicity. A toxic fraction (5 mg) from the venom of the scorpion Tityus serrulatus was entrapped in sphingomyelin-cholesterol liposomes. The liposomes were treated for 1 h at 37 degrees Celsius with a 1 per cent (w/w) trypsin solution in 0.2 M sodium carbonate buffer, pH 8.3. This treatment led to a strong reduction in venom toxicity. Immunization was performed as follows: mice were injected sc with 20 mug of the liposome-entrapped toxic fraction on days 1 and 21 and a final injection (20 mug) was administered ip on day 36. After injection of the immunogen, all mice developed an IgG response which was shown to be specific for the toxic antigen. The antibodies were measured 10 days after the end of the immunization protocol. In an in vitro neutralization assay we observed that pre-incubation of a lethal dose of the toxic fraction with immune serum strongly reduced its toxicity. In vivo protection assays showed that mice with anti-toxin antibodies could resist the challenge with the toxic fraction, which killed, 30 min after injection, all non-immune control mice.

Vaccine adjuvants: A new hope for effective immunization

Two important issue regarding the use of immunization to control infections and malignancies in the futureare: 1) the need to render poorly immunogenic, often highly purified, antigens more effective; and 2) the desire to direct the immune response in specific ways to achieve the most relevant response for each disease. The first issue can be solved by a broad range of vaccine adjuvants. The second requires careful selection among the adjuvants to allow directing of the immune response in the most appropriate manner. For exemple, in different settings expansion of a B cell response, cytotoxic T cell response, or enhancement of either a Th1 or Th2 subset response may be desired. These goals are accomplished by the use of several newly developed non-cytokine adjuvants, or by direct injection of the relevant cytokines. Some non-cytokine molecular adjuvants and cytokines used as adjuvants have already been proven effective in animal models and/or in clinical trials. Here, we review the present state of art in the use of vaccine adjuvants for control of various infections diseases.

Immunization of horses with Crotalus durissus Terrificus (South American Rattlesnake) venom: a comparision of four different procedures

A comparative study was carried out on horses immunized with Crotalus durissus terrificus venom using four different inoculation procedures, which included the use Freund's adjuvant, A1(OH)3 and liposomes as adjuvants. The antibody titer was assessed by enzyme linked immunosorbent assay (ELISA) and the neutralizing potency by the neutralizing median effective dose (ED50). The inoculation schedule used in horses to obtain antivenom serum consisted of scinjections of a 7.5 mg venom starting dose in 5.0ml sterile saline emulsified with an equal volume sterile saline at 2-dayintervals. This immunization procedure, based in low doses of antigen (37.5mg/horse) emulsified with Freund's adjuvant, proceduced a more protective andsustained immune response whencompared with other procedures using A1(OH)3 and 5.0 mg/horse in liposome) or high (870.0 mg/horse in A1(OH)3 and 20.0 mg/horse in liposome) antigen doses. The ED50 values evaluated at the end of the procedure were 15.4 *l serum/20 gmouse when antigen was emulsified with Freund's adjuvant; 21.7 * serum/20 g mouse when 870,0 mg antigen/horse was emulsified with A1(OH)3 and 30.0 *l serum/20 g mouse when 50.0 mg antigen/hors was emulsified with a1(OH)3.When antigen was emulsified with liposome, the immune serum was ineffective against the lethal effects of C.d terrificus venom. The inoculation schedule used in horses to obtain hyperimmune serum consisted of reimmunization with sc booster injections of 7.5 mg venom in 5.0 ml sterile saline emulsified with an equal volume of Freund's incomplete adjuvant. One week later, 2.5 mg venom in 12.0 ml sterile saline was inoculated at 2-day intervals.This reimmunization schedule,based on low doses of antigen (15.0 mg/horse) emulsified with Freund's incomplete adjuvant or with saline, produced a protective andsustained immune response, regardless of the initial immunization procedure. The ED50 evaluatedfor each of the animals five days after the reimmunization period was never more than 20 * serum/20 g mouse. The liposome inoculation method employed a membrane-stabilized reverse phase evaporation preparation of sphingomyelin/cholesterol 2.5/1 (w/w) liposomes. This procedure permits incorporation of 1.0 mg protein per mg of phospholipid. This liposome inoculation method , which stimulates a rapid, sustained and protective immune response in mice and rabbits inoculated with both C.d. collineatus and C.d. terrificus, was not effective when horses were immunized with C.