Collaborative study on a Guinea pig serological method for the assay of acellular pertussis vaccines.

An international collaborative study (coded BSP083) was performed under the aegis of the Biological Standardisation Programme supported by the Council of Europe and the European Commission, with the aim of replacing the in vivo challenge assays for potency determination of combined acellular pertussis (aP) vaccines by a refined procedure also allowing reduction of animal use. This study investigates whether the immunogenicity of aP vaccine components could be assayed in a guinea pig (gp) serology model, using the same vaccine immunising doses as for D and T components potency testing, instead of using separate animals as is currently done. The BSP83 project is a follow up of 3 former collaborative studies (coded BSP019, BSP034 and BSP035) on serological methods for the potency testing of tetanus (T) and diphtheria (D) vaccines for human use. The use of gp instead of mice serology has the advantage of providing a larger volume of good quality antiserum for the assay of several vaccine components in the same sample, hence providing the opportunity for animal sparing. The results of Phase I of the study demonstrated that gp serology may be a useful method for the immunogenicity assay of acellular pertussis vaccines. This was confirmed in Phase II of the study, using 7 different combined aP vaccines in an international collaborative study involving 17 laboratories from both public and private sectors. Clear dose-response relationships were observed for different vaccines by ELISA, for antibodies against aP antigens, i.e. pertussis toxin (PT), filamentous haemagglutinin (FHA), fimbrial agglutinogens-2/3 (Fim 2/3) and pertactin (PRN). Intra- and inter-laboratory variations of aP ELISA results were found to be within an acceptable range. For some combined vaccines, however, the range of vaccine dilutions for immunisation confirmed to be optimal for D and T potency testing may not provide optimal dose-response for all aP components. Method adjustments may thus be required and suitability should therefore be demonstrated for each vaccine combination and product prior to the application of this assay. The results of this study support the use of the gp serological method for the determination of the immunogenicity of aP vaccines. The application of the method for batch release testing of combined D, T and aP vaccines could significantly contribute to the implementation of the 3R principles through reduction of animal use and improved animal welfare, whilst reducing costs. As an outcome of this study, the Group of Experts No. 15 on Sera and Vaccines of the European Pharmacopoeia (Ph. Eur.) decided in February 2009 to include the gp serological assay as an example in the Ph. Eur. General chapter 2.7.16. on acellular pertussis vaccine assay.

Collaborative study for the validation of serological methods for potency testing of diphtheria toxoid vaccine (part 2).

The study is a contribution to the EDQM's efforts to meet some of the expectations of the 3 Rs: Replacement, Reduction and Refinement of animal assays as proposed by Russell and Burch in 1959 and adopted by the European Union in 1986, and specifically to validate alternative assays to replace, for batch-release purposes, the European Pharmacopoeia (Ph. Eur.) in vivo direct challenge procedures for the potency determination of diphtheria toxoid vaccines. The study results may be used in support of the replacement of the multi-dilution direct challenge procedures in different animal models by a single dilution serology test, where appropriate, and to use sera from the same animals for potency testing of several components in combined vaccines. With regard to the latter, the present study explores the possibility of testing both diphtheria and tetanus toxoid potencies using serum from the same animals.

Collaborative study for the validation of serological methods for potency testing of diphtheria toxoid vaccines-part 1.

A collaborative study on the evaluation of an alternative functional assay, the Vero cell method, to the Ph. Eur. in vivo challenge procedures for potency determination of diphtheria toxoid in 6 different combined vaccines was initiated in January 2001. The study was an extension of a previous study for the validation of serological methods for potency testing of tetanus toxoid vaccines for human use. To allow interim evaluation of test results and to monitor study progress, the project was divided into three consecutive phases. The results of Phase I and II studies are presented in this report. Pre-validation (Phase I) study, performed in two laboratories, indicated that comparable diphtheria potency estimates were obtained in the Ph. Eur. direct intradermal challenge assay in guinea pigs, in Vero cell assay and in indirect ELISA for five vaccines of different potencies (range of estimates: ca. 20-200 IU/ml). The correlation coefficients between the challenge assay and the Vero cell assay corresponded to those between the challenge assay and ELISA, confirming that the antibodies play an important role in protection and that predominantly protective/neutralising antibodies are present in guinea pigs, at the time point investigated. It was observed, for Vero cell assays, that about 16-35 (9-28 in Phase II study) fold lower titre of individual serum samples were obtained when using equine, rather than guinea pig reference serum. The study also provided preliminary information that sera from the same guinea pigs may be used for potency determination of both diphtheria and tetanus toxoid components of vaccines. In Phase II, another five laboratories analysed a subset of the vaccines included in Phase I study plus an additional vaccine. Four laboratories performed the lethal challenge assay and one laboratory carried out the intradermal challenge assay. All laboratories also performed the Vero cell assay and both ELISA for diphtheria antitoxin and ELISA for tetanus antitoxin. One laboratory also performed the tetanus ToBI assay. The correlation coefficient (r) between Vero cell assay and ELISA for diphtheria antitoxin ranged from 0.76 to 0.91 in the different laboratories. The correlation between diphtheria serological assays and challenge assays were confirmed satisfactory as ca. 90 per cent of serum-estimates lead to correct prediction of mortality. All laboratories had identical rankings of the vaccines in all serological assays and in the valid challenge assays. The ranking order was identical to assumed/provided potency for the highest and the lowest vaccine. Two of the vaccines had an inversion in some assays and laboratories. As these two vaccines have almost identical potencies in all assays, these inversions are not significant. As the vaccine doses were optimised for the diphtheria component, serum anti-tetanus toxoid/toxin activities varied widely between the vaccines, making it questionable to apply a parallel line model to calculate exact potencies. However, the dose levels used showed a clear regression and good linearity in general. DTaP vaccines containing the IPV component did not always meet the present Ph. Eur. requirements in the serological assays. It should be further investigated in the Phase III study if this is a general feature of such combined vaccines. Preliminary investigations on samples from two laboratories indicate that the neutralising activity of type 1, 2 and 3 polioviruses can also be detected, in a dose-dependent way. Further studies are in progress with serum samples from other laboratories. In the light of results obtained in the first two phases, it is recommended to proceed with Phase III study to investigate reliability of the in vitro assays. In Phase III it will also be further investigated whether the serological assays for D and T components are suitable for the control of the multi-component vaccines currently marketed in Europe.

Collaborative study for the validation of serological methods for potency testing of diphtheria toxoid vaccines - extended study: correlation of serology with in vivo toxin neutralisation.

Phase I of BSP034 collaborative study was extended in two laboratories to include correlation of serology with in vivo toxin neutralisation test (TNT) using 2 separate sets of 20 serum pools, produced in-house. The study investigated the extent to which the in vitro methods for diphtheria antibodies, Vero cell assay and diphtheria enzyme-linked immunosorbent assay for diphtheria antitoxin (D-ELISA), can detect neutralising antibodies by comparison with TNT in guinea pigs. The study was also performed to compare the antibody neutralising potency obtained in relation to guinea pig (GP) or equine (DI) antitoxin standard. In addition, the study provided an opportunity to compare ELISA for tetanus antitoxin (T-ELISA) and TNT assay for detection of anti-tetanus antibodies, from the same set of serum pools. The data obtained show that antitoxin potency obtained by Vero cell assay, D-ELISA and T-ELISA using the same GP standard, highly correlated with neutralising potency as determined in respective TNT assays. Vero cell assay with DI provided estimates that also correlated with neutralising potency, but were of significantly lower titre. Since reference to DI standard is widely used in serodiagnosis, as well as in clinical studies where diphtheria antitoxin titres obtained in the Vero cell method are taken as surrogate markers for vaccine efficacy, it should be investigated if a similar difference is also observed for human serology.

Calibration of replacement international standard and European pharmacopoeia biological reference preparation for tetanus toxoid, adsorbed.

Here we report the characterisation of a preparation of tetanus toxoid, adsorbed, and its calibration by 27 laboratories in 19 countries in a joint international collaborative study co-sponsored by World Health Organization (WHO) Expert Committee of Biological Standardization (ECBS) and the European Biological Standardisation Programme of European Directorate for the Quality of Medicines (EDQM), Council of Europe. Calibration was in terms of the Second International Standard (I.S.) for Tetanus Toxoid, Adsorbed, by the established WHO/European Pharmacopoeia (Ph Eur) challenge methods. The replacement standard preparation was found to have a unitage of 469 IU/ampoule on the basis of its calibration in guinea-pigs and 496 IU/ampoule on the basis of its calibration in mice. Assessment, both within the collaborative study and as part of candidate characterisation, indicated satisfactory stability of the candidate preparation. This study also provided some information on the effect of mouse strain on potency testing of tetanus vaccines. A limited assessment of the impact of the replacement standard on testing of current production batches of vaccines was also carried out by four manufacturers. This study did not directly address the serological approaches to potency testing. However, one laboratory offered data from mouse serology assay, which gave comparable estimates to in vivo mouse bioassay. Based on the results of this study and with the agreement of participants, the candidate standard was established as the Third International Standard for Tetanus Toxoid, Adsorbed (coded 98/552) by the WHO Expert Committee of Biological Standardization (ECBS) in November 2000. The same preparation was also established as the second Ph Eur Biological Reference Preparation (Ph Eur BRP, batch no. 2) by the Steering Committee of the Biological Standardisation Programme of the EDQM and approved by the European Pharmacopoeia Commission.

Serological methods for potency testing of tetanus toxoid vaccines for human use.

A collaborative study has been performed to validate two in vitro serological assays, ELISA and ToBI test, as alternatives to the direct challenge procedure for potency testing of tetanus toxoid vaccines for human use (Ph.Eur. monograph Tetanus vaccine (adsorbed) (0452)). In six laboratories, guinea-pigs were immunised with tetanus toxoid vaccines from different manufacturers representing various types of combined products, including one product of borderline quality. Blood samples were taken two to four days before challenge. Parameters that were analysed included: (i) correlation of vaccine potencies obtained by direct challenge test and by serological assays, (ii) prediction of survival based on antibody concentrations, and (iii) correlation of antibody concentrations obtained in ELISA, ToBI test and in vivo Toxin Neutralisation test. In addition, ELISA and ToBI test repeatability and reproducibility were further studied by titration of a total of 28 serum samples in 23 laboratories. This paper provides background information, gives an outline of the experimental design and discusses the study results. It is concluded that ELISA and ToBI test are valid alternatives to the challenge procedure. Implementation of the serological assays as alternatives to the challenge procedure for batch release of tetanus vaccines for human use will result in a marked refinement as well as a substantial reduction of numbers of laboratory animals.

A Vero cell method for potency testing of diphtheria vaccines.

A collaborative study on the evaluation of an alternative functional assay to the Ph. Eur. in vivo challenge procedure for potency determination of diphtheria toxoid vaccines was initiated in January 2001. This study is an extension of the collaborative study for the validation of serological methods for potency testing of tetanus toxoid vaccines for human use. The primary aim was to examine whether a Vero cell assay is a valid alternative to the Ph. Eur. in vivo challenge methods for potency determination of the diphtheria toxoid component of combined vaccines. The study also investigated whether sera from the same immunised guinea pigs can be used for potency determination of both the diphtheria and the tetanus toxoid components. The project was divided into three parts. In part I, summarised in this publication, the operating procedures for the methods and the optimal vaccine dilutions for the immunisation of guinea pigs were established. From the results of the part I study, performed in two laboratories, the correlation co-efficients between the Vero cell method and the challenge assay were considered satisfactory to warrant continuing with the next phase. Comparable diphtheria potency estimates were obtained in the two assays for four vaccines of different activities (range ca. 20-200 IU/ml). The study also provided preliminary information that sera from the same guinea pigs may also be used for potency determination of both diphtheria and tetanus toxoid components of vaccines by ELISA.

Collaborative study for the establishment of tetanus vaccine (adsorbed) Third International Standard and European Pharmacopoeia Biological Reference Preparation batch no. 2.

The aim of the present collaborative study was to calibrate two candidate replacement standards for tetanus vaccine for human use in the terms of the Second International Standard (IS) for Tetanus Toxoid, Adsorbed (TEXA-2) using challenge potency assays in guinea pigs and mice and to establish the 3rd IS and the Ph. Eur. BRP batch 2. Two test preparations (coded B and C) were included as candidate replacement for TEXA-2 and Ph. Eur. BRP batch 1 (EBRP-1). This project was run as a joint WHO/Ph. Eur. study. Twenty-seven laboratories representing nineteen countries participated in the study. Twenty-three laboratories performed assays in mice (11 laboratories performed lethal, 11 paralysis, and one serology assays) and fourteen laboratories performed assays in guinea pigs (10 laboratories performed lethal and 4 paralysis assays). Estimates of potency, expressed in ampoule of TEXA-2 per ampoule of candidate replacement standards were two-fold higher in mice than in guinea pigs. However, using the assumed relationship between TEXA-1 and TEXA-2 in mice and guinea pigs (Lyng and Nyerges, 1984), potency estimates for candidate replacement standards (sample coded B and C), in terms of TEXA-1, gives estimates which are similar in both animal models. Stability was assessed within the collaborative study for candidate standard B. On the basis of this collaborative study, the ECBS of WHO has established the candidate material coded B as the Third IS for Tetanus Toxoid, Adsorbed, with an assigned unitage of 469 IU/ampoule, based on its calibration by guinea pig challenge assays (WHO report BS/00.1932). Further studies were organised to assess which of the two candidate standards is most suitable as replacement for EBRP-1. Manufacturers were asked to include candidate B and candidate C in their routine quality control potency assays of tetanus vaccines in order to assess the impact of the use of either preparation on their calibration results. The features and results of this additional phase are described at the end of this report in a separate section entitled "Choice of replacement batch for EBRP-1". Based on these results, at the session in March 2001, the Ph. Eur. Commission adopted candidate B as the Tetanus vaccine (adsorbed) Ph. Eur. BRP Batch 2 with assigned potencies of 469 IU/ampoule for the guinea pig assays and 496 IU/ampoule for the mouse assays.

Calibration of replacement international standard and European Pharmacopoeia Biological Reference Preparation for Diphtheria Toxoid, Adsorbed.

We report here the characterisation of a preparation of diphtheria toxoid, adsorbed, and its calibration by twenty laboratories in fourteen countries in terms of the Second International Standard (I.S.) for Diphtheria Toxoid, Adsorbed, coded sample A (DIXA) using the established World Health Organisation (WHO)/European Pharmacopoeia (Ph Eur) challenge methods. The replacement standard preparation was found to have a unitage of 160 IU/ampoule on the basis of its calibration by in vivo bioassay. Stability was assessed within the collaborative study, and as part of candidate characterisation. Results suggest that the replacement standard will have satisfactory stability. This study also provided an opportunity to investigate serology as alternative to in vivo bioassay for potency testing of diphtheria vaccines. Six laboratories participated by performing serology according to in-house protocol. The calibration of the replacement standard in a mouse Vero cell assay gave a significantly higher results than in the established WHO/Ph Eur methods. Based on the results of this study and with the agreement of participants, the candidate standard was established as the Third International Standard for Diphtheria Toxoid, Adsorbed (coded 98/560) by the WHO Expert Committee of Biological Standardization in October 1999. The same preparation was also established as the second Ph Eur Biological Reference Preparation (Ph Eur BRP, batch no. 3) by the Steering Committee of the Biological Standardisation Programme of the European Directorate for the Quality of Medicines and approved by the European Pharmacopoeia Commission.

Serological assays as alternatives to the Ph Eur challenge test for batch release of tetanus vaccines for human use.

According to the European Pharmacopoeia (Ph Eur) monograph on Tetanus Vaccine (adsorbed) (1997: 0452), assessment of potency is based on a challenge test in guinea pigs or mice. The end-point is taken as paralysis or death. The test requires a large number of animals and causes severe distress. The aim of the present study was to refine the test, and reduce the number of animals needed, for batch release purposes. Serological assays having the potential of being internationally accepted, have been compared with Ph Eur assays. The study included five tetanus vaccines of various combinations and produced by different manufacturers. The results indicated an excellent correlation between enzyme-linked immunosorbent assay (ELISA) and the challenge test (about 93% predictive value), as well as between the toxin binding inhibition (ToBI) test and the challenge test (about 95% predictive value) and between ELISA and the ToBI test (r = 0.92). Antitoxin concentrations determined by ELISA and ToBI were generally in the same range. An overall good correlation was also seen for serum pools of the guinea pigs injected with equal vaccine doses, between toxin neutralisation test in mice (TNT) and ELISA (r = 0.93) as well as between TNT and ToBI (r = 0.97). The ultimate goal of this project was to determine whether serological assays can be used for testing combined vaccines, particularly for tetanus and diphtheria components, using sera from the same animals.

[Decomposition of chloramphenicol in eyedrops--irritation in the eyes]. / Spaltning av kloramfenikol i øyedråper--svie i øynene.

Chloramphenicol single dose eyedrops 0.5% (Nycomed Pharma) have been found to be very sensitive to exposure to light. We could detect approximately 15% decomposition after six hours of exposure to diffuse daylight. One of the decomposition products is the extremely irritant dichloroacetic acid. This may explain why some patients complain of a burning sensation in the eyes. In one of the samples of light yellow eyedrop received together with the complaints our analysis revealed 17% of the end-cleavage product p-nitrobenzaldehyde. The Norwegian Medicines Control Authority will suggest to the producers of these preparations that they market the product in special light-proof containers.

Pertussis toxin abolishes the inhibitory effects of prostaglandins E1, E2, I2 and F2 alpha on hormone-induced cAMP accumulation in cultured hepatocytes.

Several prostaglandins inhibit the cAMP response to glucagon and beta-adrenergic stimulation in hepatocytes. To probe the mechanism of this inhibition, we have examined in primary hepatocyte cultures how pretreatment with pertussis toxin (islet-activating protein) influences the ability of the cells to respond to hormones and prostaglandins. Pertussis toxin augmented the effects of glucagon, epinephrine and isoproterenol, and also markedly enhanced the cAMP response to prostaglandin E1 (PGE1). Furthermore, whereas PGE1, PGE2, PGI2 and PGF2 alpha attenuated the cAMP responses to glucagon in control cultures, this inhibition was abolished in cells pretreated with pertussis toxin. A more detailed comparison was made of the effects of PGE1 and PGF2 alpha. In cells not treated with pertussis toxin, both these prostaglandins at high concentrations reduced the cAMP response to glucagon and isoproterenol by approximately 50%, but dose-effect curves showed that PGE1 was about 100-fold more potent as an inhibitor than PGF2 alpha. Pertussis toxin abolished the inhibitory effects of PGE1 and PGF2 alpha with almost identical time and dose requirements. The results obtained with PGE1, PGE2, PGI2 and PGF2 alpha suggest that prostaglandins of different series attenuate hormone-activable adenylate cyclase in hepatocytes through a common mechanism, dependent on the inhibitory GTP-binding protein.

The potency determination of human varicella-zoster immunoglobulin by enzyme-linked immunosorbent assay, complement-fixation test and indirect fluorescent antibody tests.

Traditionally, plasma for the production of the human varicella-zoster immunoglobulin (VZIG) has been selected on the basis of the complement-fixing antibody (CFA) titre. Since immune individuals may lack CFA to varicella-zoster virus (VZV), non-CFA may be of importance in protection. In a search for a simple and reliable method for potency determination, 24 VZIG preparations were quantified by enzyme-linked immunosorbent assay (ELISA), the complement-fixation test (CFT), the indirect fluorescent antibody test to acetone-fixed (IF) and viable (FAMA) VZV-infected cells, respectively. The antibody titres obtained by the various methods were compared. Arranged in order of decreasing agreement, the correlation coefficients (r) of the regression equations between the variables were 0.62 for CFT and FAMA, 0.50 for CFT and ELISA and 0.26 for CFT and IF in a log2 plot. There was complete agreement between the titres obtained by the commercially available Enzygnost Varicella/Zoster kits (Behring Institute, Marburg, F.R. Germany) and the ELISA microtitre plates produced at our institute (r = 1). The regression equation lines for ELISA/CFT and FAMA/CFT titres tended to be parallel to each other, while the line for IF/CFT titres had a less steep slope. Similar titration curves were obtained for VZIGs fractionated by two different methods. Furthermore, the titration curves of serum pools from varicella and zoster convalescents, respectively, had a similar shape below delta OD = 0.4. Generally, a steeper slope was observed above delta OD = 0.4. As antibody detectable by ELISA seems to correlate with protection and the method is sensitive, specific, reproduceable, simple to carry out and easily automated, it may be suitable for the potency determination of VZIGs.

Efficacy of post-exposure prophylaxis with hepatitis B immunoglobulin in Norway.

The efficacy of hepatitis B immunoglobulin (HBIG) in preventing infection by hepatitis B virus (HBV) after exposure to blood or blood-containing secretions that carried hepatitis B surface antigen (HBsAg), was studied in an uncontrolled trial in Norway from 1976-1983. Of the 177 HBIG recipients, followed up for 5-24 months, 166 were exposed by needle-stick, splash on mucous membranes or open wounds, sexual contact or medical investigation. With few exceptions, this group was given a single injection of 1250 IU of antibody to HBsAg (anti-HBs) within 7 days after exposure. One person developed clinical hepatitis B (HB) of short duration and two others developed anti-HBs. Six infants with perinatal exposure were injected with three or four doses of about 1250 IU anti-HBs at intervals of 2-3 months. The first dose was given immediately after birth. One child developed clinical HB at the age of 14 months and recovered. Of five patients exposed by blood transfusion, four developed clinical HB; the fifth apparently developed passive-active immunity. One of the four probably became an HBsAg carrier. These patients, except the one without clearance of HBsAg, received one to seven doses of HBIG within 2 days after exposure. Administration of HBIG after needle-stick and similar types of exposure, as well as administration to infants at risk of contracting HB, seems to be of great value.

The identification of diphtheria, tetanus and pertussis vaccines by single radial and double immunodiffusion techniques.

The identification tests for adsorbed diphtheria, tetanus and pertussis vaccines, which are required by the European Pharmacopoeia to be undertaken in animals, may be replaced by precipitation tests, for instance in agaros gels. Such in vitro tests eliminate the use of animals and are less expensive and time-consuming. The single radial immunodiffusion technique is a suitable semiquantitative test, while the double diffusion test is necessary for the investigation of complete or partial identity. The precipitates obtained in the single radial diffusion tests and in double diffusion tests with diphtheria toxoid were visible without staining; those obtained in the double diffusion tests with tetanus toxoid were weaker and staining was sometimes needed.

Antibody responses after vaccination and disease against leukocytosis promoting factor, filamentous hemagglutinin, lipopolysaccharide and a protein binding to complement-fixing antibodies induced during whooping cough.

The serum antibody responses of vaccinated children and whooping cough patients to the highly purified Bordetella pertussis antigens, leukocytosis-promoting factor (LPF), lipopolysaccharide (LPS), a protein binding to complement-fixing antibodies induced during whooping cough (PBCA) and to a partly purified filamentous hemagglutinin fraction (FHA) were analysed in enzyme-linked immunosorbent assay. Of the IgG antibodies, those to FHA and LPS were often persistent both after infection and vaccination. The mean titers were about six to ten times higher after disease than after vaccination in corresponding age groups. IgG antibodies to LPF were frequently detected in high titers in patients (mean arbitrary units = 1723), but seldom in low titers (mean units = 20), after vaccination. IgG antibodies to PBCA disappeared some years after vaccination. IgM antibodies to PBCA, FHA and LPS were present in almost 100% after vaccination and disease. IgM antibodies to LPF were detected in 23% of the vaccinated and in 83% of the patients. The respective mean IgM units to PBCA, FHA, LPS and LPF were 14, 13, 16 and 134 times higher in patients than in vaccinated children. None of the vaccinated children and 20% of the patients had IgA antibodies to LPF. No pronounced differences in the percentage of the respective IgA responses to PBCA, the FHA fraction and LPS were found between the two groups. The striking differences in the immune response of vaccinated children and patients were to LPF. Since whooping cough protects better than vaccination against B. pertussis infection, the present study indicates that immunogenic LPF should be included in an acellular vaccine. Also addition of FHA, PBCA and possibly even of LPS, if it can be prepared in an immunogenic and atoxic form, might be necessary in order to prepare a highly effective acellular vaccine.