Nouvelles perspectives en
vaccinologie
AAEIP, Université Paris Sud, 31 Mars 2014
Claude Leclerc
DEVELOPPEMENT of HUMAN VACCINES 	

Live attenuated	

vaccines	

Genetically 	

engieneered	

Purified protein	

or polysaccharide	

Killed vaccines	

Smallpox, 1798	

	

	

Rabies, 1885	

	

	

	

BCG, 1927	

	

Yellow fever, 1935	

	

	

Polio (oral)	

Measles	

Mumps	

Rubella	

Adenovirus	

Typhoid (Ty21a)	

Varicella	

Rotavirus	

	

	

	

	

	

	

	

Diphteria, 1923	

Tetanus, 1927	

	

	

	

Pneumococcus	

Meningococcus	

Haemophilus influenzae PRP	

Hepatitis B (plasma derived)	

Tick-birne encephalitis	

H. influenzae PRP conjugate	

Typhoid (Vi)	

Acellular pertussis	

	

 	

	

	

	

 	

	

Typhoid 1896	

Cholera, 1896	

Plague, 1897	

	

 	

	

Pertussis, 1926 (killed bacteria)	

Influenza, 1936	

Rickettsia, 1938	

	

	

	

	

Polio (injected)	

Rabies (new)	

Japanese Encephalitis	

Hepatitis A	

	

	

	

	

	

	

	

	

	

	

	

	

	

Hepatitis B (recombinant)	

Human Papilloma virus	

Rotavirus	

	

18th Century	

19th Century	

Early 20th Century	

After World War II (cellular culture)
Vaccines have been made
for 36 of >400 human
pathogens	

Immunological Bioinformatics, The MIT press.	

+HPV & Rotavirus
The different types of vaccines
Attenuated
Vaccines
Killed
Vaccines
Acellular sub-
unit vaccines
Pertussis	

Diphteria	

Hepatitis B	

Tetanus	

Cholera	

Pertussis	

Hepatitis A	

Polio	

Polio	

Yellow fever	

BCG
New and improved technologies and resulting
vaccines
R Rappuoli, CW. Mandl, S Black & E De Gregorio
Nature Reviews Immunology Published online 4 November 2011
New and improved technologies and resulting
vaccines
R Rappuoli, CW. Mandl, S Black & E De Gregorio
Nature Reviews Immunology Published online 4 November 2011
New and improved technologies and resulting
vaccines
R Rappuoli, CW. Mandl, S Black & E De Gregorio
Nature Reviews Immunology Published online 4 November 2011
New and improved technologies and resulting
vaccines
R Rappuoli, CW. Mandl, S Black & E De Gregorio
Nature Reviews Immunology Published online 4 November 2011
New and improved technologies and resulting
vaccines
R Rappuoli, CW. Mandl, S Black & E De Gregorio
Nature Reviews Immunology Published online 4 November 2011
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
Dengue epidemiology
Nature Reviews Microbiology 2010
Dengue vaccines under development
Dengue vaccines under development
Sanofi Pasteur dengue vaccine enters phase III
clinical study in October 2010
The yellow fever 17D virus as a platform for new
live attenuated vaccines
Worldwide map of phase II/III dengue clinical trials, and major results
obtained so far in humans
Guy et al, Vaccine, 2011, 7229-7241
Lancet, Published Online, September 11, 2012
Serotype-specific and overall efficacy of CYD tetravalent dengue vaccine against
virologically confirmed dengue disease
Reverse cumulative distribution of serotype-specific PRNT 50 antibody titres curves for DENV
serotypes 1–4 by baseline FV-serostatus, pre-vaccination and after two and three doses of CYD-TDV
(Full Analysis Set).
Vaccine, Volume 31, 2013, 5814 - 5821
sReuters, March 25, 2014
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
Schematic representation of the CSP and the RTS,S
vaccine
P D. Crompton, SK. Pierce, L H. Miller J Clin Invest. 2010
Malaria cuts risk in half in late-stage trial
H Waters Nature Medicine Nov 2011
N Eng J Med 2012
Malaria cuts risk in half in late-stage trial
H Waters Nature Medicine Nov 2011
31%
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
How to discover protective
antigens?
Identification of new target antigens: impact of genomics	

Whole genome sequences of most bacterial pathogens and 	

parasites completed	

E. coli K-12 	

B. burgdorferi 	

B. subtilis 	

M. tuberculosis 	

R. prowazekii	

H. influenzae 	

C. pneumoniae 	

C. trachomatis 	

N. gonorrhoeae 	

S. aureus	

H. pylori 	

P. horikoshü 	

E. faecalis 	

N. meningitidis 	

S. epidermitis	

M. genitalium 	

S. pneumoniae 	

L. pneumophila 	

P. falciparum 	

S. pyogenes	

M. pneumoniae 	

T. pallidum 	

L. major 	

P. aeruginosa 	

T. cruzi	

	

 	

M. leprae 	

P. aerophilum 	

V. cholerae
Genomic-based vaccine development	

Whole genomic sequence	

Computer prediction	

Expression of recombinant proteins	

DNA preparation	

In silico vaccine candidates	

Immunogenicity testing in animal models	

Vaccine development
600 potential vaccine candidates
identified
350 proteins successfully expressed
in E.coli
344 proteins purified and used
to immunize mice
355 sera tested
91 novel surface-exposed
proteins identified
28 novel proteins
have bactericidal
activity
Meningoccocal B Vaccine: A Genomic Approach
5 vaccine candidates Rappuoli et al, 2002	

Clinical trials
2000	

 2013
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
Front Immunol 2014	

Structural vaccinology
A new computational method to design epitope-focused
vaccines, illustrated with a neutralization epitope from RSV
	
  Nature 507, 201–206 (13 March 2014)
Nature 507, 201–206 (13 March 2014)
Induction of neutralizating antibodies against RSV
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
Overview of the problems and methodologies of systems vaccinology	

Seminars in Immunology, 2013, 209 - 218
R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature
Reviews Immunology Published online 4 November
2011
Alum adjuvants are non-cystalline gels based on aluminum oxyhydroxide (referred
to as Aluminum hydroxide gel), aluminum hydroxyphosphate (referred to as
aluminum phosphate gel) or various proprietary salts such as aluminum hydroxy-
sulfate)
Alum is used in several licensed vaccines including:
•  diphtheria-pertusis-tetanus
•  diphtheria-tetanus (DT)
•  DT combined with Hepatitis B (HBV)
•  Haemophilus influenza B
•  inactivated polio virus
•  Hepatitis A (HAV)
•  Streptoccucus pneumonia
•  Menngococccal
•  Human papilloma virus (HPV)
Vaccines containing Alum Adjuvant
Dendritic cells initiate antigen-specific immune
responses	

•  most efficient of all APCs	

•  high MHC class I, II & costimulators	

•  efficient cross presentation	

•  stimulate naïve T cells (CD4, CD8) 	

All immunization strategies must target DCs	

Initiate Ag-specific immune responses
Multiple inducers of DC maturation	

Immature DC	

 Mature DC	

various T cell
responses	

Microbial products / TLR ligands	

Viral products	

Inflammatory cytokines	

Signaling receptors
Antigen-presenting cells serve as the bridge between
innate and antigen-specific responses	

2003, 2, 727-735
Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Nov 2011
Vaccine adjuvants
Innate immune responses
Innate Lymphoid Cells (ILC)
T cell differentiation pathways
Coomes S M et al. Open Biol. 2013;3:120157
©2013 by The Royal Society
Therapeutic vaccines	

for chronic infections or cancers
Cancer, a worldwide burden
 1st cause of mortality in France
 In Europ, in 2012:
- 1.75 million deaths from cancer
-  3.45 million new cases of cancer
 In the world, in 2012:
- 8.2 millions deaths
- 14 million new cases diagnosed
Cancer, a cell disease
uncontrolled proliferation
Tumor
Surgery
ChimiotherapyRadiotherapy
Anti-angiogenic
drugs
Immune responses can control the growth of tumor
cells
The immunosurveillance theory
“It is by no means inconceivable that small
accumulations of tumour cells may develop
and because of their possession of new
antigenic potentialities provoke an effective
immunological reaction, with regression of
the tumor and no clinical hint of its existence”
British Med Journal, April 1957Burnet
Tumor specific/associated antigens
Overexpressed self
antigens
Differentiation antigens
Mutated self antigens
Non self
oncoviral antigens
Altered self antigens:
Abnormal post-
translational/
transcriptional
modification:
underglycosylation
The concept of therapeutic anti-cancer vaccines
	

  Induction of specific immune responses
against tumor specific/associated antigens to
kill tumor cells or prevent their growth
without affecting normal cells
Tumor vaccines
- Whole tumor cells: + BCG or DETOX, e.g. Melacine vaccine (cell lysates), CancerVax
( irradiated melanoma cell lines), M-Vax (hapten-treated autologous cells) and gene-
modified, irradiated tumor cells (GM-CSF)	

	

- Tumor antigens: MAGE-1, MAGE-3, MART-1/Melan-A, tyrosinase, gp100, MUC-1,
CEA, etc. 	

	

- Peptide vaccines: mutated ras, mutated p53, Her-2/neu, MART -1, gp100, MUC-1	

	

- Heat shock proteins	

	

- DNA vaccines 	

	

- Dendritic cell vaccines
Response rate = 3. 8%
Current human cancer vaccines show very low objective clinical response rate
Rosenberg, Yang & Restifo
Nature Med 10:909 (2004)
Response rate = 3. 8%
Current human cancer vaccines show very low objective clinical response rate	

Rosenberg, Yang & Restifo
Nature Med (2004)
Benefit of passive immunotherapy
(antibodies)
in cancer patients
Lack of efficacy of most
current therapeutic cancer vaccines
Problems
Tumor derived antigens are weakly
immunogenic
Need for better adjuvants 	

or immunisation strategies
Dendritic cells initiate antigen-specific
immune responses
•  most efficient of all antigen-presenting cells	

•  stimulate naïve T cells (CD4, CD8)	

	

All immunization strategies must target DCs
An Approach to Initiating Immunity to Cancer:
Dendritic Cells Loaded with Tumor Antigens ex vivo
DC precursors
expanded
immature DCs
add
disease-
related
antigens
maturing DCs
presenting antigen(s)
Tumor-
specific
T cells
responding
to
dendritic
cells
2010: FDA panel passes first cancer vaccine
Original Article
Sipuleucel-T Immunotherapy for Castration-
Resistant Prostate Cancer
Philip W. Kantoff, M.D., Celestia S. Higano, M.D., Neal D. Shore, M.D., E. Roy
Berger, M.D., Eric J. Small, M.D., David F. Penson, M.D., Charles H. Redfern, M.D.,
Anna C. Ferrari, M.D., Robert Dreicer, M.D., Robert B. Sims, M.D., Yi Xu, Ph.D., Mark
W. Frohlich, M.D., Paul F. Schellhammer, M.D., for the IMPACT Study Investigators
N Engl J Med
Volume 363(5):411-422
July 29, 2010
Source: www.provenge.com/
Provenge clinical trials : prostate cancer
Source: www.provenge.com/
Provenge clinical trials : prostate cancer
Cancer vaccine pipeline
Problems
Tumor derived antigens are weakly
immunogenic
Need for better adjuvants 	

or immunisation strategies
CD8+
T cell
CD4+
T cell
Dendritic cell	

Induction of optimized T cell responses	

by in vivo dendritic cells targeting
Antigen	

targeting	

Maturation signals	

2	

1	

 Adjuvant
CyaA: a new proteinic vector targeted to dendritic cells
Bordetella pertussis
Dermonecrotic Toxin
BrkA
FHA
TCF
FIM
TCT
Pertussis Toxin
cAMP
Pertactin
Adenylate cyclase
Toxin
Dendritic
Cell
CD11b/CD18
AC
domain
RTX
domain
1 400 1706
Internalization
Endosomes
Cytosol
CyaA binds to CD11b
allowing efficient targeting
to dendritic cells
Guermonprez et al, J. Exp. Med, 2001
Adenylate cyclase (CyaA)
Recombinant CyaA	

+	

Activation of CD8+	

Cytotoxic T lymphocytes	

Dendritic Cell	

ϕ	

CD11b/CD18	

Antigen	

Th	

CD4+	

MHC-II	

endosomes	

lysosomes	

ϕ	

ϕ
MHC class II presentation	

Activation of CD4+	

Helper T lymphocytes	

MHC class I presentation 	

Endoplasmic	

Reticulum	

CTL	

CD8+	

MHC-I/β2	

ϕ	

Translocation	

 Endocytosis	

Antigens grafted in CyaA are delivered to both MHC class I & MHC
class II presentation pathways
Immunisation in mice and non-human primates by
recombinant CyaA carrying a variety of antigens (such as
from M. tuberculosis or HIV) stimulates strong CTL and Th1
responses, even in the absence of adjuvant.
Préville et al, Cancer Res, 2005, Mascarell et al, J. Virol 2005, Majlessi et al, Inf Immun,
2005, Hervas-Stubb et al, Inf Immun, 2006, Mascarell et al, Vaccine 2006, Berraondo et al,
Cancer Res, 2007, Fayolle et al, Vaccine 2010.	

CyaA: a new proteinic vector targeted to
dendritic cells
80
HPV infection life cycle
Few months to few years Up to 20 years
Goodman A., Wilbur D. C.
Human papilloma virus
- The HPV E6 and E7 oncoproteins are expressed 	

 	

	

throughout the replicative cycle of the virus and are 	

 	

	

necessary for the onset and maintenance of malignant 	

	

transformation.
	

- HPV E6 and E7 antigens are potential targets for specific
	

immunotherapy. 	

Rational
MHGDTPTLHEYMLDLQPETTDLYCYEQLN
CyaAE5
GQAEPDRAHYNIVTFCCKCDSTLRLCVQSTHVDIRTLEDLLMGTLGIVCPICSQKP
CyaA-E7∆30-42
Catalytic domain
224 235
319 320
1 400 1706
LQ
LQ
Recombinant CyaA carrying E7 from HPV16
GMP batch produced in recombinant E. coli
Therapeutic vaccination with recombinant
HPV16-E7 CyaAs eradicates established tumors
No treatment	

 CyaA-OVA	

0	

500	

1000	

1500	

2000	

0	

10	

5/5 	

 10/10 	

0/10 	

20	

30	

40	

50	

60	

70	

80	

90	

0	

500	

1000	

1500	

2000	

CyaA-HPV16E7∆30-42	

- Graft of TC-1 cells at day 0	

- At day 10, one injection of:	

- 50 µg of CyaA-E7 or 	

of control CyaA-OVA	

Preville et al, Cancer Res. 2005; Berraondo, K. et al. Cancer Res. 2007
A therapeutic vaccine candidate against HPV chronic infection
and/or cervical cancer
Clinical trials started in 2010
0 102030405060708090
0
500
1000
1500
2000
0 102030405060708090
0
500
1000
1500
2000
0 102030405060708090100
0
20
40
60
80
100
0 5 10 15 20 25 30 35
0.0
0.2
10
20
daysdays days
CyaAE5 HPV16E7∆30-42CyaAE5 CysOVA
Controls
One injection at
Day 10
CyaAE5 HPV16E7∆30-42
Préville et al, Cancer Res, 2005
http://www.genticel.com	

ProCervix - Phase 2 Clinical Trial
Merci de votre attention !
claude.leclerc@pasteur.fr

Noi principii in vaccinare C Leclerc 2014

  • 1.
    Nouvelles perspectives en vaccinologie AAEIP,Université Paris Sud, 31 Mars 2014 Claude Leclerc
  • 2.
    DEVELOPPEMENT of HUMANVACCINES Live attenuated vaccines Genetically engieneered Purified protein or polysaccharide Killed vaccines Smallpox, 1798 Rabies, 1885 BCG, 1927 Yellow fever, 1935 Polio (oral) Measles Mumps Rubella Adenovirus Typhoid (Ty21a) Varicella Rotavirus Diphteria, 1923 Tetanus, 1927 Pneumococcus Meningococcus Haemophilus influenzae PRP Hepatitis B (plasma derived) Tick-birne encephalitis H. influenzae PRP conjugate Typhoid (Vi) Acellular pertussis Typhoid 1896 Cholera, 1896 Plague, 1897 Pertussis, 1926 (killed bacteria) Influenza, 1936 Rickettsia, 1938 Polio (injected) Rabies (new) Japanese Encephalitis Hepatitis A Hepatitis B (recombinant) Human Papilloma virus Rotavirus 18th Century 19th Century Early 20th Century After World War II (cellular culture)
  • 3.
    Vaccines have beenmade for 36 of >400 human pathogens Immunological Bioinformatics, The MIT press. +HPV & Rotavirus
  • 4.
    The different typesof vaccines Attenuated Vaccines Killed Vaccines Acellular sub- unit vaccines Pertussis Diphteria Hepatitis B Tetanus Cholera Pertussis Hepatitis A Polio Polio Yellow fever BCG
  • 5.
    New and improvedtechnologies and resulting vaccines R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 6.
    New and improvedtechnologies and resulting vaccines R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 7.
    New and improvedtechnologies and resulting vaccines R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 8.
    New and improvedtechnologies and resulting vaccines R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 9.
    New and improvedtechnologies and resulting vaccines R Rappuoli, CW. Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 10.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 11.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 12.
  • 13.
    Nature Reviews Microbiology2010 Dengue vaccines under development
  • 14.
    Dengue vaccines underdevelopment Sanofi Pasteur dengue vaccine enters phase III clinical study in October 2010
  • 15.
    The yellow fever17D virus as a platform for new live attenuated vaccines
  • 17.
    Worldwide map ofphase II/III dengue clinical trials, and major results obtained so far in humans Guy et al, Vaccine, 2011, 7229-7241
  • 18.
    Lancet, Published Online,September 11, 2012
  • 19.
    Serotype-specific and overallefficacy of CYD tetravalent dengue vaccine against virologically confirmed dengue disease
  • 21.
    Reverse cumulative distributionof serotype-specific PRNT 50 antibody titres curves for DENV serotypes 1–4 by baseline FV-serostatus, pre-vaccination and after two and three doses of CYD-TDV (Full Analysis Set). Vaccine, Volume 31, 2013, 5814 - 5821
  • 22.
  • 23.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 24.
    Schematic representation ofthe CSP and the RTS,S vaccine P D. Crompton, SK. Pierce, L H. Miller J Clin Invest. 2010
  • 26.
    Malaria cuts riskin half in late-stage trial H Waters Nature Medicine Nov 2011
  • 27.
    N Eng JMed 2012
  • 28.
    Malaria cuts riskin half in late-stage trial H Waters Nature Medicine Nov 2011 31%
  • 31.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 32.
    How to discoverprotective antigens?
  • 33.
    Identification of newtarget antigens: impact of genomics Whole genome sequences of most bacterial pathogens and parasites completed E. coli K-12 B. burgdorferi B. subtilis M. tuberculosis R. prowazekii H. influenzae C. pneumoniae C. trachomatis N. gonorrhoeae S. aureus H. pylori P. horikoshü E. faecalis N. meningitidis S. epidermitis M. genitalium S. pneumoniae L. pneumophila P. falciparum S. pyogenes M. pneumoniae T. pallidum L. major P. aeruginosa T. cruzi M. leprae P. aerophilum V. cholerae
  • 34.
    Genomic-based vaccine development Wholegenomic sequence Computer prediction Expression of recombinant proteins DNA preparation In silico vaccine candidates Immunogenicity testing in animal models Vaccine development
  • 35.
    600 potential vaccinecandidates identified 350 proteins successfully expressed in E.coli 344 proteins purified and used to immunize mice 355 sera tested 91 novel surface-exposed proteins identified 28 novel proteins have bactericidal activity Meningoccocal B Vaccine: A Genomic Approach 5 vaccine candidates Rappuoli et al, 2002 Clinical trials
  • 37.
  • 38.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 39.
  • 40.
    A new computationalmethod to design epitope-focused vaccines, illustrated with a neutralization epitope from RSV  Nature 507, 201–206 (13 March 2014)
  • 41.
    Nature 507, 201–206(13 March 2014) Induction of neutralizating antibodies against RSV
  • 42.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 43.
    Overview of theproblems and methodologies of systems vaccinology Seminars in Immunology, 2013, 209 - 218
  • 46.
    R Rappuoli, CW.Mandl, S Black & E De Gregorio Nature Reviews Immunology Published online 4 November 2011
  • 47.
    Alum adjuvants arenon-cystalline gels based on aluminum oxyhydroxide (referred to as Aluminum hydroxide gel), aluminum hydroxyphosphate (referred to as aluminum phosphate gel) or various proprietary salts such as aluminum hydroxy- sulfate) Alum is used in several licensed vaccines including: •  diphtheria-pertusis-tetanus •  diphtheria-tetanus (DT) •  DT combined with Hepatitis B (HBV) •  Haemophilus influenza B •  inactivated polio virus •  Hepatitis A (HAV) •  Streptoccucus pneumonia •  Menngococccal •  Human papilloma virus (HPV) Vaccines containing Alum Adjuvant
  • 48.
    Dendritic cells initiateantigen-specific immune responses •  most efficient of all APCs •  high MHC class I, II & costimulators •  efficient cross presentation •  stimulate naïve T cells (CD4, CD8) All immunization strategies must target DCs Initiate Ag-specific immune responses
  • 49.
    Multiple inducers ofDC maturation Immature DC Mature DC various T cell responses Microbial products / TLR ligands Viral products Inflammatory cytokines Signaling receptors
  • 50.
    Antigen-presenting cells serveas the bridge between innate and antigen-specific responses 2003, 2, 727-735
  • 51.
    Rappuoli, CW. Mandl,S Black & E De Gregorio Nature Reviews Immunology Nov 2011 Vaccine adjuvants
  • 52.
  • 53.
  • 54.
    T cell differentiationpathways Coomes S M et al. Open Biol. 2013;3:120157 ©2013 by The Royal Society
  • 55.
    Therapeutic vaccines for chronicinfections or cancers
  • 56.
    Cancer, a worldwideburden  1st cause of mortality in France  In Europ, in 2012: - 1.75 million deaths from cancer -  3.45 million new cases of cancer  In the world, in 2012: - 8.2 millions deaths - 14 million new cases diagnosed
  • 57.
    Cancer, a celldisease uncontrolled proliferation Tumor Surgery ChimiotherapyRadiotherapy Anti-angiogenic drugs
  • 58.
    Immune responses cancontrol the growth of tumor cells The immunosurveillance theory “It is by no means inconceivable that small accumulations of tumour cells may develop and because of their possession of new antigenic potentialities provoke an effective immunological reaction, with regression of the tumor and no clinical hint of its existence” British Med Journal, April 1957Burnet
  • 59.
    Tumor specific/associated antigens Overexpressedself antigens Differentiation antigens Mutated self antigens Non self oncoviral antigens Altered self antigens: Abnormal post- translational/ transcriptional modification: underglycosylation
  • 60.
    The concept oftherapeutic anti-cancer vaccines   Induction of specific immune responses against tumor specific/associated antigens to kill tumor cells or prevent their growth without affecting normal cells
  • 61.
    Tumor vaccines - Wholetumor cells: + BCG or DETOX, e.g. Melacine vaccine (cell lysates), CancerVax ( irradiated melanoma cell lines), M-Vax (hapten-treated autologous cells) and gene- modified, irradiated tumor cells (GM-CSF) - Tumor antigens: MAGE-1, MAGE-3, MART-1/Melan-A, tyrosinase, gp100, MUC-1, CEA, etc. - Peptide vaccines: mutated ras, mutated p53, Her-2/neu, MART -1, gp100, MUC-1 - Heat shock proteins - DNA vaccines - Dendritic cell vaccines
  • 62.
    Response rate =3. 8% Current human cancer vaccines show very low objective clinical response rate Rosenberg, Yang & Restifo Nature Med 10:909 (2004)
  • 63.
    Response rate =3. 8% Current human cancer vaccines show very low objective clinical response rate Rosenberg, Yang & Restifo Nature Med (2004) Benefit of passive immunotherapy (antibodies) in cancer patients Lack of efficacy of most current therapeutic cancer vaccines
  • 64.
    Problems Tumor derived antigensare weakly immunogenic Need for better adjuvants or immunisation strategies
  • 65.
    Dendritic cells initiateantigen-specific immune responses •  most efficient of all antigen-presenting cells •  stimulate naïve T cells (CD4, CD8) All immunization strategies must target DCs
  • 66.
    An Approach toInitiating Immunity to Cancer: Dendritic Cells Loaded with Tumor Antigens ex vivo DC precursors expanded immature DCs add disease- related antigens maturing DCs presenting antigen(s) Tumor- specific T cells responding to dendritic cells
  • 67.
    2010: FDA panelpasses first cancer vaccine
  • 68.
    Original Article Sipuleucel-T Immunotherapyfor Castration- Resistant Prostate Cancer Philip W. Kantoff, M.D., Celestia S. Higano, M.D., Neal D. Shore, M.D., E. Roy Berger, M.D., Eric J. Small, M.D., David F. Penson, M.D., Charles H. Redfern, M.D., Anna C. Ferrari, M.D., Robert Dreicer, M.D., Robert B. Sims, M.D., Yi Xu, Ph.D., Mark W. Frohlich, M.D., Paul F. Schellhammer, M.D., for the IMPACT Study Investigators N Engl J Med Volume 363(5):411-422 July 29, 2010
  • 70.
  • 71.
  • 72.
  • 75.
    Problems Tumor derived antigensare weakly immunogenic Need for better adjuvants or immunisation strategies
  • 76.
    CD8+ T cell CD4+ T cell Dendriticcell Induction of optimized T cell responses by in vivo dendritic cells targeting Antigen targeting Maturation signals 2 1 Adjuvant
  • 77.
    CyaA: a newproteinic vector targeted to dendritic cells Bordetella pertussis Dermonecrotic Toxin BrkA FHA TCF FIM TCT Pertussis Toxin cAMP Pertactin Adenylate cyclase Toxin Dendritic Cell CD11b/CD18 AC domain RTX domain 1 400 1706 Internalization Endosomes Cytosol CyaA binds to CD11b allowing efficient targeting to dendritic cells Guermonprez et al, J. Exp. Med, 2001 Adenylate cyclase (CyaA)
  • 78.
    Recombinant CyaA + Activation ofCD8+ Cytotoxic T lymphocytes Dendritic Cell ϕ CD11b/CD18 Antigen Th CD4+ MHC-II endosomes lysosomes ϕ ϕ MHC class II presentation Activation of CD4+ Helper T lymphocytes MHC class I presentation Endoplasmic Reticulum CTL CD8+ MHC-I/β2 ϕ Translocation Endocytosis Antigens grafted in CyaA are delivered to both MHC class I & MHC class II presentation pathways
  • 79.
    Immunisation in miceand non-human primates by recombinant CyaA carrying a variety of antigens (such as from M. tuberculosis or HIV) stimulates strong CTL and Th1 responses, even in the absence of adjuvant. Préville et al, Cancer Res, 2005, Mascarell et al, J. Virol 2005, Majlessi et al, Inf Immun, 2005, Hervas-Stubb et al, Inf Immun, 2006, Mascarell et al, Vaccine 2006, Berraondo et al, Cancer Res, 2007, Fayolle et al, Vaccine 2010. CyaA: a new proteinic vector targeted to dendritic cells
  • 80.
    80 HPV infection lifecycle Few months to few years Up to 20 years Goodman A., Wilbur D. C.
  • 81.
  • 82.
    - The HPVE6 and E7 oncoproteins are expressed throughout the replicative cycle of the virus and are necessary for the onset and maintenance of malignant transformation. - HPV E6 and E7 antigens are potential targets for specific immunotherapy. Rational
  • 83.
    MHGDTPTLHEYMLDLQPETTDLYCYEQLN CyaAE5 GQAEPDRAHYNIVTFCCKCDSTLRLCVQSTHVDIRTLEDLLMGTLGIVCPICSQKP CyaA-E7∆30-42 Catalytic domain 224 235 319320 1 400 1706 LQ LQ Recombinant CyaA carrying E7 from HPV16 GMP batch produced in recombinant E. coli
  • 84.
    Therapeutic vaccination withrecombinant HPV16-E7 CyaAs eradicates established tumors No treatment CyaA-OVA 0 500 1000 1500 2000 0 10 5/5 10/10 0/10 20 30 40 50 60 70 80 90 0 500 1000 1500 2000 CyaA-HPV16E7∆30-42 - Graft of TC-1 cells at day 0 - At day 10, one injection of: - 50 µg of CyaA-E7 or of control CyaA-OVA Preville et al, Cancer Res. 2005; Berraondo, K. et al. Cancer Res. 2007
  • 85.
    A therapeutic vaccinecandidate against HPV chronic infection and/or cervical cancer Clinical trials started in 2010 0 102030405060708090 0 500 1000 1500 2000 0 102030405060708090 0 500 1000 1500 2000 0 102030405060708090100 0 20 40 60 80 100 0 5 10 15 20 25 30 35 0.0 0.2 10 20 daysdays days CyaAE5 HPV16E7∆30-42CyaAE5 CysOVA Controls One injection at Day 10 CyaAE5 HPV16E7∆30-42 Préville et al, Cancer Res, 2005
  • 86.
  • 87.