what is new with hcv vaccines - globe-network.org · pipeline hcv new therapeutic agents: > 70...
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transgeneL’immunothérapie appliquée
au traitement des cancers
et des maladies infectieuses
Immunotherapy to fight cancer
and infectious diseases
G Inchauspé
Christophe Mérieux Conference, New Trends in tumor Virology, Jan. 2010
WHAT IS NEW WITH HCV VACCINES ?
transgene
Five major cancers(worldwide): liver fith
Lung(1.239.000)
Breast(1.050.000)
Colo-rectum(943.000)
Stomach(875.000)
Liver(566.000)
[Parkin et al., Int J Cancer 2001]
VHB(53%)
VHC(25%)
Autres(22%)
Current medical need
HBV + HCV = 75% ofAll liver cancers
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Spontaneous
Clearance(1% ??)
Primary
Infection
Spontaneous
Clearance(15-30%)
Chronic Carrier
State(70-85%)
Chronic Liver
Inflammation
Fibrosis, Cirrhosis,
Hepatocellular Carcinoma(5- 70%) Healthy Carriers
(30 %) +/- Antiviral TherapiesAcute phase (< 6 months)
Chronic phase (>6 months)
HCV vaccine options
Preventive Therapeutic
Before disease During disease
transgene Name of the speaker Page 4
HCV: Current and Evolution of Standard of Care (SOC)
2011
New SOC(tri-therapy with
antiprotease):
45% cure
70 % cure(clin. trials…real
life ?? )
2009
Pipeline HCV New therapeutic
agents:
> 70 molecules!
2016
New SOCBi or tri-
therapy,
small molecules
only, no more
IFN-a:
≥ 70 %
cure
Therapeutic
vaccines
Very active competition
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Therapeutic vaccines provides a mechanism of action different
than those already exploited by Standard-of-Care (SOC)/ small
molecules
• small molecules = direct effect on virus (or key cell proteins)
effect on viral replication
• therapeutic vaccines = effect on host immune system
effect on infected cells
Therapeutic vaccines versus SOC/antivirals: what
is different
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HCV-specific CD8+ T cell responses (IIFN- g) associated
with clearance
Weeks after infection
HCV
2 4 6 8 10 12 14 16 18
Active
replication
T cell
induction
6-8 weeks
1
10
100Sustained Adaptive
responses
HCV%tet.+
CD8+ T cells
1
10
100
0.4
0.8
Weeks after infection2 4 6 8 10 12 14 16 18 20
% IFNg+/CD8HCV-RNA
Weeks after infection
1
10
100
200
300
100
0
CHIMPANZEE
INFECTIONHUMAN INFECTION
0 8 16 24 32 40
Thimme, R. et al, J Exp Med 2001 Shoukry, N. et al, J Exp Med 2003
NS3 is a key
target
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Goal = priming of multifunctional effector T cells immune responses
in the « already infected host »
• Infected host = impaired immune responses (B and T),
exhaustion, escape, immature, T-regs, ….
• Would therapeutic vaccines:
• be capable directly overcome some of these limitations e.g.
effective priming of novel T cells ? « stand alone vaccination »
early clinical proof-of-concept• Would therapeutic vaccines be most effective as « add-on » therapies ?
ongoing (initiation of clinical trials)
Why HCV (HBV) therapeutic vaccines could work
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CD8+ priming: the «importance of the « where »
An advantage for therapeutic vaccines for HCV/HBV infections ?
The site of viral infection and of antigenic expression plays a
critical role in the quality of induced T cell responses (Bowen et
al., 2004):
In transgenic mice expressing transgenes both in the liver and
periphery:
• Naïve CD8+ T cells activated within liver exhibit defective cytotoxic
function and shortened half-life
•Naïve CD8+ T cells activated within lymph nodes are fully activated
and capable of lytic activity
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The different ways leading to HCV-specific CD8+ CTL
priming according to the site of viral entry (Racanelli 2007)
PREFERED SITE OF
EXPRESSION
FOLLOWING VACCINE
ADMINISTRATION
Activation of T cells in
lymph nodes = effective
LIVER = PREFERED INFECTION AND EXPRESSION SITE
Activation of T cells in the liver = impaired
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HCV therapeutic vaccines: first and second generation
Company Vaccine
Innogenetics INNO10101 (E1) HCV +
Intercell IC41-102 (5 HCV peptides) HCV +
GlobeImmune GI-5005 (Yeast - NS3/Core) HCV +
Novartis/CSL ISCOMATRIX (Core) HCV -
Novartis HCV-MF59 (E1E2) HCV -/+
Kurume Univ. ND (4 peptides) HCV +
Tripep/Inovio ChronVac-C® (NS3) HCV +
Transgene TG4040 (MVA-NS345B) HCV+
Okairos Adenos (NS3-NS5) HCV-
Target populations Preclinical Phase I Phase II Phase III
Safety + Lack of
efficacy. Stopped
Safety + lack of
efficacy
Safety + efficacy ?
Safety
Safety
Safety + efficacy ?
Safety + early efficacy
Safety + early efficacy
Safety
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Poxvirus (MVA)-based therapeutic vaccine TG4040.01
(NS3-NS4-NS5B) – Transgene
8 12 16 20 40 44 4828 32 360
TG4040 TG4040 (cohort 3)
weeks4 24
Viral load
Immunology
Collected samples for:
Transcriptomic■
PHASE I Multicenter (France) Safety Study in treatment naïve pts
(genotype 1; 0< F< 2), dose escalating; Preliminary efficacy
Cohort 1: 3 injections of 106 pfu at D1, D8 and D15 in 3 patients
Cohort 2: 3 injections of 107 pfu at D1, D8 and D15 in 3 patients
Cohort 3: 3 injections of 108 pfu at D1, D8 and D15 in 9 patients + 1 boost injection
at M6
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Interim Clinical results
TG4040 is safe at all dose levels:
- most common AEs related to TG4040 = injection site reactions
7 subjects experienced a viral load reduction ranging from 0.5 to 1.24 log10:
- 3/3 patients from cohort 1 (106 pfu/dose)
- 3/3 patients from cohort 2 (107 pfu/dose)
- 1/9 patients from cohort 3 (108 pfu/dose)
-1.5
-1.0
-0.5
0
0.5
1
Ch
an
ge in
HC
V R
NA
(lo
g10 IU
/ml)
D22 D37 M2 M3Mean +/- SD
D1 D8 D15
TG4040 injections
transgene
Delta-S
po
ts (Sp
ecific –b
kgd
spo
ts)
NS4B NS5/1 NS5/2NS3/1 NS3/2 VL
ELISPOT analysis versus viral load changes (Cohort
1: 106 pfu)
tested only for VL
Vir
al lo
ad F
old
ch
ang
e/b
asel
ine
(lo
g10
)
-2 0
Pt 02
-1
-0,5
0
0,5
1
0
100
200
250
28
BL
D22
M6
D37
0-1
-0,5
0
0,5
1
100
200
250
28ND
Pt 01
BL D22
M6D37
M2n
eg
neg
neg
Pt 031
-1,5
-1
-0,5
0
0,5BL
D22 M6
2850
100
150
200
250
ND ND
transgene NS4B NS5/1 NS5/2NS3/1 NS3/2 VL
-1
-0,5
0
0,5
1
0
100
200
250
BL
M6
D37D22
Pt 05
28
BL
D8D22
D37M2
M6
-1
-0,5
0
0,5
1
0
100
200
Pt 08
Vir
al lo
ad F
old
ch
ang
e/b
asel
ine
(lo
g10
)D
elta-Sp
ots (S
pecific –
bkg
d sp
ots)
28
-1
-0,5
0
0,5
1
100
200
300
28
Pt 04
BL
M6D37
0ND ND
neg
ELISPOT analysis versus viral load changes (Cohort
2: 107 pfu)
tested only for VL
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LUMINEX analysis: Pt 03, “responder”
Cohort 1: 106 pfu
1
-1,5
-1
-0,5
0
0,5BL
D22
M6
50
100
150
200
250
ND ND
Limited Th1/proinflammatory panel of cytokine at M-1,
D22: extension of Th1/proinflammatory panel mostly in response to TG4040-derived
antigens
M6: widening of D22-cytokine panel, emergence of Th2 cytokines (IL-5/IL-13/IL-4)
IL-1
5
IL-1
a
IFN
g
GM
-CS
F
IL-1
b
sC
D40L
IP10
IL-2
M-1
D22
M6
IL-5
IL-1
3
IL-4
IL-1
7
NS3/1 NS3/2 NS4b
NS5/1 NS5/2
Elispot/VL
LuminexPeptide pools for restim.:
transgene
MC
P-1
Fra
cta
lkin
e
IL-1
0
EG
F
IP10
VE
GF
M-1
D1
D22
IL-5
IL-1
2 p
40
IL-2
D37
M2
M6 D8
M6 D22
D8
Limited Th2/anti-inflammatory panel of cytokine at M-1& D1,
Very limited panel of soluble factors at each time point during follow-up
-1,0
-0,5
0
0,5
1,0
BL
D22 M6
M9 M12
LUMINEX Analysis: Pt 17, “non responder” Cohort 3:
108 pfu
NS3/1 NS3/2 NS4b
NS5/1 NS5/2
Elispot/VL
LuminexPeptide pools for restim.:
transgene
Anti- MVA antibodies (preliminary results)
Total anti-MVA Abs
Time
Cohort 1
0
40,000
80,000
120,000
M-1 D22 M2 M6
Cohort 2
M-1 D22 M2 M6
Cohort 3
M-1 D22 M2 M6 M12
Neutralizing anti-MVA Abs
0200400600
80010001200
Tite
r
M-1 D22 M2 M6 M-1 D22 M2 M6 M-1 D22 M2 M6 M12
140,000
Cut-off
2,700
Cut-off
300
Measure of anti-MVA antibodies following TG4040 vaccination at the three different injected doses (3 cohorts)
Neutralizing Abs detected only with highest dose of vaccine
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Conclusion
The preliminary results show that TG4040 is:
1. Well tolerated at all dose levels:
The most commonly AEs are injection site reactions.
2. Immunogenic:
Detection of TG4040-specific IFN-g production in 7/15 treatment
naïve patients
Strongest TG4040-induced immune responses in 2/7 treatment
naïve patients with highest viral load decrease
Moreover, 7 subjects experienced a viral load reduction ranging from 0.5
to 1.24 log10 concordant to TG4040 injections.
Phase II in preparation: TG4040 combined with SOC (Q12010). Further
development with antivirals is planned.
transgeneMatti Sällberg, cot 09 19
ChronVac-C, a DNA vaccine delivered by in vivo
electroporation or the treatment of chronic HCV infection
Phase I/II : Karolinska Institute/Tripep AB/Inovio Biomedical- NS3NS4A
Inclusion criteria: HCV genotype 1, treatment naive, low viral load (<800,000 IU/mL)
Study aims: safety, activation of HCV-specific immune responses, effects on viral load
Site: Karolinska University Hospital, Stockholm (PI: Prof Ola Weiland, MD, PhD)
Blood samples and clinical follow up
Dose No. of patients M/F Age HCV RNA (log10)
167µg 3 1/2 43±13 3,4±3,1
500µg 3 2/1 43±7 5,8±0,1
1500µg 3(+3) 3 41±5 5,42±1
Screening
Vaccinations with DNA and in vivo EP
1 m 2 m 3 m 4 m 5 m 6 m 7 m 8 m 9 m
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Relation between T cell responses and HCV RNA
levels
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HCV Therapeutic vaccines: conclusion
Whether B or T cell inducers, they all show a good safety
profileNo exhacerbation of liver inflamation
A few have shown capacity to induce T-cells in face of
ongoing viral replication
For a couple (MVA/ DNA), have shown capacity to induce
specific T-cells concomittent with viral decrease
But vaccine responses are not long lastingAdditional booster vaccinations needed ?
Viral replication too rapid/ VL yet too high ?• Future combination with antivirals
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Optimization of therapeutic vaccination
C Ferrari Gastroenterology 08
Recovery of HCV T-cell responsivness by inducing decline opf antigen load ?
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ARM C
4 8 12 16 20 24 40 44 48 52 56 60 64 68 7228 32 360
SOC
TG4040 107
PRIMARY ENDPOINT
cEVR (undetectability)
N=49
ARM C
4 8 12 16 20 24 40 44 48 52 56 60 64 68 7228 32 360
SOC
N=49
ARM A
4 8 12 16 20 24 40 44 48 52 56 60 64 68 7228 32 360
SOC
N=25
TG4040 107
If viral load is detectable:
stop treatment
TG4040 in combination with SOC:
Design of the Phase II
Three arms study:
transgene
Acknowledgement
TG. Infectious Diseases Department
Emilie Jacquier
Perrine Martin
Estelle Gérossier
Alexeï Evlachev
Anne Fournillier
Geneviève Inchauspé
TG. Molecular Immunology Department
JM Balloul/Joerg Schneider
Nathalie Silvestre
Doris Schmitt
Renée Brandely
Michel Julien/ JP Lemarchand
Karola Rittner
TG TG4040 Product Team
Delphine Agathon
Christine Bain
Bernard Burtin
Patricia Zerr
Geraldine Honnet
Sophie Jallat
Sandrine Lemius
Clémentine Spring-Giusti
Arend Winter
Lyon Biopôle
Ministary of French
Industry
CliniciansC. Trépo, Lyon
JP. Zarski, Grenoble
F. Habersetzer, Strasbourg
Tripep
M Salbërg