Efficacy and safety of temelimab in multiple sclerosis: Results of a randomized phase 2b and extension study.

BACKGROUND: The envelope protein of human endogenous retrovirus W (HERV-W-Env) is expressed by macrophages and microglia, mediating axonal damage in chronic active MS lesions. OBJECTIVE AND METHODS: This phase 2, double-blind, 48-week trial in relapsing-remitting MS with 48-week extension phase assessed the efficacy and safety of temelimab; a monoclonal antibody neutralizing HERV-W-Env. The primary endpoint was the reduction of cumulative gadolinium-enhancing T1-lesions in brain magnetic resonance imaging (MRI) scans at week 24. Additional endpoints included numbers of T2 and T1-hypointense lesions, magnetization transfer ratio, and brain atrophy. In total, 270 participants were randomized to receive monthly intravenous temelimab (6, 12, or 18 mg/kg) or placebo for 24 weeks; at week 24 placebo-treated participants were re-randomized to treatment groups. RESULTS: The primary endpoint was not met. At week 48, participants treated with 18 mg/kg temelimab had fewer new T1-hypointense lesions (p = 0.014) and showed consistent, however statistically non-significant, reductions in brain atrophy and magnetization transfer ratio decrease, as compared with the placebo/comparator group. These latter two trends were sustained over 96 weeks. No safety issues emerged. CONCLUSION: Temelimab failed to show an effect on features of acute inflammation but demonstrated preliminary radiological signs of possible anti-neurodegenerative effects. Current data support the development of temelimab for progressive MS. TRIAL REGISTRATION: CHANGE-MS: ClinicalTrials.gov: NCT02782858, EudraCT: 2015-004059-29; ANGEL-MS: ClinicalTrials.gov: NCT03239860, EudraCT: 2016-004935-18.

Human endogenous retroviruses and multiple sclerosis: Causation, association, or after-effect?

From the early days of MS discovery, infections have been proposed as a possible cause of the disease. In the last three decades, an association between human endogenous retrovirus expression and MS has been further investigated and confirmed. Nevertheless, the role of such retroviruses in the disease needs clarification. In this review, we introduce MSRV/HERV-W and describe its association with MS. We then summarize the evidence for the involvement of MSRV/HERV-W in the aetiology and progression of MS and its possible role as biomarker and drug target. Biological mechanisms for HERV effects in MS may involve the activation of innate immune pathways by the envelope protein of MSRV (MSRVEnv). In addition to in vitro and experimental studies, further insight on how HERVs may influence immune-mediated pathology in MS may also come from the use of antiretroviral treatments in patients.

COMPASS identifies T-cell subsets correlated with clinical outcomes.

Advances in flow cytometry and other single-cell technologies have enabled high-dimensional, high-throughput measurements of individual cells as well as the interrogation of cell population heterogeneity. However, in many instances, computational tools to analyze the wealth of data generated by these technologies are lacking. Here, we present a computational framework for unbiased combinatorial polyfunctionality analysis of antigen-specific T-cell subsets (COMPASS). COMPASS uses a Bayesian hierarchical framework to model all observed cell subsets and select those most likely to have antigen-specific responses. Cell-subset responses are quantified by posterior probabilities, and human subject-level responses are quantified by two summary statistics that describe the quality of an individual's polyfunctional response and can be correlated directly with clinical outcome. Using three clinical data sets of cytokine production, we demonstrate how COMPASS improves characterization of antigen-specific T cells and reveals cellular 'correlates of protection/immunity' in the RV144 HIV vaccine efficacy trial that are missed by other methods. COMPASS is available as open-source software.

HIV vaccines: brief review and discussion of future directions.

A major barrier to the design of a successful HIV vaccine is virus diversity,which is particularly apparent in the envelope glycoprotein, the target of neutralizing antibodies. An antibody generated to one envelope glycoprotein may not recognize an isolate bearing a different envelope glycoprotein. Thus, single-envelope glycoprotein vaccines have protected against homologous but not necessarily against heterologous challenge. Antigenic diversity has been addressed in the design of vaccines for other pathogens by the preparation of polyvalent vaccines. The poliovirus vaccine, for example, comprises three serotypes of poliovirus, a feature that was essential in providing full protection against polio infection. Similarly, the authors propose that overcoming HIV diversity is likely to require the administration of a cocktail of envelope glycoprotein antigens. Delivery of such an array of envelope glycoproteins will elicit a broad immune response that is potentially capable of recognizing the diverse population of HIV-1 isolates. This article reviews data relevant to the development of cocktail vaccines which have been designed to elicit a wide range of envelope glycoprotein-specific B- and T-cell responses.

HIV-1 envelope-elicited neutralizing antibody titres correlate with protection and virus load in chimpanzees.

In an attempt to compare the protective effect of vaccination with two forms of envelope antigens, and to define immunological correlates of protection against HIV infection, chimpanzees were vaccinated with either recombinant gp160 or gp120. Homologous HIV challenge was performed 3 weeks after the fourth immunization. The animal with the highest level of serum neutralizing antibodies (gp160 immunogen) was protected against HIV infection. All other chimpanzees became infected, but displayed various levels of infected PBMCs. The postchallenge data gave rise to the following conclusions: (1) protection correlated with the level of the serological immune response, but not with the nature of immunogen (gp120 versus gp160); (2) the virus-neutralizing titre at day of challenge correlated with protection from infection; (3) the relative magnitude of the lymphoproliferative T-cell response at day of challenge did not correlate with any protective effect; (4) the peak numbers of virus-infected PBMCs in vaccinated animals were lower than those observed in control animals, and this effect was correlated with the intensity of the antibody response at day of challenge. This raises the possibility that a beneficial effect of HIV vaccination may be achieved in a situation where sterile immunity is not consistently obtained.

Detection of CTL activity in PBMCS taken from HIV-ENV immunized individuals after in vitro viral infection.

The cellular immune response to the AIDS virus in healthy individuals immunized with HIV-1 antigens has not yet been entirely understood. Unlike HIV-1 infected patients where direct measurements of anti HIV-1 CTL activities can be readily performed with fresh peripheral blood mononuclear cells, uninfected volunteers immunized against HIV-1 antigens have fewer circulating CTL necessitating an in vitro activation in order to amplify the cytotoxic signal and make it measurable. This study presents experiments where specific CTLs are successfully obtained simply by in vitro infection of PBMCs from HIV-1 Envelope immunized individuals.

The prospects for AIDS vaccines.

Several vaccine strategies against HIV are under study in phase 1 clinical trials. Many involve recombinant subunit preparations, and the question is which of these components of the virus may be immunogenic. Immune effectors and mediators that protect against HIV are also undefined. Vaccines may ultimately be used to treat as well as prevent AIDS.