The present invention is directed to multivalent conjugates, immunogenic compositions, and vaccines comprising carrier protein conjugated bacterial capsular polysaccharides and uses thereof. In particular, compositions of the invention comprise monovalent and multivalent bacterial capsular polysaccharide-protein conjugates, wherein the bacterial capsular polysaccharides and oligosaccharides are derived from serotypes of Streptococcus pneumoniae. The carrier protein is conjugated to bacterial capsular polysaccharides through mono functional as well as bi-functional linkers, preferably of defined lengths and the mono-functional or bi-functional linkers may be homo-mono-functional, homo-bi-functional, hetero-mono-functional, or hetero-bifunctional.
Streptococcus pneumoniae is a Gram-positive pathogen responsible for invasive pneumococcal diseases (IPDs) such as pneumonia, bacteremia, meningitis, and acute Otitis media. Pneumonia is the most common manifestation of invasive pneumococcal disease, whereas bacterial spread within the respiratory tract may result in middle-ear infection, sinusitis or recurrent bronchitis. Pneumococcus is encapsulated with a chemically linked polysaccharide which results in serotype specificity. At least 90 pneumococcal serotypes are known of which about 23 account for 90% of invasive diseases and capsular polysaccharide is a poor immunogen.
There are currently three PCV vaccines available on the global market: PREVNAR®, SYNFLORIX®, and PREVNAR-13®. There is a need to address remaining unmet medical need for coverage of pneumococcal disease due to serotypes not found in PREVNAR-13® and potential for serotype replacement over time. There is a need for immunogenic compositions that can be used to induce an immune response against additional Streptococcus pneumoniae serotypes in humans and in children less than two years old.
A capsular polysaccharide (CPS) is a key virulence determinant and generally insufficiently immunogenic to induce a T cell-dependent immune response in infants and children. Conjugation of a carrier protein to CPS can induce an immune response that undergoes class switching. Accordingly, a 7-valent (PCV-7, Pfizer Inc., USA), a 10-valent (Synflorox-10, GSK Vaccines) and a 13-valent pneumococcal conjugate vaccine (PCV-13, Pfizer Inc., USA) have been developed to efficiently prevent the incidence of IPDs. Reductive amination chemistry and cyanylation chemistry has been widely used to prepare the conjugate vaccines.
In these conjugates, the short C—N linkage (2.1 Å) between CPS and carrier protein leads to steric shielding of the CPS epitopes by the carrier protein and low CPS/protein ratio. Important parameters are needed to minimize disadvantages of the current vaccines.
U.S. Pat. No. 9,492,559 discloses immunogenic compositions comprising conjugated capsular polysaccharide antigens and uses thereof. The immunogenic compositions disclosed include an 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 or 20-valent pneumococcal conjugate composition. Also disclosed is a 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 73, 24 or 25-valent pneumococcal conjugate composition.
International Application Publication No. WO 2014/097099A2 discloses a glycoconjugation process directed to several serotypes in addition to Preevnar-13 valent conjugates. New polysaccharide conjugates are added to formulation to increase efficacy of the vaccine.
U.S. Patent Application Publication No. 2011/023526 discloses a 15-valent pneumococcal polysaccharide-protein conjugate vaccine composition. This patent is directed to 15-valent conjugate vaccines made by adding two or more serotypes with currently available 1-3 vaccines.
International Application Publication No. WO 2016/207905 discloses multivalent pneumococcal conjugate vaccine. This application is directed to a 13 or greater valent conjugate vaccine and deletion of serotype 6A.
U.S. Patent Application Publication No. 2017/007713 discloses a linker containing ((2-oxoethyl) thio) with enhanced functionality.
International Application Publication No. WO 2014/092377 discloses a 13 valent composition wherein 12 serotypes were selected from the group consisting of serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F and one from 12 or 9N.
International Application Publication No. WO 2014/092378 discloses an immunogenic composition having 13 different polysaccharide-protein conjugates wherein each conjugate contained a capsular polysaccharide isolated from 12 serotypes selected from the group consisting of serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F, and serotypes 22F or 33F.
Chinese Application Publication No. 101590224 discloses a 14-valent pneumococcal polysaccharide-protein conjugate vaccine containing serotypes 1, 2, 4, 5, 6A, 6B, 7F, 9N, 9V, 14, 18C, 19A, 19F and 23F.
Chinese Application Publication No. 104069488 discloses 14 valent polysaccharide protein conjugate wherein the 14 serotypes were 1, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F and 33F.
International Application Publication No. WO 2016207905 discloses a multivalent Pneumococcal conjugate vaccine comprising conjugates of CRM 197 and at least 14 capsular polysaccharides selected from serotypes 1, 3, 4, 5, 6B, 7F, 9N, 9V, 14, 15B, 18C, 19A, 19F, 22F, 23F and 33F. U.S. Pat. No. 8,192,746 disclosed a 15 valent immunogenic composition comprising capsular polysaccharides from serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 22F, 23F, and 33F conjugated to CRM197.
International Application Publication No. WO 2013/191459 discloses a 15 valent composition comprising S. pneumoniae capsular polysaccharides form serotypes of 1, 2, 3, 4, 5, 6A, 6B, 7F, 9N, 9V, 14, 18C, 19A, 19F and 23F.
Chinese Application Publication No. 103656632 discloses multi valent pneumococcal capsular polysaccharide composition containing serotype 6A and at least one extra serotype selected from the group consisting of 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F which provided protection against 24 different pneumococci serotypes.
Chinese Application Publication No. 103656631 discloses a multivalent pneumococcus capsular polysaccharide-protein conjugate composition comprising capsular polysaccharides of pneumococcus of 24 different serotypes viz. 1, 2, 3, 4, 5, 6A, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F.
U.S. Patent Application Publication No. 2016/0324950 discloses immunogenic polysaccharide-protein conjugates comprising a capsular polysaccharide (CP) from Streptococcus agalactiae, also referred to as group B streptococcus (GBS), and a carrier protein, wherein the CP is selected from the group consisting of serotypes Ia, Ib, II, III, IV, V, VI, VII, VIII, and IX. This was meant for treatment of chronic diabetes mellitus, cancer, heart failure, neurologic, and urologic conditions. The carrier protein capsular polysaccharide conjugates varied.
U.S. Pat. No. 5,360,897 discloses immunogenic conjugate comprising reductive amination product of an intact capsular polymer of the bacterial pathogen S. pneumoniae having at least two carbonyl groups and a bacterial toxin or toxoid, said conjugate comprising a cross-linked conjugate in which there is a direct covalent linkage between the capsular polymer and the toxin or toxoid.
U.S. Pat. No. 7,862,823 describes a multivalent conjugate vaccine composition with at least two different carrier proteins.
U.S. Pat. No. 8,808,708 discloses a 13-valent immunogenic composition consisting of Polysaccharide-protein conjugates where serotypes consist of 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F, and wherein the carrier protein is CRMI97.
U.S. Patent Application Publication No. 2009/0017059 discloses an immunogenic composition where serotypes 19A and 19F were conjugated to different bacterial toxoids.
International Application Publication No, WO 2011/110241 describes pneumococcal conjugate immunogenic compositions or vaccines wherein different conjugation chemistries were used for different components of the immunogenic composition or vaccine. Reductive amination was used for the conjugation of at least one serotype and a conjugation other than reductive amination was used for the conjugation of a different serotypes. The conjugation method selected for different serotypes allowed each serotype to be presented using a conjugation method that allowed the best presentation of the saccharide epitope. Some pneumococcal saccharides conjugated well using reductive amination, whereas other pneumococcal saccharides were conjugated differently to allow the ring structure to remain unbroken and provide better results.
U.S. Pat. No. 7,955,605 discloses a process of making carrier protein polysaccharide conjugate consisting serotype 19A where the activated serotype 19A polysaccharide and carrier protein are resuspended in dimethyl sulfoxide (DMSO) to form a conjugate.
U.S. Patent Application Publication No. 2010/0074922 discloses immunogenic composition containing 10 or more serotypes wherein 19F capsular saccharide was conjugated to diphtheria toxoid (DT), serotype 18C capsular saccharide is conjugated to tetanus toxoid and serotypes 1, 4, 5, 6B, 7F, 9V, 14 and 23F capsular saccharides are conjugated to Protein D from Haemophilus influenza.
U.S. Patent Application Publication No. 2010/0239604 discloses a composition comprising multivalent S. pneumoniae capsular saccharide conjugates wherein serotype 19A was conjugated to a first bacterial toxoid and 19F is conjugated to a second bacterial toxoid and 2-9 of the S. pneumoniae capsular saccharides are conjugated to protein D. Apart from increasing the scope of protection by developing vaccines which will offer protection against larger number of serotypes, efforts were focused on developing newer methods of synthesis.
U.S. Pat. No. 7,709,001 describes a method of synthesis of carrier protein conjugate of capsular polysaccharide which consists of 1) reacting purified polysaccharide with a mild acid resulting in size reduction 2) reacting the polysaccharide of step 1 with an oxidizing agent in the presence of bivalent cations resulting in an activated polysaccharide; 3) compounding the activated polysaccharide with a carrier protein 4) reacting activated polysaccharide of step 3 and carrier protein with a reducing agent to form a polysaccharide—carrier protein conjugate; and 5) capping unreacted aldehydes in product of step 4 to yield an immunogenic polysaccharide-carrier protein conjugate.
International Application Publication No. WO 2014/097099 discloses a method of synthesizing a carrier protein conjugate, which involves a) reacting a saccharide with 2,2,6,6-tetramethyl-1-piperidinyloxy (TEMPO) and N-chlorosuccinimide (NCS) in an aqueous solvent to produce an activated saccharide; and b) reacting the activated saccharide with a carrier protein comprising one or more amine groups.
U.S. Patent Application Publication No. 2012/321658 discloses an immunogenic composition wherein serotypes 1, 3, 19A and 19F linked to protein carriers either directly or indirectly through a chemistry other than reductive amination, and one or more different saccharides is/are selected from a second group consisting of serotypes 4, 5, 6A, 6B, 7F, 9V, 14, 18C and 23F which is/are linked to a protein carriers) by reductive amination.
Pneumococcal vaccines are based on 1) pneumococcal polysaccharide vaccine and 2) pneumococcal conjugate vaccines. PNEUMOVAX® marketed by Merck comprises of unconjugated polysaccharides belonging to serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18e, 19F, 19A, 20, 22F, 23F and 33F. Infants and young children respond poorly to most pneumococcal polysaccharides. Immunogenicity of poor immunogens is enhanced by conjugating with carrier proteins. Polysaccharide protein conjugate vaccines are made using capsular polysaccharides linked to protein carriers. The conjugate induces T cell dependent enhanced immune response against the specific serotype.
Conjugates are synthesized using various reagents, such as homo bifunctional, hetero bifunctional linkers of varying lengths. Three pneumococcal conjugate vaccines are available in market, PREVNAR®, SYNFLORIX®, and PREVNAR-13®. PREVNAR® is a heptavalent vaccine that contains the capsular polysaccharides from serotypes 4, 6B, 9Y, 14, 18C, 19F and 23F, each conjugated to a carrier protein designated CRM197. SYNFLORIX® is a deca-valent vaccine from GSK Biologicals that incorporates ten capsular polysaccharides conjugated to protein D from NTHi offering coverage against three additional pneumococcal strains, serotypes 1, 5 and 7F. PREVNAR-13® is a tri-deca-valent vaccine containing 13 capsular polysaccharide prepared from thirteen serotype of Streptococcus pneumoniae (1, 3, 4, 5, 6A, 6B, 7F, 9Y, 14, 18C, 19 A, 19F, and 23F) conjugated to a carrier protein designated CRM197.
Increasing microbial resistance to antibiotics and the increasing number of immunocompromised persons have necessitated the development of pneumococcal vaccines with even broader protection, which leads to development of multivalent vaccines effective against increasing number of serotypes especially for coverage of pneumococcal disease due to serotypes not found in PREVNAR-13®. The need for a specific serotype depends on the region and antibiotic resistance developed. Thus, U.S. Pat. No. 8,192,746 reports a multivalent immunogenic composition having 15 distinct polysaccharide-protein conjugates. Each conjugate consists of a capsular polysaccharide prepared from serotype of Streptococcus pneumoniae (1, 3, 4, 5, 6A, 6B, 7F, 9\1, 14, 18C, 19A, 19F, 22F, 23F, or 33F) conjugated to a carrier protein CRM197. There is a need for vaccines that induce an immune response against serotype 15B, 15C, and 15A.
With increasing number of polysaccharide antigens in the multivalent conjugate vaccine formulations, the carrier protein content increases. This increase leads to an increase of immune response to the carrier protein which can cause a systemic overload.
Thus, there is a need to develop a pneumococcal vaccine that provides protection against increasing number of serotypes. Although a higher valent vaccine is highly desirable with a conjugation, preferably the immune response to the carrier protein is also reduced. In the development of multivalent vaccines that extend the scope of protection to additional serotypes, there is a need to improve immunogenicity and avidity of the conjugate vaccine to accommodate the increased number of serotypes without compromising the immune responses to all, which is not possible with conventional conjugation methods. In addition to protection against increasing number of serotypes, there is also a need for to develop new linkers for conjugation to improve the immune response even with the increasing number of serotypes as well as a decrease in the carrier protein response (and also avoiding steric hindrance).
Although many references recite efficacy of currently available vaccines, when adding multiple new serotypes, the immune responses decrease with increase in numbers to the original serotypes. Additional serotypes are needed to increase the efficacy of the immune response. In addition, the greater efficacy should preferably include a reduction of the immune response to carrier protein. Thus, there remains a great need for higher valency pneumococcal conjugate vaccines to provide a barrier against infections throughout the world.
The present invention overcomes the problems and disadvantages associated with current strategies and designs and provides new immunogenic compositions comprising conjugated capsular saccharides and uses thereof.
One embodiment of the invention is directed to multivalent S. Pneumoniae conjugate vaccines comprising two groups of conjugates, wherein group one comprises monovalent bacterial capsular polysaccharide conjugates and group two comprises multivalent conjugates containing conjugates of bivalent bacterial capsular polysaccharide having cross reactivity. Preferably, group one conjugates are composed of monovalent capsular polysaccharide conjugates of one or more S. Pneumoniae serotypes 1, 2, 3, 4, 5, 7F, 8, 10A, 11A, 12F, 14, 17F, 18C, 20, 22F, 23F, 24F, 33F and 35B. Preferably, group two conjugates are composed of a bivalent or multivalent capsular polysaccharide conjugate of cross reactive serotypes of one, two or more of S. Pneumoniae serotypes 6A/6B/6C/6D, one, two or more of S. Pneumoniae serotypes 9V/9N/9A/9B, one, two or more of S. Pneumoniae serotypes 15B/15A/15C, or S. Pneumoniae serotypes 19A/19F; and carrier proteins. Preferably, the second group constituting the multivalent S. Pneumoniae conjugate vaccine comprises multivalent conjugates of S. Pneumoniae cross reactive serotypes wherein the conjugates are bivalent unimolecular and are derived from bacterial capsular polysaccharides. Preferably, the vaccine comprises capsular polysaccharide of two immunologically cross-reactive serotypes conjugated to the same carrier protein sequentially or concurrently. Preferably monovalent bacterial capsular polysaccharide conjugates of the first or second group are synthesized from native bacterial capsular polysaccharides with molecular weight ranges of 10 KDa to 50 KDa, 30 KDa-100 KDa, or 100 KDa-300 KDa.
Preferably, the bivalent capsular polysaccharide of two immunologically cross-reactive serotypes is represented by the formula PS1-Carrier Protein-PS2 and, also preferably, the conjugate comprises GAPS-CRM197-6BPS. Preferably the carrier protein comprises Tetanus Toxoid, Diphtheria Toxoid, CRM197, Tetanus Toxoid fragments (TTHc), N. meningitidis protein PorB, RSV virus proteins, B. Pertussis proteins, Pertussis toxoid (PT), Adenylate cyclase Toxin (ACT), 69 KDa protein, Human Papilloma viral protein antigens, Human Papilloma virus VLP forms, Hepatitis B virus core antigen, Hepatitis B virus VLP forms, derivatives of HBsAg, or combinations thereof. Preferably a single dose of bivalent cross-reactive polysaccharide conjugates comprises less than 4 micrograms in comparison to monovalent conjugates of the same two polysaccharide vaccines which are 4 micrograms or more.
Preferably, total carrier protein quantity in the multivalent conjugate vaccine is significantly less than the quantity used in the mono conjugates of the individual polysaccharides of the same cross-reactive serotypes. Preferably, the vaccines of the present invention, the carrier protein amount being conjugated to a bivalent cross-reactive polysaccharide has less protein per serotype in comparison to that of the monovalent conjugates of the same two polysaccharides thereby the carrier protein immune response generated by the vaccine is lower than the response to the carrier protein of vaccines made by others containing the mono conjugates of the individual polysaccharides. Preferably total carrier protein content in the multivalent conjugate vaccine is from 0.5 to 0.7% by weight of the mono conjugates of the individual polysaccharides of the same cross-reactive serotypes (which is 1:1 ratio between PS: Carrier Protein). Preferably, the conjugate vaccine further comprises at least one adjuvant selected from the group consisting of aluminum or an aluminum salt, calcium phosphate, a liposome of monophosphoryl lipid A (MPLA), saponin QS-21, and/or a potent TLR7/8 agonist. Preferably the at least one adjuvant comprises an aluminum adjuvant selected from the group consisting of aluminum phosphate, aluminum sulfate and aluminum hydroxide. Preferably the bacterial polysaccharides are selected from the group consisting of cross reacting two or more serotypes from different bacterial capsular polysaccharides and/or the bacterial polysaccharides comprise: S. pneumoniae and H. influenza type a, b serotypes; S. pneumoniae and Group B Streptococcus serotypes, H. influenza type a, b serotypes, or N. meningitis serotypes. Preferably the capsular polysaccharides comprise polysaccharides derived from Streptococcus pneumoniae, Haemophilus influenza, N. meningitis, Group B Streptococcus, or Moraxella catarrhalis lipo-oligosaccharides (LOS). Also preferably, the S. pneumoniae capsular polysaccharide is immunochemically cross-reactive with serotypes selected from the group consisting of 6A/6B/6C/6D; 9V/9A/9B, 9N; 15A/15B; 19A/19F and similar types of cross reactive polysaccharides. Preferably, the capsular polysaccharide is derived from Haemophilus influenza serotypes a/b/c/d/e/f, non-typeable Haemophilus influenza (NTHi) polysaccharides, or Moraxella catarrhalis Lipooligosaccharides (LOS), or N. meningitis serotypes A, B, C, Y, W-135 or X, or Group B Streptococcus serotypes Ia, Ib, II, III, IV, V, VI, VII, VIII. IX and N, and N. meningitis serotypes A, C, Y, X, and W-135.
Another embodiment of the invention is directed to conjugate vaccines for the treatment or prevention of infection by Gram-positive and Gram-negative pathogens comprising a therapeutically effective amount of the conjugate vaccine of the invention and, optionally, a pharmacologically acceptable carrier. Preferably the capsular polysaccharides are derived from Haemophilus influenza, N. meningitis, Group B Streptococcus, N. meningitis, H. influenza, Moraxella catarrhalis lipo-oligosaccharides (LOS), and combination thereof.
Another embodiment of the invention is directed to methods for coupling polysaccharides with carrier protein comprising: activating the polysaccharide; attaching a define length spacer arm of about 2.0-40 Å to the activated polysaccharide; and attaching the activated polysaccharide attached spacer arm to a carrier protein.
Another embodiment of the invention is directed to methods coupling a carrier protein with polysaccharides comprising: activating the said carrier protein, reducing the carrier proteins disulfide to create sulfhydryl groups, preferably creating a sulfhydryl group using 2-iminothiolane (2-IT), SMPH like bi-functional linker; attaching a defined length spacer arm of 4-40 Å to the activated carrier protein; and attaching the polysaccharide to a spacer arm attached to activated carrier protein. Preferably the activated carrier protein is selected from the group consisting of cross-reactive material (CRM197) obtained or derived from C. diphtheria, or recombinant CRM197 obtained or derived from P. fluorescens or E. coli.
Another embodiment of the invention is directed to bifunctional linkers that are is homo-bifunctional or hetero-bifunctional.
Another embodiment of the invention is directed to multivalent S. Pneumoniae conjugate vaccine wherein carrier protein is cross-reactive material (CRM197) obtained from C. diphtheria, recombinant CRM197 obtained from P. fluorescens, or recombinant CRM197 obtained from E. coli.
Other embodiments and advantages of the invention are set forth in part in the description, which follows, and in part, may be obvious from this description, or may be learned from the practice of the invention.
Streptococcus pneumoniae is a Gram-positive bacterium which can cause diseases such as pneumonia, bacteraemia, meningitis, and acute Otitis media. Pneumococcus is encapsulated with a chemically linked polysaccharide which results in serotype specificity. At least 90 pneumococcal serotypes are known of which about 23 account for 90% of invasive diseases. The protection against invasive pneumococci disease is related to the antibody specific to the capsular polysaccharide, the protection is therefore serotype specific.
It was surprisingly discovered that multivalent S. Pneumoniae conjugate vaccine comprising of a linker between the carrier protein and the polysaccharide to form two groups of conjugates, wherein group one comprises monovalent bacterial capsular polysaccharide conjugates and the other group comprises multivalent carrier protein conjugates provides substantially improved results. Specifically, the bivalent conjugates and bivalent unimolecular conjugates are preferably synthesized by the reaction between carrier protein and bifunctional linkers attached to cross reactive S. Pneumoniae serotypes. Results achieved are substantially improved compared to vaccines containing multivalent S. Pneumoniae conjugate vaccine containing monovalent bacterial capsular polysaccharide conjugates with the same number of serotypes with a direct conjugation between the two instead of a linker.
One embodiment of the invention is directed to multivalent conjugate vaccines comprised of bivalent-polysaccharide protein conjugates with enhanced immunogenicity. Bivalent conjugates with general structure PS1-carrier protein-PS2 have higher immunogenicity compared to similar monovalent conjugates wherein PS1 and PS2 are two different serotype polysaccharides from gram-negative and gram-positive bacterial pathogens. By developing a bi-valent conjugate vaccine, the efficacy of the vaccine increases and carrier immunogenicity is reduced. The chemistry disclosed herein substantially increases the conjugates immunogenicity, at the same time reduces carrier protein load.
Another embodiment of the invention is directed to vaccines with lower molecular weight polysaccharides and longer arm bifunctional linkers preferably with enhanced immunogenicity. Another embodiment of the invention is directed to providing higher immunogenicity and avidity of bivalent conjugates as well as lower carrier protein immunogenicity. Another embodiment of the invention is directed to reducing conjugate vaccine dose with higher immunogenicity.
As disclosed herein, four parameters have been introduced to minimize the disadvantages of conventional vaccines:
These four parameters taken together are profoundly effective to increase the conjugates polysaccharide/protein ratio, to reduce carrier protein load, and to provide several folds of increase in immunogenicity and avidity.
The present invention is directed to polysaccharide-protein conjugates with enhanced immunogenicity displaying significantly high antibody titers. The carrier protein is obtained from, for example, tetanus toxoid, diphtheria toxoid, CRM197, tetanus toxoid fragments (TTHc), N. meningitidis protein PorB, RSV virus proteins, B. Pertussis proteins like pertussis toxoid (PT), adenylate cyclase toxin (ACT), 69 KDa protein and Human Papilloma viral protein antigens or its VLP form, Hepatitis B core antigen or its VLP form or derivatives of HBsAg, and other conventional carriers. Polysaccharide fragment is obtained from group of group of gram positive bacteria and gram-negative bacteria, preferably from immunochemically cross-reactive polysaccharides of S. Pneumoniae. The present invention is also directed to a process of preparing the polysaccharide-protein conjugates in which carrier protein reacts with cleaved and depolymerized polysaccharide fragments of optimum chain length.
Immunogenic compositions of the present invention provide for appropriate level and improved protection against S. pneumoniae serotypes not found in PREVNAR-13 ®, and SYNFLORIX-10®.
Bivalent conjugates with cross-reactive polysaccharides of S. Pneumoniae serotypes (6A/6B, 9V/9N, 15A/15B and 19A/19F and similar cross-reactive serotypes) with short chain molecular size (10-50 KDa) was used to prepare 16-26-valent pneumococcal CPS conjugate vaccine in the present study. Pneumococcus type 6A and 6B polysaccharide was used as the model cross-reactive CPSs. CRM197 was used as the carrier protein for its clinical acceptance.
Multivalent monoconjugates have also been prepared using shorter PS chain length (0-50 KDa), long spacer arm (9-40 Å) with homo or hetero-bifunctional PEG or non-PEG linker with carrier protein CRM197.
CPS was activated either by oxidation or by cyanylation chemistry and oxidized by sodium periodate and introduced with either-reactive aldehyde or isothiocyanate (—OCN) groups in CPS.
Two strategies (short and long linker, short and long CPSs) were used to introduce, respectively. Physicochemical and immunological characteristics of the bivalent conjugates vaccines were then investigated independently or combining with multivalent conjugate formulation.
The following examples illustrate embodiments of the invention, but should not be viewed as limiting the scope of the invention.
6A and 6B Polysaccharide
100 mg each of capsular polysaccharides of S. pneumoniae 6A and 6B is dissolved in 10 ml of aqueous solution containing 10 mM of Acetic acid or 0.1 M HCl at pH 2.5-3.0 and hydrolysis is carried out by maintaining the solution at a temperature of 60-85° C. for a period of 60-120 mins. The so-obtained oligosaccharides after neutralization, diafiltered using 3-10 KDa TFF Centricon filters. Upon 1H NMR analysis (
CPS (50 mg) moiety (native polysaccharides of size between ≥200-500 KDa or size-reduced polysaccharides of size between 10-50 KDa) were activated cyanylation reagents commonly used in activation process (Table 1). Polysaccharide molecular size distributions were determined using SEC-HPLC (Shodex SB-405 and SB-406 SEC columns) with analysis using (10-1000 KDa) Pollulan mixture as reference standard (Pollulan standards from Shodex, USA).
Short spacer arm was introduced to PS by reaction with 5-8-fold molar excess of ADH (Sigma) at pH 5.6-6.0 for 3-5 hr. Long spacer arm (bifunctional linker or long 4-arm linker) was introduced into PS by reaction with 5-10-fold molar excess of at pH 5.6-6.0 for 3-5 h.
Activated PS is further derivatized with short arm linker (adipic acid di-hydrazide, ADH, 174.2 g/mole), one more spacer arm linkers with varying size from 2-4 Å to 8-20 Å (600 g/mol-3.5 g/mole).
Homo or hetero-bifunctional PEG linkers with diamine functional groups attached, e.g. NH2-PEG0.6K—NH2, NH2-PEG3.5K—COOH (Table 2).
Two aliquots of 2 ml each of the derivatized CPS (10 mg/ml) were mixed with 1 ml aliquot of the two CRM197 protein samples (10 mg/ml) at 4° C. for 8-12 hrs. The conjugates with long and short spacer arm were purified by a 100-300 KDa Centricon filters (EMD Millipore) (Table 3).
CDAP (1-Cyano-4-dimethylaminopyridinium tetrafluoroborate (Sigma Aldrich, USA)) cyanuric chloride (2,4,6-trichloro-1,3,5-triazine) or cyanogen bromide (CNBr) and coupling carrier protein (see
Polysaccharide solution (10 mg/ml) was incubated with 10 mg/ml CDAP (100 mg/ml in acetonitrile) in 2M NaCl or 200-300 mM bicarbonate buffer at RT for 4-6 minutes. pH was maintained at 10-10.5 using either 1N NaOH or 1N HCl. Then, pH was adjusted to 8.1-8.2, pegylated linkers (Hz-PEG-HZ) were allowed to react with CDAP treated PS. For 8-12 hrs at RT. The reaction mixtures were depth filtered followed by 100-300 KDa cutoff centricon fiters 5-8 times using 150 mM NaCl.
Derivatization of Activated Size Reduced Polysaccharides
Activated oligosaccharides were further derivatized with short chain homo-bifunctional hydrazide linker. Typical reagent was adipic Acid di-hydrazide, ADH, Molecular weight 174.2 g/mole). Homo or hetero-bifunctional PEG linkers bearing di-amine, di-hydrazide, or amine or hydrazide-carboxylic acid/aldehyde functional groups, e.g. NH2-PEG(1K-3.5K)—NH2, HZ-PEG(1-3.5K)—HZ, NH2-PEG3.5K—COOH were used. (Table 2). Several other homo- or hetero-bifunctional spacer arms can also be used for derivatization (Table 2). Short spacer arm was introduced to oligosaccharide by reaction with 5-8 fold molar excess of adipic acid di-hydrazide (Sigma) at pH 5.8-6.0 for 3-5 hr. long chain linker (bifunctional linker or long tetra functional linker (Table 2), No. 12 four arm linker) was introduced into Polysaccharide by reaction with 5-10-fold molar excess of the linker to the oligosaccharide at pH 5.8-6.0 for 3-5 hrs. at RT.
Derivatization of Carrier Protein with Short or Long-Linkers
Carrier protein CRM197 was further derivatized with short chain homo-bifunctional hydrazide linker. Typical reagent was adipic Acid di-hydrazide, ADH, molecular weight 174.2 g/mole). Homo or hetero-bifunctional PEG linkers bearing di-amine, di-hydrazide, or amine or hydrazide-carboxylic acid/aldehyde functional groups, e.g., NH2-PEG(1K-3.5K)—NH2, HZ-PEG(1-3.5K)—HZ, NH2-PEG3.5K—COOH were used. (Table 2). Several other homo- or hetero-bifunctional spacer arms can also be used for derivatization as listed in Table 2). Short spacer arm was introduced to carrier protein CRM197 by reaction with 5-8 fold molar excess of adipic Acid di-hydrazide (Sigma) at pH 5.8-6.2 in 300-600 mM MES buffer for 3-5 hr at RT. Long chain linker (bifunctional linker or long tetra functional linker (Table 2, No. 12 four arm linker) was introduced into carrier protein by reaction with 5-10-fold molar excess of the linker to the oligosaccharide at pH 5.8-6.2 in 300-600 mM MES buffer for 3-5 hr at RT (room temperature).
Activation of the oligosaccharide derived from the capsular polysaccharide of S. Pneumoniae Type 6A and 6B conjugation with CRM197 and introduction of the primary amino groups to the oligosaccharides concurrently.
Native or size reduced polysaccharide of serotype 6A and 6B (≥200-400 KDa) were conjugated using the same procedure as described in Examples 1 and 2.
The oligosaccharides mixture thus obtained as reported in Example 1 are dissolved in WFI, to an end concentration of 10 mg/ml. At the end of the reaction, the Oligosaccharide are purified by diafiltration using 3-10 KDa Centricon filters.
The Oligosaccharides into which the amino groups have been introduced are diluted to a concentration of 10 mg/ml in an aqueous solution of DMSO (at 20-30% v/v) to DMSO containing ADH short linker or long spacer arm linkers in molar excess relatively to the amino groups introduced into the oligosaccharide (usually 5-10:1). The reaction was carried out by keeping the solutions at RT for a time of 4-12 hours. At the end of the period, oligosaccharide was again purified using 3-10 KDa Centricon filters.
Two separate aliquots of same or differently size reduced and derivatized size reduced Polysaccharides (with short spacer arm ADH and Long spacer arm HZ-PEG-HZ) as synthesized in example 3 (10 mg/ml) were mixed with 1 ml aliquot of the CRM197 protein sample (10 mg/ml) at 4° C. for 8-12 hrs. The conjugates containing both long and short chain linkers were purified using 100-300 KDa centricon filters (EMD Millipore). Each monovalent conjugates were assayed for total polysaccharide content by either anthrone or uronic acid assay, total protein content by BCA or Lowry assay (Table 4).
All other cross-reactive Polysaccharide conjugates are made using the same procedure as above.
Pneumo Polysaccharide-CRM197 conjugates for serotypes containing 1, 3, 5, 7F, 14, 15B, 18C, 22F, 23F, 33F, 35B and cross-reactive polysaccharide conjugates 6A, 6B, 9V, 9N, 15A, 15B, 19A, and 19F were combined to yield final antigen concentration of 4.0 μg PS/mL. Sodium chloride (150 mM) solution, 10-20 mM Histidine, Succinic acid and 0.001% Tween-20 was also used during the formulation process as diluent, and aluminum phosphate (Adju-Phos, Brenntag, USA) was used as investigational adjuvant. 16-V conjugate was aseptically filled in 2 mL sterile vials. PNEUMOVAX® (Merck, USA) or PREVNAR-13® (Pfizer, USA) was used as two control commercial vaccine formulation.
A New Zealand white rabbit model (NZW) was selected in this work to compare the immunogenicity of the Pneumo PS-CRM197 conjugates. Rabbits from all groups (16-V {valent}, PREVNAR-13®, and PNEUMOVAX®) were examined for clinical signs before and after immunization periods. For all groups, pre-immunization, booster dose (7 and 14-days) and terminal bleed (28 days) were collected and aliquoted and store at minus 80° C. until use. Multiplexed Immunogenicity assay for the determination of Total IgG were performed according to the standard protocol using reference standard serum 007 (CBER, FDA, USA). Reference serum and rabbit serum were diluted and pre-adsorbed for cross-reacting antibodies by treatment with pneumococcal CWPS and either 22F PS or 25 PS. Human monoclonal anti-polysaccharide antibodies (Pamlico Biopharma, USA) were used for total IgG estimation. Bio-Plex 200 (Bio-Rad). Multiplex reader was used as per manufacturer's instructions (see
Serotypes of 6A/6B, 9V/9N, 15A/15B and 19A/19F which are cross-reactive serotypes are used for the synthesis of bi-valent conjugates containing capsular poly saccharides and carrier protein. Bivalent conjugates by definition contain two capsular polysaccharide attached to CRM 197 simultaneously or concurrently.
Activation of the size reduced polysaccharide derived from the capsular polysaccharide of S. Pneumoniae Type 6A and 6B, conjugation with CRM197 and introduction of the primary amino or hydrazide groups to the oligosaccharides carried out concurrently.
Native polysaccharides or size reduced oligosaccharide of serotype 6A and 6B (≥200-500 KDa) were conjugated using the same procedure as described in Example 1-4.
The size reduced polysaccharides mixtures thus obtained were dissolved in water for injection, so that the final concentration was 10 mg/ml. The size reduced polysaccharides into which the amino or hydrazide groups were introduced were diluted to a concentration of 10 mg/ml in an aqueous solution of dimethyl sulfoxide (DMSO) so the percentage of DMSO was in the range of 20-30% (v/v). This was added to DMSO containing short chain linker such as ADH or long chain linkers as described in Table 2 in molar excess relatively to the amino/hydrazide groups introduced into the size reduced polysaccharides (usually 5:1 or 10:1), more specifically 8:1.
The reaction was carried out at room temperature for a duration of 4-12 hours. At the end of the reaction period, the reaction product was again purified using 3-10 KDa Centricon filters.
The aqueous solution containing 15 mg/ml of CRM197, was added to DMSO containing the linker attached oligosaccharide (20-30% in water) derived from the capsular polysaccharide of S. pneumoniae Type 6A. The ratio of linker attached oligosaccharide to CRM197 was selected from 1:1, 2:1, 1:2. The mixture so obtained was kept, under mild stirring, at room temperature for 8-12 hrs. At the end of said time, the solution containing the derivatized oligosaccharide derived from the capsular polysaccharide of S. Pneumoniae 6B was added. The molar ratio of capsular polysaccharide of S. Pneumoniae 6B to the CRM197, was selected from 1:1, 2:1, 1:2). The resulting mixture was kept for 8-12 hrs at room temperature (Table 5). The conjugation reaction can also be carried out by adding, at the same time (concurrently), to the CRM197-containing solution, the two-activated oligosaccharide respectively derived from the capsular polysaccharide of S. pneumoniae Type 6A and from the capsular polysaccharide of S. pneumoniae Type 6B. The oligosaccharide-protein conjugates so obtained were dialyzed using 100-300 KDa dialysis membrane (Spectrum lab, USA), conditioned in 0.01 M phosphate buffer containing 0.2M NaCl (pH=6.6-7.0) and finally filtered through a 0.22 μm filter.
All other cross-reactive Polysaccharide conjugates were made using the same procedure as used above. Reaction sequences are depicted in
Pneumococcal Polysaccharide-CRM197 conjugates for serotypes containing 1, 3, 5, 7F, 14, 18C, 22F, 23F, 33F, 35B (10 serotypes Polysaccharides) and cross-reactive polysaccharide conjugates of (6A, 6B), (9V, 9N), (15A, 15B) and (19A, 19F) (8 serotypes) were combined to yield final polysaccharide concentration of 2.2-4.4 μg PS/mL (1.1-2.2 μg/human dose, 0.5 mL). Sodium chloride (150 mM) solution, 10-20 mM histidine, 20 mM HEPES or MOPS buffer and 0.001% Tween-20 was also used during the formulation process as diluent, and aluminum phosphate (Adju-Phos, Brenntag, USA) was used as investigational adjuvant.
18-valent or higher valent (>20V-24V) conjugate was aseptically filled in 2 mL sterile vials. PNEUMOVAX® (Merck, USA) and/or PREVNAR-13® (Pfizer, USA) were used as controls.
A New Zealand white rabbit model (NZW) was selected in this work to compare the immunogenicity of the Pneumococcal PS-CRM197 conjugates. Rabbits from all groups (18 or higher-Valent conjugates, PREVNAR-13®, Pfizer and PNEUMOVAX®-23 (Merck USA) were examined for serological titers before and after immunization periods. For all groups, pre-immunization, booster dose (7 and 14-days) and terminal bleed (28 days) were collected and aliquoted and store at −80° C. until use. Immunogenicity assay for the determination of Total IgG were performed according to the standard protocol using reference standard serum 007 (CBER, FDA, USA). Reference serum and Rabbit serum were diluted and pre-adsorbed for cross-reacting antibodies by treatment with Pneumococcal CWPS and non-vaccine serotype 25 PS. Human/rabbit/mouse monoclonal anti-polysaccharide antibodies were used for total IgG estimation. Bio-Plex 200 (Bio-Rad) reader were used as per the manufacturer's instructions.
Immunogenicity of the conjugates, i.e. capsular polysaccharide specific antibodies (total IgG) were measured using bead-based ELISA assay method were given in Table 6. Total IgG values were compared head to head with PREVNAR-13® in rabbit immunogenicity data. 14-day data shows significant increase in titer in IVT-18V-1 vaccine compared to PREVNAR-13® vaccine. Similarly, IVT-18V-1 data has significant booster on IgG values as compared to PREVNAR-13® (Table 6).
7F
7F
Immunogenicity of the conjugates, capsular polysaccharide specific antibodies (total IgG) were measured using bead-based ELISA assay method were given in Table 7. Total IgG values were compared head to head with PREVNAR-13® in rabbit immunogenicity data. 14-day data shows significant increase in titer in IVT-18V-2 vaccine compared to PREVNAR-13® vaccine. Interestingly, IVT-18V-2 total IgG data for bivalent conjugates serotypes (for example. 6A/6B, 9V/9N, 15A/15B, and 19A/19F) has significant booster on IgG values as compared to IVT-18V-1 formulation with monovalent conjugates. Therefore, it can be concluded that Bivalent conjugates has better immunogenicity in comparison to monovalent conjugates (Table 7). Therefore, IVT-18V-2 conjugate vaccine formulation has superior immunogenicity not only against PREVNAR-13® but also against IVT-18V-1 formulation. Polysaccharide conjugated with either 1-3.5K linker (HZ-PEG-HZ) elicits much higher immunogenicity in compared to short linker (ADH) or no linker conjugates as in PREVNAR-13®.
7F
Immunogenicity of the conjugates, i.e. capsular polysaccharide specific antibodies (total IgG) were measured using Multiplex bead-based ELISA assay method were given in Table 8. Total IgG values were compared head to head with PREVNAR-13® in rabbit immunogenicity data. 14-day data shows significant increase in titer in IVT-18V-3 vaccine compared to PREVNAR-13® vaccine. Interestingly, IVT-18V-3 formulations with lower dose (2.2 vs 1.1 ug dose), total IgG data for bivalent conjugates serotypes (for example. 6A/6B, 9V/9N, 15A/15B, and 19A/19F) has comparable IgG values as compared to IVT-18V-2 formulations for bivalent conjugate serotypes. Therefore, it can be concluded that bivalent conjugates has better immunogenicity in comparison to monovalent conjugates with lower dose. Therefore, IVT-18V-2 conjugate vaccine formulation has superior immunogenicity not only against PREVNAR-13® but also against IVT-18V-1 formulation. Polysaccharide conjugated with either 1-3.5K linker (HZ-PEG-HZ) elicits much higher immunogenicity in compared to short linker (ADH) or no linker conjugates as in PREVNAR-13® (Table 8).
7F
Other embodiments and uses of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. All references cited herein, including all publications, U.S. and foreign patents and patent applications, are specifically and entirely incorporated by reference. It is intended that the specification and examples be considered exemplary only with the true scope and spirit of the invention indicated by the following claims. Furthermore, the term “comprising of” includes the terms “consisting of” and “consisting essentially of.”
This application claims priority to U.S. Provisional Application No. 62/517,905 filed Jun. 10, 2017, the entirety of which is specifically incorporated by reference.
Number | Name | Date | Kind |
---|---|---|---|
4673574 | Anderson | Jun 1987 | A |
4686102 | Ritchey et al. | Aug 1987 | A |
4902506 | Anderson et al. | Feb 1990 | A |
5360897 | Anderson et al. | Nov 1994 | A |
5371197 | Marburg et al. | Dec 1994 | A |
5565204 | Kuo et al. | Oct 1996 | A |
5623057 | Marburg et al. | Apr 1997 | A |
5681570 | Yank et al. | Oct 1997 | A |
5807553 | Malcolm | Sep 1998 | A |
5847112 | Kniskern et al. | Dec 1998 | A |
5849301 | Lees | Dec 1998 | A |
5866132 | Malcolm | Feb 1999 | A |
5965714 | Ryall | Oct 1999 | A |
6132723 | Malcolm | Oct 2000 | A |
6177085 | Yank et al. | Jan 2001 | B1 |
6224880 | Chan et al. | May 2001 | B1 |
6656472 | Chong et al. | Dec 2003 | B1 |
6863893 | Wizemann et al. | Mar 2005 | B2 |
7018637 | Chong et al. | Mar 2006 | B2 |
7435421 | Wizemann et al. | Oct 2008 | B2 |
7501132 | Ades et al. | Mar 2009 | B2 |
7524821 | Wang et al. | Apr 2009 | B2 |
7709001 | Hausdorff et al. | May 2010 | B2 |
7862823 | Leroy | Jan 2011 | B1 |
7955605 | Prasad | Jun 2011 | B2 |
8007807 | Borkowski | Aug 2011 | B2 |
8029798 | Leroy | Oct 2011 | B2 |
8048432 | Lee et al. | Nov 2011 | B2 |
8173135 | Lee | May 2012 | B2 |
8226959 | Gibson et al. | Jul 2012 | B2 |
8246964 | Beninati et al. | Aug 2012 | B2 |
8361477 | Borkowski | Jan 2013 | B2 |
8444992 | Borkowski | May 2013 | B2 |
8465749 | Lee et al. | Jun 2013 | B2 |
8481054 | Nahm et al. | Jul 2013 | B2 |
8557250 | Lee | Oct 2013 | B2 |
8575319 | Timmerman | Nov 2013 | B2 |
8603484 | Prasad | Dec 2013 | B2 |
8642048 | Ades et al. | Feb 2014 | B2 |
8652480 | Yuan et al. | Feb 2014 | B2 |
8703148 | Biemans et al. | Apr 2014 | B2 |
8753649 | Lee et al. | Jun 2014 | B2 |
8784826 | Borkowski | Jul 2014 | B2 |
8795689 | Crinean | Aug 2014 | B2 |
8808707 | Siber et al. | Aug 2014 | B1 |
8808708 | Hausdorff et al. | Aug 2014 | B2 |
8815254 | Biemans et al. | Aug 2014 | B2 |
8895024 | Hausdorff et al. | Nov 2014 | B2 |
8933218 | Biemans et al. | Jan 2015 | B2 |
8999697 | Yuan et al. | Apr 2015 | B2 |
9095567 | Khandke et al. | Aug 2015 | B2 |
9107872 | Biemans et al. | Aug 2015 | B2 |
9173931 | Jessouroun et al. | Nov 2015 | B2 |
9175033 | Lee | Nov 2015 | B2 |
9198976 | Lee et al. | Dec 2015 | B2 |
9205143 | Davis et al. | Dec 2015 | B2 |
9399060 | Hausdorff et al. | Jul 2016 | B2 |
9474795 | Lee et al. | Oct 2016 | B2 |
9475804 | Wightman | Oct 2016 | B2 |
9480736 | Hausdorff et al. | Nov 2016 | B2 |
9492559 | Emini et al. | Nov 2016 | B2 |
9499593 | Malley et al. | Nov 2016 | B2 |
9517274 | Gu et al. | Dec 2016 | B2 |
9610339 | Biemans et al. | Apr 2017 | B2 |
9610340 | Biemans et al. | Apr 2017 | B2 |
9669084 | Siber et al. | Jun 2017 | B2 |
9675681 | Yuan et al. | Jun 2017 | B2 |
9778266 | Nahm et al. | Oct 2017 | B2 |
9884113 | Biemans et al. | Feb 2018 | B2 |
9902724 | Wightman | Feb 2018 | B2 |
9950054 | Gu et al. | Apr 2018 | B2 |
9981035 | Hausdorff et al. | May 2018 | B2 |
9981045 | Prasad | May 2018 | B2 |
20010048929 | Chong et al. | Dec 2001 | A1 |
20020094338 | Jonsdottir | Jul 2002 | A1 |
20030099672 | Schultz | May 2003 | A1 |
20030138447 | Wizemann et al. | Jul 2003 | A1 |
20030147922 | Capiau et al. | Aug 2003 | A1 |
20050118199 | Esser et al. | Jun 2005 | A1 |
20050142145 | Wizemann et al. | Jun 2005 | A1 |
20050159341 | Wang et al. | Jul 2005 | A1 |
20050214329 | Laferriere et al. | Sep 2005 | A1 |
20050226891 | Ades et al. | Oct 2005 | A1 |
20060051361 | Laferriere et al. | Mar 2006 | A1 |
20060093626 | Capiau et al. | May 2006 | A1 |
20060140981 | Jonsdottir | Jun 2006 | A1 |
20060228380 | Hausdorff et al. | Oct 2006 | A1 |
20070110762 | Jessouroun et al. | May 2007 | A1 |
20070141084 | Lee et al. | Jun 2007 | A1 |
20070184071 | Hausdorff et al. | Aug 2007 | A1 |
20070184072 | Hausdorff et al. | Aug 2007 | A1 |
20070231340 | Hausdorff et al. | Oct 2007 | A1 |
20070253985 | Look et al. | Nov 2007 | A1 |
20080260773 | Del Giudice | Oct 2008 | A1 |
20080286838 | Yuan et al. | Nov 2008 | A1 |
20090017060 | Timmerman | Jan 2009 | A1 |
20090092632 | Lee | Apr 2009 | A1 |
20090130137 | Hausdorff et al. | May 2009 | A1 |
20090136548 | Ades et al. | May 2009 | A1 |
20090317412 | Alexander | Dec 2009 | A1 |
20100034847 | Borkowski | Feb 2010 | A1 |
20100074922 | Biemans et al. | Mar 2010 | A1 |
20100143414 | Nahm et al. | Jun 2010 | A1 |
20100158953 | Crinean | Jun 2010 | A1 |
20100183662 | Biemans et al. | Jul 2010 | A1 |
20100209450 | Biemans et al. | Aug 2010 | A1 |
20100239604 | Biemans et al. | Sep 2010 | A1 |
20100303852 | Biemans et al. | Dec 2010 | A1 |
20100316666 | Hausdorff et al. | Dec 2010 | A1 |
20100322959 | Biemans et al. | Dec 2010 | A1 |
20110071279 | Hausdorff et al. | Mar 2011 | A1 |
20110076301 | Beninati et al. | Mar 2011 | A1 |
20110091506 | Gibson et al. | Apr 2011 | A1 |
20110117123 | Leroy | May 2011 | A1 |
20110159030 | O'Hagan | Jun 2011 | A1 |
20110195086 | Caulfield | Aug 2011 | A1 |
20110201791 | Prasad | Aug 2011 | A1 |
20110311574 | Borkowski | Dec 2011 | A1 |
20120076817 | Lee et al. | Mar 2012 | A1 |
20120135037 | Mizel et al. | May 2012 | A1 |
20120195922 | Lee | Aug 2012 | A1 |
20120231086 | Killen et al. | Sep 2012 | A1 |
20120237542 | Hausdorff et al. | Sep 2012 | A1 |
20120321658 | Biemans et al. | Dec 2012 | A1 |
20130004535 | Borkowski | Jan 2013 | A1 |
20130004536 | Borkowski | Jan 2013 | A1 |
20130072881 | Khandke et al. | Mar 2013 | A1 |
20130315958 | Nahm et al. | Nov 2013 | A1 |
20130337004 | Lee et al. | Dec 2013 | A1 |
20140010843 | Biemans et al. | Jan 2014 | A1 |
20140044748 | Lee | Feb 2014 | A1 |
20140099337 | Davis et al. | Apr 2014 | A1 |
20140154286 | Malley et al. | Jun 2014 | A1 |
20140227317 | Wightman | Aug 2014 | A1 |
20140314805 | Hausdorff et al. | Oct 2014 | A1 |
20140322258 | Lee et al. | Oct 2014 | A1 |
20140322263 | Siber et al. | Oct 2014 | A1 |
20140348868 | Donati et al. | Nov 2014 | A1 |
20140363463 | Yuan et al. | Dec 2014 | A1 |
20150038685 | Hausdorff et al. | Feb 2015 | A1 |
20150079132 | Maisonneuve et al. | Mar 2015 | A1 |
20150165017 | Yuan et al. | Jun 2015 | A1 |
20150202309 | Emini et al. | Jul 2015 | A1 |
20150216996 | Gu et al. | Aug 2015 | A1 |
20150231270 | Prasad | Aug 2015 | A1 |
20150265702 | Biemans et al. | Sep 2015 | A1 |
20150328328 | Han et al. | Nov 2015 | A1 |
20150344530 | Kapre | Dec 2015 | A1 |
20160136256 | Lee et al. | May 2016 | A1 |
20160158345 | Hausdorff et al. | Jun 2016 | A1 |
20160324948 | Gu et al. | Nov 2016 | A1 |
20160324949 | Han et al. | Nov 2016 | A1 |
20170021006 | Watson et al. | Jan 2017 | A1 |
20170021008 | Drew | Jan 2017 | A1 |
20170037045 | Wightman | Feb 2017 | A1 |
20170143821 | Porro | May 2017 | A1 |
20170224804 | Gu et al. | Aug 2017 | A1 |
20170246313 | Gill et al. | Aug 2017 | A1 |
20170252423 | Siber et al. | Sep 2017 | A1 |
20180136224 | Nahm et al. | May 2018 | A1 |
20180186792 | Wightman | Jul 2018 | A1 |
20180221467 | Gu et al. | Aug 2018 | A1 |
20180250390 | Hausdorff et al. | Sep 2018 | A1 |
20180256739 | Prasad | Sep 2018 | A1 |
20180353591 | Kapre et al. | Dec 2018 | A1 |
20190000953 | Gu et al. | Jan 2019 | A1 |
Entry |
---|
Song et al. 2011 (Comparison of Casular Genes of Streptococcus pneumoniae Serotype 6A, 6B, 6C, and 6D isolates; Journal of Clinical Microbiology; 49(5):1758-1764) (Year: 2011). |
Henrichsen 1995 (Six Newly Recognized Types of Streptococcus pneumoniae Journal of Clinical Microbiology 33(10:2759-2762) (Year: 1995). |
International Search Report and Preliminary Opinion for Application No. PCT/US2018/36868 dated Oct. 25, 2018. |
Number | Date | Country | |
---|---|---|---|
20180353591 A1 | Dec 2018 | US |
Number | Date | Country | |
---|---|---|---|
62517905 | Jun 2017 | US |