WO2006091722A2 - Alkyl-glycoside enhanced vaccination - Google Patents
Alkyl-glycoside enhanced vaccination Download PDFInfo
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- WO2006091722A2 WO2006091722A2 PCT/US2006/006391 US2006006391W WO2006091722A2 WO 2006091722 A2 WO2006091722 A2 WO 2006091722A2 US 2006006391 W US2006006391 W US 2006006391W WO 2006091722 A2 WO2006091722 A2 WO 2006091722A2
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- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/39—Medicinal preparations containing antigens or antibodies characterised by the immunostimulating additives, e.g. chemical adjuvants
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/70—Carbohydrates; Sugars; Derivatives thereof
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- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/12—Viral antigens
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/12—Viral antigens
- A61K39/235—Adenoviridae
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
- A61K47/26—Carbohydrates, e.g. sugar alcohols, amino sugars, nucleic acids, mono-, di- or oligo-saccharides; Derivatives thereof, e.g. polysorbates, sorbitan fatty acid esters or glycyrrhizin
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/0012—Galenical forms characterised by the site of application
- A61K9/0014—Skin, i.e. galenical aspects of topical compositions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
- A61P31/04—Antibacterial agents
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- A—HUMAN NECESSITIES
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- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/51—Medicinal preparations containing antigens or antibodies comprising whole cells, viruses or DNA/RNA
- A61K2039/525—Virus
- A61K2039/5254—Virus avirulent or attenuated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
- A61K2039/55511—Organic adjuvants
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
- A61K2039/55511—Organic adjuvants
- A61K2039/55583—Polysaccharides
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
- C12N2710/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA dsDNA viruses
- C12N2710/00011—Details
- C12N2710/10011—Adenoviridae
- C12N2710/10041—Use of virus, viral particle or viral elements as a vector
- C12N2710/10043—Use of virus, viral particle or viral elements as a vector viral genome or elements thereof as genetic vector
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
- Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
- Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
- Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change
Definitions
- Humoral immunity involves antibodies that directly bind to antigens. Antibody molecules as the effectors of humoral immunity are secreted by B lymphocytes.
- Cellular immunity involves specialized cytotoxic T lymphocytes (CTLs), which recognize and kill other cells and produce non-self antigens. CTLs respond to degraded peptide fragments that appear on the surface of the target cell bound to MHC (major histocompatibility complex) class I molecules. It is understood that proteins produced within the cell are continually degraded to peptides as part of cellular metabolism. These fragments are bound to the MHC molecules and are transported to the cell surface.
- MHC major histocompatibility complex
- Vaccination is the process of priming an animal for responding to an antigen.
- the antigen can be administered as a protein (classical) or as a gene, which then expresses the antigen (genetic immunization).
- the process involves T and B lymphocytes, other types of lymphoid cells, as well as specialized antigen presenting cells (APCs), which can process the antigen and display it in a form which can activate the immune system.
- APCs antigen presenting cells
- Current modes for the administration of genetic vaccines have focused on invasive procedures, which include injection by needles, scarification, and gene gun-mediated penetration. Inoculation using invasive techniques requires equipment and personnel with special medical training, and is usually associated with discomfort and potential hazards (e.g. , bleeding, infection).
- the efficacy of a vaccine is measured by the extent of protection against a later challenge by a tumor or a pathogen.
- Effective vaccines are immunogens that can induce high titer and long-lasting protective immunity for targeted intervention against diseases after a minimum number of inoculations.
- genetic immunization is an approach to elicit immune responses against specific proteins by expressing genes encoding the proteins in an animal's own cells. The substantial antigen amplification and immune stimulation resulting from prolonged antigen presentation in vivo can induce a solid immunity against the antigen. Genetic immunization simplifies the vaccination protocol to produce immune responses against particular proteins because the often difficult steps of protein purification and combination with adjuvant, both routinely required for vaccine development, are eliminated.
- Genetic vaccines may also be delivered in combination without eliciting interference or affecting efficacy, which may simplify the vaccination scheme against multiple antigens. Noninvasive approaches to administering vaccines have been investigated.
- vaccination usually requires equipment, e.g., syringe needles or a gene gun, and special skill for the administration of the vaccine.
- equipment e.g., syringe needles or a gene gun
- special skill for the administration of the vaccine.
- a large number of diseases could potentially be immunized against through the development of noninvasive vaccination because the procedure is simple, effective, economical, painless, and potentially safe.
- noninvasive vaccination may boost vaccine coverage in developing countries where medical resources are in short supply, as well as in developed countries due to patient comfort.
- Infectious diseases caused by (1) viruses, including AIDS and flu, (2) bacteria, including tetanus and TB, (3) parasites, including malaria, and (4) malignant tumors, including a wide variety of cancer types may all be prevented or treated with noninvasive vaccines without requiring special equipment and medical personnel.
- viruses including AIDS and flu
- bacteria including tetanus and TB
- parasites including malaria
- malignant tumors including a wide variety of cancer types
- compositions, kits, and devices for the noninvasive immunization of a subject are described herein.
- the advantages of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the aspects described below. The advantages described below will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive.
- Figure 1 shows a device for the administration of noninvasive vaccines.
- Figure 2 shows the permeablization of stratum corneum by tetradecyl-jS-D- maltoside surfactant.
- Figure 3 shows the effect of tetradecyl- ⁇ -D-maltoside (TDM) as an epicutaneous vaccine enhancer.
- TDM tetradecyl- ⁇ -D-maltoside
- Ranges may be expressed herein as from “about” one particular value, and/or to "about” another particular value. When such a range is expressed, another aspect includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent "about,” it will be understood that the particular value forms another aspect. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint.
- These and other materials are disclosed herein, and it is understood that when combinations, subsets, interactions, groups, etc. of these materials are disclosed that while specific reference of each various individual and collective combinations and permutation of these compounds may not be explicitly disclosed, each is specifically contemplated and described herein. For example, if a number of different alkyl glycosides and vaccines are disclosed and discussed, each and every combination and permutation of the alkyl glycoside and vaccine are specifically contemplated unless specifically indicated to the contrary.
- the sub-group of A-E, B-F, and C-E are specifically contemplated and should be considered disclosed from disclosure of A, B, and C; D, E, and F; and the example combination A-D.
- This concept applies to all aspects of this disclosure including, but not limited to, steps in methods of making and using the disclosed compositions.
- steps in methods of making and using the disclosed compositions are a variety of additional steps that can be performed it is understood that each of these additional steps can be performed with any specific embodiment or combination of embodiments of the disclosed methods, and that each such combination is specifically contemplated and should be considered disclosed.
- Certain materials, compounds, compositions, and components disclosed herein can be obtained commercially or readily synthesized using techniques generally known to those of skill in the art.
- the starting materials and reagents used in preparing the disclosed compounds and compositions are either available from commercial suppliers such as Aldrich Chemical Co., (Milwaukee, Wis.), Acros Organics (Morris Plains, NJ.), Fisher Scientific (Pittsburgh, Pa.), or Sigma (St.
- the methods herein contemplate administering an alkyl glycoside and vaccine to a subject sequentially or concurrently.
- One way to administer the alkyl glycoside and vaccine concurrently is to admix the components together prior to administration.
- the alkyl glycoside and the vaccine may or may not react with one another. Described below are different aspects of the alkyl glycoside and vaccine that can be used herein.
- alkyl glycoside is used in combination with a vaccine in order to immunize a subject.
- alkyl group as used herein is a branched or unbranched saturated hydrocarbon group of 1 to 25 carbon atoms, such as methyl, ethyl, ra-propyl, isopropyl, 7z-butyl, isobutyl, t-butyl, pentyl, hexyl, heptyl, octyl, decyl, tetradecyl, hexadecyl, eicosyl, tetracosyl and the like.
- longer chain alkyl groups include, but are not limited to, an oleate group or a palmitate group.
- a "lower alkyl” group is an alkyl group containing from one to six carbon atoms.
- alkyl is also used herein to include unsaturated hydrocarbons known as "alkenes” or “alkenyl groups,” which as used herein refer to a hydrocarbon group of at least 2 carbon atoms with a structural formula containing at least one carbon- carbon double bond.
- alkenes unsaturated hydrocarbons
- alkenyl groups unsaturated hydrocarbons
- alkyl groups disclosed herein can also be substituted.
- substituted is contemplated to include all permissible substituents of organic compounds.
- the permissible substituents include acyclic and cyclic, branched and unbranched, carbocyclic and heterocyclic, and aromatic and nonaromatic substituents of organic compounds.
- Illustrative substituents include, for example, those described below.
- the permissible substituents can be one or more and the same or different for appropriate organic compounds.
- the heteroatoms, such as nitrogen can have hydrogen substituents and/or any permissible substituents of organic compounds described herein which satisfy the valences of the heteroatoms.
- substitution or “substituted with” include the implicit proviso that such substitution is in accordance with permitted valence of the substituted atom and the substituent, and that the substitution results in a stable compound, e.g., a compound that does not spontaneously undergo transformation such as by rearrangement, cyclization, elimination, etc.
- the alkyl group can be substituted with one or more groups including, but not limited to, alkyl, halogenated alkyl, alkoxy, alkenyl, alkynyl, aryl, heteroaryl, aldehyde, amino, carboxylic acid, ester, ether, halide, hydroxy, ketone, sulfo-oxo, sulfonyl, sulfone, sulfoxide, or thiol.
- the alkyl glycoside is any saccharide/carbohydrate joined by a linkage to any hydrophobic alkyl group.
- alkyl groups bonded to the anomeric carbon of a saccharide/carbohydrate via an ether linkage as well as as alkyl groups bonded to the anomeric carbon of a saccharide/carbohydrate through an ether linkage.
- Other linkages of alkyl groups and saccharide/carbohydrates are also possible, e.g., thioethers, thioesters, amines, amides, ureas, carbamates, and the like.
- the hydrophobic alkyl group can be chosen of any desired size, depending on the hydrophobicity desired and the hydrophilicity of the saccharide moiety.
- the alkyl group can be from 6 to 25 carbon atoms, 6 to 20 carbon atoms, 6 to 18 carbon atoms, 6 to 16 carbon atoms, or 6 to 14 carbon atoms. In other examples, the alkyl group can be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19, 20 ,21, 22, 23, 24, or 25 group, where any of the stated values can form an upper or lower endpoint as appropriate.
- saccharide includes, but is not limited to, monosaccharides, oligosaccharides, or polysaccharides in straight chain or ring forms. Oligosaccharides are saccharides having two or more monosaccharide residues, while polysaccharides have more than two monosaccharide units.
- the alkyl glycoside is generally nontoxic to the subject. "Nontoxic” as used herein, is defined as a molecule that has a sufficiently low toxicity to be suitable for administration to the subject. It is desirable that the alkyl glycoside be nonirritating to the tissue to which it is applied. The alkyl glycoside should be of minimal toxcity to the cell, such as not to cause damage to the cell. Toxicity for any given alkyl glycoside may vary with the concentration of alkyl glycoside used. It is also beneficial if the alkyl glycoside chosen is metabolized or eliminated by the body, and if this metabolism or elimination is done in a manner that will not be harmfully toxic. In one aspect, the alkyl glycoside can be nonionic.
- hydrophilic character of the alkyl glycoside can also vary, which can be quantified as the hydrophile-lipophile balance number.
- the HLB is a direct expression of the hydrophilic character of the surfactant, i.e., the larger the HLB, the more hydrophilic the compound.
- the alkyl glycoside has a hydrophile-lipophile balance number in the range of about 10 to 20, 11 to 19, 11 to 18, 11 to 17, 11 to 16, or 11 to 15. In other examples, the alkyl glycoside has a hydrophile-lipophile balance number of about 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20, where any of the stated values can form an upper or lower endpoint when appropriate.
- the saccharide portion of the alkyl glycoside can be chosen from any currently commercially available saccharide species or can be synthesized.
- the saccharide can be a monosaccharide, a disaccharide, an oligosaccharide, a polysaccharide, or a combination thereof to form a saccharide chain.
- saccharides useful herein include, but are not limited to, erythrose, threose, ribose, arabinose, xylose, lyxose, allose, altrose, glucose, mannose, gulose, idose, galactose, talose, fructose, maltose, cellobiose, maltotriose, maltotetraose, sucrose, lactose, trehalose, raffmose, or a derivative or combination thereof.
- one or more oxygen atoms within the saccharide can be substituted with sulfur in order to decrease susceptibility to hydrolytic cleavage by glycohydrolases in the body (Defaye and Gelas, in Studies in Natural Product
- the heteroatom of the sugar ring can be either oxygen or sulfur, or the linkage between monosaccharides in an oligosaccharide can be oxygen or sulfur (Horton and Wander, "Thio Sugars and Derivatives," The Carbohydrates: Chemistry and Biochemistry, Reyman and Horton eds., Academic Press, New York, 2d. Ed. Vol. IB, pp. 799-842, 1972).
- Oligosaccharides can have either the alpha or beta anomeric configuration (see Pacsu et ah, in Methods in Carbohydrate Chemistry, Whistler et al, eds., Academic Press, New York, Vol. 2, pp. 376-385, 1963).
- alkyl glycosides can be synthesized using techniques known in the art. For example, the techniques described in Rosevear et al., Biochemistry 19:4108-4115, 1980; Koeltzow and Urfer, JAm Oil Chem Soc, 61:1651-1655, 1984; U.S. Patent No. 3,219,656; U.S. Patent No. 3,839,318; Li et al, J Biol Chem, 266:10723-10726, 1991; or Gopalan et al, J Biol Chem, 267:9629-9638, 1992, which are incorporated by reference in their entireties, can be used to synthesize alkyl glycosides.
- the linkage between the hydrophobic alkyl group and the hydrophilic saccharide can include, but is not limited to, a glycosidic linkage, a thioglycosidic linkage (Horton), an amide linkage (Carbohydrates as Organic Raw Materials, Lichtenthaler ed., VCH Publishers, New York, 1991), an ureide linkage (Austrian Pat. 386,414 (1988); Chem. Abstr. 110:137536p, 1989, see Gruber and Greber, "Reactive Sucrose Derivatives" in Carbohydrates as Organic Raw Materials, Lichtenthaler, ed., VCH Publishers, New York, pp. 95-116, 1991), or an ester linkage (Sugar Esters: Preparation and Application, Colbert ed., Noyes Data Corp., New Jersey, 1974). ,
- alkyl glycosides useful herein include, but are not limited to, hexyl-, heptyl-, octyl-, nonyl-, decyl-, undecyl-, dodecyl-, tridecyl-, tetradecyl, pentadecyl-, hexadecyl-, heptadecyl-, and octadecyl a- or /3-D-maltoside or - glucoside, which can be synthesized according to methods disclosed in, e.g., Koeltzow and Urfer, JAm Oil Chem Soc, 61:1651-1655, 1984, or obtained commercially from such suppliers as Anatrace Inc.(Maumee, Ohio), Calbiochem, (San Diego, CA), or Fluka Chemie, (Switzerland).
- alkyl glycoside examples include, but are not limited to, hexyl-, heptyl-, octyl-, nonyl-, decyl-, undecyl-, dodecyl-, tridecyl-, tetradecyl-, pentadecyl-, hexadecyl-, heptadecyl-, and octadecyl esters of sucrose.
- Furhter examples include alkyl thiomaltosides such as hexyl-, heptyl-, octyl-, dodecyl-, tridecyl-, and tetradecyl- ⁇ -D-thiomaltoside, which can be synthesized according to methods disclosed in Defaye and Pederson, "Hydrogen Fluoride, Solvent and Reagent for Carbohydrate Conversion Technology," in Carbohydrates as Organic Raw Materials, Lichtenthaler, ed., VCH Publishers, New York, 247-265, 1991, and Ferenci, JBacteriol 144:7-11, 1980.
- alkyl thiomaltosides such as hexyl-, heptyl-, octyl-, dodecyl-, tridecyl-, and tetradecyl- ⁇ -D-thiomaltoside, which can be synthesized according to methods disclosed in
- alkyl thioglucosides such as heptyl- or octyl- 1-thio- ⁇ - or ⁇ -D- glucopyranoside, which are commercially available from such sources as Anatrace, Inc. (Maumee, Ohio) or can be synthesized by methods disclosed in, e.g., Saito and Tsuchiya, Chem Pharm Bull, 33:503-508, 1985.
- alkyl thiosucroses which can be synthesized according to methods disclosed in, e.g.,
- Long chain aliphatic carbonic acid amides of sucrose /?-amino-alkyl ethers are further suitable examples and can be synthesized according to methods disclosed in, e.g., Austrian Patent 382,381 (1987), Chem Abstr 108:114719, 1988, and Gruber and Greber "Reactive Sucrose Derivatives," in Carbohydrates as Organic Raw Materials, Lichtenthaler, ed., VCH Publishers, New York, pp. 95-116, 1991.
- Derivatives of palatinose or isomaltamine linked by an amide linkage to an alkyl chain and derivatives of isomaltamine linked by urea to an alkyl chain are also suitable and can be synthesized according to methods disclosed in, e.g., Kunz, "Sucrose-based Hydrophilic Building Blocks as Intermediates for the Synthesis of Surfactants and Polymers" in Carbohydrates as Organic Raw Materials, Lichtenthaler, ed., VCH Publishers, New York, pp. 127-153, 1991).
- Long chain aliphatic carbonic acid ureides of sucrose ⁇ -amino-alkyl ethers and long chain aliphatic carbonic acid amides of sucrose j8-amino-alkyl ethers are also suitable examples and can be synthesized according to methods disclosed in, e.g., Austrian Patent 382,381 (1987), Chem Abstr 108:114719, 1988, and Gruber and Greber, "Reactive Sucrose Derivatives" in Carbohydrates as Organic Raw Materials, Lichtenthaler, ed., VCH Publishers, New York, pp. 95-116, 1991.
- the refernces disclosed in this paragraph are each incorporated by reference herein at least for their teachings of the synthesis of alkyl glycosides.
- the alkyl glycoside can be maltose, sucrose, glucose, or a combination thereof linked by a glycosidic linkage to an alkyl chain of 9, 10, 12 or 14 carbon atoms, e.g., nonyl-, decyl-, dodecyl- and tetradecyl sucroside, glucoside, and maltoside.
- these compositions are nontoxic because they are degraded to an alcohol and an oligosaccharide.
- the term "vaccine” as used herein is any agent that induces or potentiates an immunological response in a subject upon administration.
- the vaccine can be a protein-based vaccine, a DNA-based vaccine, or a RNA-based vaccine.
- the vaccine can be Antirabies Serum; Antivenin (Latrodectus mactans); Antivenin (Micrurus Fulvius); Antivenin (Crotalidae) Polyvalent; BCG Vaccine; Botulism Antitoxin; Cholera Vaccine; Diphtheria Antitoxin; Diphtheria Toxoid; Diphtheria Toxoid Adsorbed; Globulin, Immune; Hepatitis B Immune Globulin; Hepatitis B Virus Vaccine Inactivated; Influenza Virus Vaccine; Measles Virus Vaccine Live; Meningococcal Polysaccharide Vaccine Group A; Meningococcal Polysaccharide Vaccine Group
- the vaccine is a vector.
- a "vector” is a tool that allows or facilitates the transfer of an entity from one environment to another.
- WO 99/60164 and WO98/00166 van Ginkel et ah, "Adenoviral gene delivery elicits distinct pulmonary- associated T helper cell responses to the vector and to its transgene," J Immunol 159(2):685-93, 1997; and Osterhaus et al., "Vaccination against acute respiratory virus infections and measles in man,” Immunobiology 184(2-3): 180-92, 1992, which contain information concerning expressed gene products, antibodies and uses thereof, vectors for in vivo and in vitro expression of exogenous nucleic acid molecules, promoters for driving expression or for operatively linking to nucleic acid molecules to be expressed, method and documents for producing such vectors, compositions comprising such vectors or nucleic acid molecules or antibodies, dosages, and modes and/or routes of administration (including compositions for nasal administration), inter alia, can be employed in the practice of this invention and are incorporated by herein reference in their entireties.
- vector compositions are formulated by admixing the vector with a suitable carrier or diluent.
- the gene product, the immunological product, or the antibody compositions can be formulated by admixing the gene, the immunological product, or the antibody with a suitable carrier or diluent; see, e.g., U.S. Patent No. 5,990,091, International Publication Nos. WO 99/60164 and WO 98/00166, and documents cited therein.
- the vector expresses a gene which encodes, for example, influenza hemaglutinin, influenza nuclear protein, influenza M2, tetanus toxin C- fragment, anthrax protective antigen, anthrax lethal factor, rabies glycoprotein, HBV surface antigen, HIV gp 120, HW gp 160, human carcinoembryonic antigen, malaria CSP, malaria SSP, malaria MSP, malaria pfg, mycobacterium tuberculosis HSP or a mutant thereof.
- influenza hemaglutinin influenza nuclear protein
- influenza M2 tetanus toxin C- fragment
- anthrax protective antigen anthrax lethal factor
- rabies glycoprotein HBV surface antigen
- HIV gp 120, HW gp 160 human carcinoembryonic antigen
- malaria CSP malaria SSP
- malaria MSP malaria MSP
- malaria pfg mycobacterium tuberculosis HSP or a mutant thereof.
- the immune response in the subject is induced by genetic vectors expressing genes encoding antigens of interest in the subject's cells such as, for example, epidermal or mucosal cells
- the antigen of interest includes, but is not limited to, influenza hemaglutinin, influenza nuclear protein, influenza M2, tetanus toxin C-fragment, anthrax protective antigen, anthrax lethal factor, anthrax germination and outgrowth-associated proteins, rabies glycoprotein, HBV surface antigen, HIV gp 120, HIV gp 160, human carcinoembryonic antigen, malaria CSP, malaria SSP, malaria MSP, malaria pfg, and mycobacterium tuberculosis HSP.
- the immune response is against a pathogen or a neoplasm.
- the genetic vector is used as a prophylactic vaccine or a therapeutic vaccine.
- the genetic vector includes genetic vectors capable of expressing an antigen of interest in the subject's cells.
- the vector can be exogenous DNA.
- exogenous DNA for expression in a vector e.g., encoding an epitope of interest, an antigen, or a therapeutic
- U.S. Patent No. 5,990,091 e.g., encoding an epitope of interest, an antigen, or a therapeutic
- the vector can be a viral vector, a bacterial vector, a protozoan vector, a retrotransposon, a transposon, a virus shell, or a DNA vector.
- the viral vector, the bacterial vector, the protozoan vector and the DNA vector can be recombinant vectors.
- the immune response is against influenza A.
- the immune response against influenza A is induced by the genetic vector expressing a gene encoding an influenza hemaglutinin, an influenza nuclear protein, an influenza M2, or a fragment thereof in the subject's cells.
- the vector can be a viral vector and plasmid DNA.
- the vector can be an adenovirus.
- the adenovirus recombinant can include El -defective, E3 -defective, and/or E4-defective adenovirus vectors, or the "gutless" adenovirus vector, where all viral genes are deleted.
- the "gutless" adenovirus vector is the latest model in the adenovirus vector family. Its replication requires a helper virus and a special human 293 cell line expressing both EIa and Cre, a condition that does not exist in natural environment. The vector is deprived of all viral genes; thus, the vector as a vaccine carrier is non- immunogenic and may be inoculated for multiple times for re- vaccination.
- the "gutless" adenovirus vector also contains 36 kb space for accommodating transgenes, thus allowing co-delivery of a large number of antigen genes into cells.
- Specific sequence motifs such as the RGD motif can be inserted into the H-I loop of an adenovirus vector to enhance its infectivity.
- An adenovirus recombinant is constructed by cloning specific transgenes or fragments of transgenes into any of the adenovirus vectors such as those described above.
- the adenovirus recombinant can be used to transduce epidermal or mucosal cells of a subject in a noninvasive mode for use as an immunizing agent.
- the adenovirus vector can be defective in its El region. In another example, the adenovirus vector can be defective in its E3 region. In a further example, the adenovirus vector can be defective in its El and E3 regions.
- the DNA is in plasmid form.
- the genetic vector can encode an immunomodulatory gene such as, for example, a co-stimulatory gene, a cytokine gene, or a chemokine.
- the gene can be a GM-CSF gene, a B7-1 gene, a B7-2 gene, an interleukin-2 gene, an interleukin-12 gene and interferon genes.
- the vector can encode a complete gene, a fragment of a gene or several genes, or gene fragments fused with immune modulatory sequences such as, for example, ubiquitin or CpG-rich synthetic DNA, together with transcription/translation signals necessary for expression.
- immune modulatory sequences such as, for example, ubiquitin or CpG-rich synthetic DNA
- the vector has all viral genes deleted. In still other examples, the vector induces an anti-tumor effect in the subject. In a further example, the vector expresses an oncogene, a tumor-suppressor gene, or a tumor-associated gene. In another example, the vector further contains a gene such as, for example, a co-stimulatory gene and cytokine gene.
- the plasmid DNA when the vector is a DNA/adeno virus complex, the plasmid DNA can be complexed with adenovirus vectors utilizing a suitable agent such as, for example, polyethylenimine or polylysine.
- a suitable agent such as, for example, polyethylenimine or polylysine.
- the adenovirus vector within the complex can be either "live” or “killed” by UV irradiation.
- the UV-inactivated adenovirus vector can be used as a receptor-binding ligand and an endosomolysis agent for facilitating DNA-mediated transfection.
- the DNA/adenovirus complex can be used to transfect epidermal or mucosal cells of a subject in a noninvasive mode for use as an immunizing agent.
- DNA/liposome complexes can be used as the vector to transfect epidermal or mucosal cells of a subject in a noninvasive mode for use as an immunizing agent.
- the vector can code for immunomodulatory molecules that can act as an adjuvant to provoke a humoral and/or cellular immune response.
- immunomodulatory molecules include, but are not limited to, cytokines, co-stimulatory molecules, or any molecules that may change the course of an immune response.
- the vaccines used herein can take any number of forms, and are not limited to any particular genetic material coding for any particular polypeptide. All forms of vectors including viral vectors, bacterial vectors, protozoan vectors, transposons, retrotransposons, virus-like-particles, and DNA vectors, when used as noninvasive vaccine carriers, are contemplated herein. 3. Pharmaceutical Compositions
- any of the alkyl glycosides and vaccines described above can be combined with at least one pharmaceutically-acceptable carrier to produce a pharmaceutical composition
- the pharmaceutical composition comprises an alkyl glycoside and a vector.
- the pharmaceutical compositions can be prepared using techniques known in the art.
- the composition is prepared by admixing the alkyl glycoside and/or vaccine with a pharmaceutically-acceptable carrier.
- admixing is defined as mixing the two components together. Depending upon the components to be admixed, there may or may not be a chemical or physical interaction between two or more components.
- Pharmaceutically-acceptable carriers are known to those skilled in the art.
- compositions may include carriers, thickeners, diluents, buffers, preservatives, surface active agents and the like in addition to the molecule of choice.
- Pharmaceutical compositions may also include one or more active ingredients such as antimicrobial agents, antiinflammatory agents, anesthetics, and the like.
- Preparations for administration include sterile aqueous or non-aqueous solutions, suspensions, and emulsions.
- non-aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media.
- Parenteral vehicles if needed for collateral use of the disclosed compositions and methods, include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's, or fixed oils.
- Intravenous vehicles if needed for collateral use of the disclosed compositions and methods, include fluid and nutrient replenishers, electrolyte replenishers (such as those based on Ringer's dextrose), and the like. Preservatives and other additives may also be present such as, for example, antimicrobials, anti-oxidants, chelating agents, and inert gases and the like.
- Formulations for topical administration may include ointments, lotions, creams, gels, drops, ointments, suppositories, sprays (e.g., aerosols), liquids and powders.
- Conventional pharmaceutical carriers, aqueous, powder or oily bases, thickeners and the like may be necessary or desirable.
- the alkyl glycoside and vaccine can be admixed under sterile conditions with a physiologically acceptable carrier and any preservatives, buffers, propellants, or absorption enhancers as may be required or desired.
- the formulation can be in the form of a drop, a spray, an aerosol, or a sustained release format.
- the spray and the aerosol can be achieved through use of the appropriate dispenser.
- the sustained release format can be an ocular insert, erodible microparticulates, swelling mucoadhesive particulates, pH sensitive microparticulates, nanoparticles/latex systems, ion- exchange resins and other polymeric gels and implants (e.g., Ocusert, which is available from Alza Corp. (Mountain View, California) and those disclosed in International Publication No. WO 91/19481). These systems maintain prolonged drug contact with the absorptive surface preventing washout and nonproductive drug loss.
- alkyl glycoside and vaccine in a specified case will vary according to the specific compounds being utilized, the particular compositions formulated, the mode of application, and the particular situs and subject being treated. Dosages for a given host can be determined using conventional considerations, e.g., by customary comparison of the differential activities of the subject compounds and of a known agent, e.g., by means of an appropriate conventional pharmacological protocol. Physicians and formulators, skilled in the art of determining doses of pharmaceutical compounds, will have no problems determining dose according to standard recommendations (Physicians Desk Reference, Barnhart Publishing, 1999. B. Methods of Use
- noninvasive as used herein is defined as any technique that does not involve the penetration of the tissue of the subject with a device in order to deliver the vaccine.
- noninvasive does include any pretreatment of the subject prior to administration of the alkyl glycoside and vaccine to the subject.
- the skin of a subject can be brushed with an abrasive (e.g., a pad or brush) to make the skin more permeable to the alkyl glycoside and vaccine.
- an abrasive e.g., a pad or brush
- step (b) contacting the skin of the subject with an effective amount of the vaccine, whereby the amount of vaccine that penetrates the skin of the subject is greater after step (b) when compared to the amount of vaccine that penetrates the skin in the absence of step (a).
- described herein is a method for enhancing an immune response in a subject, comprising: (a) contacting the skin of the subject with an effective amount of an alkyl glycoside; and
- step (b) contacting the skin of the subj ect with an effective amount of a vaccine whereby the immune response is greater after step (b) when compared to the immune response in the absence of step (a).
- a method for inducing or potentiating a therapeutic response in a subject comprising:
- a method for inducing or potentiating an immune response or a therapeutic response in a subject comprising:
- step (b) contacting the mucosal surface of the subject with an effective amount of the vaccine, whereby the amount of vaccine that penetrates the mucosal surface of the subject is greater after step (b) when compared to the amount of vaccine that penetrates the mucosal surface in the absence of step (a), wherein the contacting steps (a) and (b) are not performed by inhalation.
- a method for enhancing an immune response in a subject comprising:
- step (b) contacting the mucosal surface of the subject with an effective amount of a vaccine, whereby the immune response is greater after step (b) when compared to the systemic immune response in the absence of step (a), and wherein the contacting steps (a) and (b) are not performed by inhalation.
- a method for inducing or potentiating a therapeutic response in a subject comprising: (a) contacting the mucosal surface of a subj ect with an effective amount of an alkyl glycoside; and
- a method for inducing or potentiating an immune response or a therapeutic response in a subject comprising:
- a method for increasing the penetration of a vector through the mucosal surface of a subject comprising:
- step (b) contacting the mucosal surface of the subject with an effective amount of the vector, whereby the amount of vector that is penetrates the mucosal surface is greater after step (b) when compared to the amount of vector that is absorbed in the absence of step (a).
- a method for enhancing an immune response in a subject comprising:
- step (a) contacting the mucosal surface of the subject with an effective amount of an alkyl glycoside; and (b) contacting the mucosal surface of the subject with an effective amount of a vector, whereby the immune response is greater after step (b) when compared to the systemic immune response in the absence of step (a).
- a method for inducing or potentiating a therapeutic response in a subject comprising:
- the methods described herein can induce or potentiate an immune response in a subject (e.g., systemic or local immune response) or therapeutic response (e.g., systemic or local therapeutic response).
- induce means initiating a desired response or result that was not present prior to the induction step.
- potentiate means sustaining a desired response at the same level prior to the potentiating step or increasing the desired response over a period of time.
- enable includes both inducing and potentiating a desired response.
- subject is meant an individual.
- the subject can include any vertebrate.
- the subject can be a mammal such as a primate or a human.
- subject can also include domesticated animals including, but not limited to, cats, dogs, etc., livestock (e.g., cattle, horses, pigs, sheep, goats, etc.), and laboratory animals (e.g., mouse, rabbit, rat, guinea pig, etc.).
- livestock e.g., cattle, horses, pigs, sheep, goats, etc.
- laboratory animals e.g., mouse, rabbit, rat, guinea pig, etc.
- the subject can also include birds (e.g., chickens, ducks, or turkeys), reptiles, amphibian, or fish.
- the administration of the alkyl glycoside to the subject enhances or increases the desired effect the vaccine can impart (e.g., immunization of the subject) when compared to administering the vaccine in the absence of the alkyl glycoside.
- an immune response one can determine a resulting immune response by any of several methods, including detecting the presence of antibodies specific for the antigen, determining T-cell proliferative response, determining a cytotoxic T-cell response, among other detection means known in the art. Such methods are known in the art and described herein.
- immune response is meant any response of the immune system, including but not limited to cellular as well as local and systemic humoral immunity, such as CTL responses, including antigen-specific induction of CD8+ CTLs, helper T-cell responses including T-cell proliferative responses and cytokine release, and B-cell responses including antibody response.
- therapuetic response is meant as the prevention or alleviation of a disease or symptoms of disease due to administration of a vaccine.
- the flu vaccine either prevents a subject from influenza infection or in the case of infection attenuates the infection and consequent symptoms.
- a rabies vaccine administered after transmission of virus prevents progression of disease.
- the use of the alkyl glycoside in combination with a vaccine can increase the penetration (i.e., absorption) of the vaccine into skin or mucosal surface two times, three times, four times, five times, six times, seven times, eight times, nine times, or ten times more when compared to administration of the vaccine in the absence of the alkyl glycoside.
- the alkyl glycoside can increase the immunization or therapeutic effect two times, three times, four times, five times, six times, seven times, eight times, nine times, or ten times more when compared to administration of the vaccine in the absence of the alkyl glycoside.
- the alkyl glycoside and vaccine can be administered to a subject sequentially or concurrently.
- the alkyl glycoside can be administered to the subject first followed the administration of the vaccine.
- the alkyl glycoside and vaccine can be administered in the same or different media.
- the alkyl glycoside and vaccine can be admixed to form a composition, followed by administration of the composition to the subject.
- the alkyl glycoside and the vaccine can be administered to the subject in a number of ways depending on whether local or systemic treatment is desired, and on the area to be treated.
- administration can be topical, including ophthalmically, vaginally, rectally, or intranasally.
- the mode of administration can be by inhalation.
- the mode of administration does not involve the use of needles or syringes.
- the alkyl glycoside and the vaccine are administered in the form of a drop, a spray, an aerosol, a sustained-release format, or a combination thereof.
- the administration step further comprises disposing the vaccine such as, for example, a genetic vector containing the gene of interest on a delivery device and applying the device having the genetic vector containing the gene of interest therein to the skin of the subject.
- the vaccine such as, for example, a genetic vector containing the gene of interest
- the alkyl glycoside and the vaccine are administered to the subject by applying the alkyl glycoside and vaccine to the skin of the subject.
- the alkyl glycoside and the vaccine can be administered to the subject by direct transfer of the genetic material to the skin without utilizing any devices, or by contacting naked skin utilizing a bandage or a bandage-like device.
- the alkyl glycoside and vaccine are in aqueous solution. Not wishing to be bound by theory, it is believed that the alkyl glycoside makes the skin more permeable to the vaccine and facilitates the ability of the vaccine to pass through the stratum corneum of the skin so that the vaccine can more efficiently reach the epidermal and dermal layers.
- any cell of a subject such as, for example, an epidermal or mucosal cell that can be contacted with the alkyl glycoside and vaccine using noninvasive techniques can be used to induce or potentiate an immune or therapeutic response.
- contacting is meant an instance of exposure by close physical contact of at least one substance to another substance.
- contacting can include contacting a substance, such as a pharmacologic agent, with a cell.
- a cell can be contacted with a test compound, for example, an alkyl glycoside and vaccine, by adding the agent to the culture medium (by continuous infusion, by bolus delivery, or by changing the medium to a medium that contains the agent) or by adding the agent to the extracellular fluid in vivo (by local delivery, systemic delivery, intravenous injection, bolus delivery, or continuous infusion).
- the contacting step can be performed in vitro or ex vivo.
- the duration of contact with a cell or group of cells is determined by the time the test compound is present at physiologically effective levels or at presumed physiologically effective levels in the medium or extracellular fluid bathing the cell.
- the methods described herein contemplate the use of one or more alkyl glycosides and vaccines.
- two or more vaccines can be admixed with one or more alkyl glycosides to produce a composition to be administered to a subject.
- one or more alkyl glycosides can be administered first followed by the administration of two or more different vaccines.
- the noninvasive methods described herein can also be used in combination with other therapies that utilize invasive techniques.
- a vaccine can be administered to a subject using invasive techniques prior to or after the noninvasive administration of alkyl glycoside and vaccine.
- the methods described herein also contemplate periodic administration of the alkyl glycoside and vaccine such as in the course of therapy or treatment for a condition and/or booster administration of immunological compositions and/or in prime-boost regimens, where the time and manner for sequential administrations can be ascertained without undue experimentation.
- the quantity of alkyl glycoside and vaccine to be administered will vary depending upon the alkyl glycoside and vector selected, the mode of administration, and the subject.
- effective amount is meant a therapeutic amount needed to achieve the desired result or results, e.g., increasing the expression of a gene.
- the amount of alkyl glycoside is in the range of from about 0.01% to about 10%, from about 0.01% to about 9%, from about 0.01% to about 8%, from about 0.01% to about 7%, from about 0.01% to about 6%, from about 0.01% to about 5%, from about 0.01% to about 4%, from about 0.01% to about 3%, from about 0.01% to about 2%, from about 0.01% to about 1%, from about 0.01% to about 0.9%, from about 0.01% to about 0.8%, from about 0.01% to about 0.7%, from about 0.01% to about 0.6%, from about 0.01% to about 0.5%, from about 0.025% to about 5%, from about 0.05% to about 0.5%, or from about 0.125% to about 0.5% by weight of the composition.
- the amount of vaccine can vary from one or a few to a few hundred or thousand micrograms, e.g., 1 ⁇ g to 1 mg, 1 ⁇ g to 0.75 mg, 1 ⁇ g to 0.5 mg, 1 ⁇ g to 0.1 mg.
- the amount of vaccine to be administered is from 100 ng/kg to 100 mg/kg, 100 ng/kg to 75 mg/kg, 100 ng/kg to 50 mg/kg, 100 ng/kg to 10 mg/kg of body weight per day.
- the amount of alkyl glycoside and vaccine to be administered can be readily determined using techniques known in the art.
- a gene product can be isolated from cells from a subject, where the vaccine such as, for example, a vector, was administered to a subject using the compositions and methods described herein.
- the immunological products, antibodies, or expressed products obtained by the methods described herein can be expressed in vitro and used in a manner where immunological products, expressed products, or antibodies are typically used.
- the cells that express the immunological product, expressed product, or antibody can be employed in vitro and/or ex vivo applications such as, for example, in diagnostics, assays, and ex vivo therapy.
- WO 99/60164 and WO 98/00166 disclose the use of cells that express the gene product and/or immunological response, expanded in vitro, and reintroduced into the host or animal.
- expressed antibodies or gene products that are produced and isolated from the methods described herein can be administered in compositions in a manner similar to the administration of subunit epitopes, antigens, therapeutics, or antibodies to induce or potentiate an immune or therapeutic response.
- the delivery device can be a bandage, a patch, an adhesive dressing, a spot-on formulation and its application devices, a pour-on formulation and its application devices, a roll-on formulation and its application devices, a shampoo formulation and its application devices, and the like.
- Pour-on and spot-on formulations are described in U.S. Patent Nos. 6,010,710 and 5,475,005.
- a roll-on device is described in U.S. Patent No. 5,897,267. The contents of these documents are hereby incorporated by reference for their teachings.
- the device is an adhesive bandage.
- a device for non-invasive vaccination includes a non-allergenic, skin adhesive patch having a bleb disposed therein.
- the patch is further composed of plastic, approximately 1 cm in diameter.
- the vaccine composition can be disposed within the bleb.
- the bleb contains approximately 1 mL of vaccine (as liquid, lyophilized powder with reconstituting fluid, and variants thereof).
- the surface of the bleb in contact with the skin is intentionally weaker than the opposite surface, such that when pressure is applied to the opposite surface, the lower surface breaks and releases the vaccine contents of the bleb onto the skin.
- the plastic patch traps the vaccine against the skin surface.
- the alkyl glycoside can be applied to the skin followed by the application of the patch or, in the alternative, the patch can contain the alkyl glycoside and the vaccine.
- kits for the preparation of compositions for the noninvasive delivery of vaccines include the alkyl glycoside, the vaccine and an optional pharmaceutically-acceptable carrier or diluent.
- the components can be in separate containers each in its own packaging, and the kit can optionally include instructions for admixture of the ingredients and/or administration of the composition.
- the kit can also optionally contain a delivery device.
- reaction conditions e.g., component concentrations, desired solvents, solvent mixtures, temperatures, pressures and other reaction ranges and conditions that can be used to optimize the product purity and yield obtained from the described process. Only reasonable and routine experimentation will be required to optimize such process conditions.
- mice were immunized by topical application of an E. coli vector expressing tetC mixed with TDM at the indicated concentration and sera were analyzed 2 months postimmunization. No increase over the control was observed when the skin was not ablated by brushing.
- mice were immunized by topical application of an adenovirus vector expressing tetC mixed with TDM at the indicated concentration, and sera were analyzed 1 month postimmunization. No significant increase over the control was observed.
- Mouse skin was ablated by mechanical brushing prior to topical application of TDM, followed by incubation of TDM at the indicated concentration with naked skin for 15 min, followed by examination of the cutaneous architecture under an electron microscope.
- Figure 2 shows the permeablization of the stratum corneum by the TDM surfactant. Tests of the ability of TDM to enhance the potency of an E. coli- vectored epicutaneous vaccine when co-administered with ablation of the stratum corneum were also conducted.
- mouse skin was ablated by mechanical brushing prior to topical application of TDM at the indicated concentration. After incubation for 15 min, TDM was removed and mice were immunized by topical application of an E. coli vector expressing tetC, and sera were analyzed 2 weeks postimmunization. The results are shown in Figure 3.
Abstract
Description
Claims
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Also Published As
Publication number | Publication date |
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US20060233761A1 (en) | 2006-10-19 |
CN101163494A (en) | 2008-04-16 |
JP2008531581A (en) | 2008-08-14 |
EP1863511A2 (en) | 2007-12-12 |
MX2007010306A (en) | 2007-09-26 |
US7524510B2 (en) | 2009-04-28 |
AU2006216671A1 (en) | 2006-08-31 |
WO2006091722A3 (en) | 2007-07-12 |
KR20070120970A (en) | 2007-12-26 |
CA2598806A1 (en) | 2006-08-31 |
BRPI0607474A2 (en) | 2016-11-01 |
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