Wednesday, August 11, 2021

Study shows efficacy of gamma irradiation of SARS-CoV-2 vaccine candidate in mouse model

A new study reports a cost-effective and more rapid method of viral inactivation in an effort to increase the appeal of inactivated viral vaccines against the ongoing coronavirus disease 2019 (COVID-19) pandemic.

The COVID-19 pandemic prompted a surge of research aimed towards making safe and effective vaccines available that are capable of preventing viral transmission and severe symptoms of the disease. Among the earliest developed COVID-19 vaccines include the messenger ribonucleic acid (mRNA) vaccines from Moderna and Pfizer-BioNTech, which encode the viral spike (S) glycoprotein within the recipient’s body. This technology is being used in viral vaccines for the first time in clinical history.

The current study reports on the efficacy of an inactivated virus vaccine that uses gamma irradiation rather than chemical inactivation of the virus. This has the advantage of avoiding the purification step, while simultaneously stimulating the immune response in a more effective manner.

Background

Chemical inactivation by formaldehyde or β-propiolactone is traditionally used to render viruses harmless for vaccine production. However, the process of chemical inactivation is long and requires many additional purification steps. During the purification process, the product mass may be decreased, viral proteins may be degraded, and toxicity may occur.

In contrast, the gamma irradiation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for COVID-19, avoids unwanted toxicity while simultaneously maintaining its efficacy, as demonstrated in several animal models. By preventing viral loss, gamma irradiation also becomes a more cost-effective method of virus purification.

The inactivation of the vaccine virus was tested by allowing the vaccine to grow on cultured cells for 21 days. The virus strain, which was called OZG-38.61.3, was then used for intradermal immunization in mice to reduce the required concentration of the vaccine candidate.

The advantages of viral inactivation include the increased ease of production prior to when genomic sequencing is accomplished. In contrast to recombinant vaccines, the virus only needs to be isolated, grown too large numbers (the rate-limiting step), and inactivated. Recombinant vaccine production, conversely, requires virus identification and genome sequencing.

Study details

Individual strains were characterized and subsequently grown in successive cultures to achieve the required number. Since many variations occur during consecutive passaging, half of the unit volume of each isolate was frozen and ultimately pooled to get the final product, OZG-38.61.3.

This process proved to be an effective and safe method that yielded a mix containing most of the mutations identified so far in SARS-CoV-2. Along with the >99% homology of the OZG-38.61.3 vaccine candidate with the original virus isolate, this ensures that the inactive vaccine will remain effective in a large population.

Neither gamma irradiation nor lyophilization changed the structure of the vaccine virus; however, the aggregate formation was observed. For this reason, the researchers stabilized the product with human albumin, as this would keep viral particles from sticking to the vial walls without compromising the efficacy of the vaccine.

No viral deoxyribonucleic acid (DNA) was present in the vaccine doses. Notably, protein levels were less than 4 nanograms (ng), thus indicating efficient purification had taken place.

The researchers found that OZG-38.61.3 vaccination intradermally into mice engineered to express human angiotensin-converting enzyme 2 (hACE2) receptors for the virus, provided 3 log10 reductions in the viral load in mice immunized with 1014 viral particles, relative to unimmunized controls.

The mice developed both antibody- and cell-mediated immunity against the virus, including neutralizing antibodies. No signs of toxicity were seen. Immunoglobulin G (IgG) antibodies, particularly IgG1, were increased.

The vaccine candidate was tested at two doses. Both vaccine doses produced a cellular immune response; however, only the higher dose was associated with specific neutralizing antibodies. The T-cell interferon γ (IFNγ) responses and the release of Th1 dominant cytokines also indicate vaccine efficacy.

The occurrence of skin injury during vaccination of mice may perhaps have reduced the efficacy of the procedure and skewed the findings. However, at both doses, viral copy numbers were reduced, and viral clearance was observed in some mice. X-rays of the lungs failed to show signs of COVID-19, as confirmed by histopathology.

The absence of such changes may have been due to the inadequate time of 96 hours that was given or an insufficient viral load to travel to the lungs during this period. At both doses, neutralization was observed.

What are the conclusions?

The researchers point out that the Oxford AstraZeneca, Moderna, and Pfizer vaccines are all based on new vaccine technology; therefore, all vaccines carry some inherent unknowns. In contrast, inactivated virus vaccine technology has been around for decades.

The OZG-38.61.3 virus presents viral strains that contain the frequently encountered mutations of SARS-CoV-2. When the vaccine antisera were tested against the P.1 lineage, effective neutralization was found to occur, despite the fact that this is a SARS-CoV-2 variant of concern (VoC) that resists neutralization.

This study demonstrated that the OZG-38.61.3 vaccine candidates created with gamma-irradiated inactivated SARS-CoV-2 viruses produced neutralizing antibodies, especially effective in the 1014 viral RNA copy formulation, and this was effective in protecting transgenic human ACE2 expressing mice against the SARS-CoV-2 virus.”

 

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Thursday, April 29, 2021

The difference between vaccine efficacy and vaccine effectiveness – and why it matters

With India’s Covid-19 vaccination campaign proceeding, two terms that sound similar are prone to misinterpretation: vaccine efficacy and vaccine effectiveness. The dictionary meanings of these terms are different from the way they are used in scientific discourse. Understanding them could help readers make informed decisions when they are getting vaccinated.

Vaccine efficacy

Many people interpret vaccine efficacy to mean the percentage of people who would not get the disease after vaccination. Sometimes, it is also interpreted as the percent of possibility that a vaccinated person would be protected from the disease. However, it is not as straightforward.

To understand vaccine efficacy, one has to first know a little bit about randomised controlled trials, a type of research design, commonly used for clinical trials – in this case, for Covid-19 vaccines. In RCTs, the study participants are randomly assigned into two comparable groups. In one, the experimental group, the actual vaccine is administered. The other, the control group, gets a placebo – a neutral, unharmful substance that is not a vaccine.

The process takes place in optimal conditions, which means that it occurs in an environment that is scientifically controlled and is similar for both experimental and control groups. If the outcome in the experimental group, in statistical terms, is significantly better than the outcome in the control group, the vaccine would be called efficacious.

Interpreting vaccine efficacy

The efficacy of Covid-19 vaccines is mentioned in percentages. The way it is calculated and interpreted is a little more complicated.

If, for instance, a vaccine is 90% efficacious, this means that out of the total number of people enrolled in the vaccine trial, if about 1% of the people in the control group (who received the placebo instead of the vaccine) get symptomatic Covid-19, only 0.1% of those in the experimental group (who received the vaccine) would get symptomatic Covid-19.

Efficacy is a comparative measure of vaccine performance and not its absolute measure. Ninety per cent efficacy simply means that if 10 people out of 100 unvaccinated people normally get symptomatic disease, only one out of 100 vaccinated ones would get it. The formula used to measure vaccine efficacy is 100 x [1 - (attack rate in the experimental group divided by attack rate in the control group)]. In our example, it would be 100 x [1 - (1/10)] = 90%.

India is currently using two vaccines for Covid-19: Covishield, produced by the Serum Institute of India, and Covaxin, produced by Bharat Biotech. Based on the first clinical trial results, Covishield was 90% efficacious in preventing symptomatic Covid-19 after two doses as per the prescribed schedule, while Covaxin is 81% efficacious.

However, the Covishield vaccine efficacy has been lowered over time and the latest results show that it is 76% efficacious against symptomatic Covid-19. Efficacy rates change based on the gap between the first and the second dose of the vaccine. India has changed the schedule of Covishield vaccine – the recommended gap between the two doses is now six-eight weeks, up from four weeks earlier.

The Sputnik V vaccine, being manufactured in India by Dr Reddy’s Laboratories, is due to be used in the country soon. Its efficacy is said to be 91.6%, next only to the vaccines by Pfizer-BioNTech and Moderna, the two vaccines that are not currently used in India.

Efficacy in what terms?

Vaccines are primarily aimed at preventing a disease due to infection and in turn, its spread. They stimulate an immune response within the body without causing a real infection, which in turn protects the body should there be a real infection later. Therefore, efficaciousness of a vaccine is often measured in terms of the level of immune response generated in the body. For instance, the Oral Polio Vaccine stimulates the immune system to produce anti-poliovirus antibodies against three types of poliovirus. These antibodies will protect the body should there be an infection of poliovirus at a later stage.

In case of Covid-19 vaccines, the efficacy is measured differently. It has been little over a year that we have known about the novel coronavirus, its different strains and the disease. The immune response that the virus stimulates in human body could either be antibody-mediated or cell-mediated. Which kind of immune response is activated when and why is still being studied. Therefore, it has been not easy to measure the efficacy of Covid-19 vaccines in terms of the immune response produced.

However, a vaccine was urgently needed to contain the disease, if not to completely prevent it. Consequently, vaccine performance was measured in terms of the symptoms averted. This way, at least severe symptoms and deaths due to Covid-19 can be potentially prevented. This is the reason we hear that the vaccine does not guarantee complete protection from Covid-19 after vaccination and that it only prevents symptomatic disease. 

Limited knowledge about the behaviour of the virus and human immune response, and at a very short time in which the vaccines have been developed and tested are some of the key reasons these vaccines do not assure complete prevention of the disease. This is why these vaccines have got “emergency use approvals” in most countries and vaccination is made voluntary.

Vaccine effectiveness

Vaccine efficacy and effectiveness, both conceptually measures of a vaccine’s performance, are different in terms of the conditions in which they are measured. But these conditions may well be a deciding factor for using a vaccine in the long run.

The optimal conditions in efficacy studies are used for recruiting the participants for a vaccine trial in order for the experimental and control groups to be comparable. Depending on the aim of the trial, specific eligibility criteria such as age, setting, prior exposure could be used for creating optimal conditions during efficacy trials. These are akin to the laboratory research, which takes place in controlled or ideal conditions.

Vaccine effectiveness, however, is measured in real-world settings. Vaccines are administered at various places (primary care centres, vaccination camps and more), to people of various age groups, sex, varied levels of prior exposure, comorbidities and so on. These uncontrolled conditions give a broader, more detailed picture of vaccine performance in a range of conditions. Considering this broad array of biological, social, genetic and environmental factors, vaccine effectiveness is aimed at measuring several aspects of vaccine outcomes. 

These include (but are not limited to) differences in clinical outcomes based on personal, demographic and clinical parameters, adverse event following immunisation, cost effectiveness (disease cost vs vaccine cost), side effects and more. In other words, effectiveness is a measure of the real-world application of a laboratory experiment. In addition, because of the large sample size in effectiveness studies, it becomes a well-rounded measure of vaccine performance.

Vaccine effectiveness studies are critical in making decisions about the long-term use of vaccines.

In the case of Covid-19 vaccines, owing to the limited time period for which they have been used, effectiveness studies are rare. Much data on effectiveness of vaccines used in India is not yet available. As a result, the extent to which these vaccines are effective in the real-world settings and in the long run.

Why it matters

In a world of quick communication, readers are bombarded with information but are not always equipped to verify its authenticity. This is especially true in matters of health, which are frequently discussed but in a way that could lead to misinterpretation. These frequent misinterpretations may lead to mistrust, doubt, politicisation, vaccine hesitancy and fear. This could ultimately impact personal and public health outcomes. 

Note: Vaccine efficacy percentages are based on the currently available research. Some media reports may mention different efficacy percentages.

Dr Sumedh MK is a public health professional, currently working as a consultant with the Maharashtra government’s public health department.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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Monday, February 22, 2021

Artemisia plant extracts show potential anti-SARS-CoV-2 activity in vitro

A team of scientists from Germany and the USA recently explored the effectiveness of traditional plant medicines in treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Their findings reveal that various extracts of two medicinal plants, namely Artemisia annua and Artemisia afra, can potentially inhibit SARS-CoV-2 replication in vitro without causing any cytotoxicity. The study is currently available on the bioRxiv* preprint server.

Study: In vitro efficacy of Artemisia extracts against SARS-CoV-2. Image Credit: Scisetti Alfio / Shutterstock Background
Study: In vitro efficacy of Artemisia extracts against SARS-CoV-2. Image Credit: Scisetti Alfio / Shutterstock Background

Background

The recent outbreak of coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 pathogen, has put a large burden on the healthcare systems of many countries globally. Although about 80% of COVID-19 patients develop only mild symptoms or remain asymptomatic, the disease has claimed more than 2.4 million lives worldwide since its emergence in December 2019. In the initial phase of the pandemic, many antiviral medicines already approved for other diseases have been repurposed to treat critically ill COVID-19 patients. Many vaccines with good efficacy and safety levels have also been developed and approved in record time to curb the pandemic's growth.

Various synthetic derivatives (artesunate) of artemisinin, which is a bioactive natural compound found in Artemisia annua plants, are typically being used as antimalarial medicines. The antimicrobial properties of these bioactive compounds have been recognized clinically. Different extracts of Artemisia annua containing high amount of artemisinin are currently undergoing phase 2 clinical trials to treat COVID-19 patients. Since April 2020 in Madagascar, Covid-Organics drinks containing mainly Artemisia annua extracts are being used as a miracle intervention to treat and prevent COVID-19.     

In the current study, the scientists have explored the efficacy of Artemisia annua and Artemisia afra extracts and Covid-Organics in preventing SARS-CoV-2 infection in vitro. Using various animal cell lines, they specifically examined whether these plant products are able to inhibit replication of SARS-CoV-2 and feline coronavirus.

Important observations

Both water and ethanolic extracts of dried leaves of Artemisia annua and Artemisia afra were used in this study. In addition, 500 mg of pure artemisinin and dried form of 50 ml of Covid-Organics were dissolved in dimethyl sulfoxide and tested for activity using various in vitro experimentations.

To determine its antiviral activity, the scientists first incubated feline coronavirus with different concentrations of plant extracts and pure artemisinin solution on a monolayer of feline kidney cells. Using plaque formation assay, they observed that all tested extracts significantly inhibited viral replication in a dose-dependent manner. Specifically, they observed that at a concentration range of 5 – 10 mg/ml, all tested extracts significantly inhibited viral replication, whereas no inhibition was observed at less than 2 mg/ml concentration. Based on these findings, they selected the most potent extracts with the highest antiviral activity for further experimentations on SARS-CoV-2.

A set of experiments conducted using the monkey kidney cell line revealed that the extracts at a concentration of less than 2 mg/ml had potent antiviral activity against SARS-CoV-2. The strongest SARS-CoV-2 inhibitory effects were observed for water extracts of Artemisia annua and Artemisia afra and an ethanolic extract of Artemisia annua. Since Artemisia afra does not contain artemisinin, the scientists believe that other bioactive compounds present in the plant may be responsible for the observed anti-SARS-CoV-2 activity.  

Using a separate set of experiments, the scientists estimated that these extracts could induce cytotoxic effects at a concentration range of 10 – 20 mg/ml, which was significantly higher than the concentrations required for antiviral activities. This observation indicates that these extracts can potently inhibit SARS-CoV-2 replication without affecting cell viability.

The preparations made from Covid-Organics drink showed higher antiviral activity against SARS-CoV-2 compared to Feline coronavirus. However, the selectivity index (the window between cytotoxicity and antiviral activity) of Covid-Organics drink was estimated to be 5.2, making it less promising as an antiviral medicine.

(a) Images of the SARS-CoV-2 plaques incubated with different dilutions of Covid- Organics. The dose is expressed by percentage of the raw drink. (b) Concentrationdependent inhibition SARS-CoV-2 replication using different extracts. Values are expressed as mean ±SD,
(a) Images of the SARS-CoV-2 plaques incubated with different dilutions of Covid- Organics. The dose is expressed by percentage of the raw drink. (b) Concentrationdependent inhibition SARS-CoV-2 replication using different extracts. Values are expressed as mean ±SD, n=3.

Study significance

The study reveals that various extracts of Artemisia annua and Artemisia afra have potential antiviral activities against SARS-CoV-2. However, the scientists mention that further studies are required to check whether appropriate serum levels of Artemisia compounds needed to inhibit SARS-CoV-2 can be achieved in patients. Moreover, further animal and human clinical trials are required to determine whether these in vitro observations can be translated for actual clinical use.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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