Influenza virus evolution: A tale of birds, pigs, and other mammals.

Transcription

1 Vaccination: an evolutionary engine for species? Les Pensieres November 26 th, 2013 Influenza virus evolution: A tale of birds, pigs, and other mammals. Albert Osterhaus DVM PhD Professor/Head Department of Virology Erasmus University/MC (NL) Professor Wildlife Virology & Virus Discovery Utrecht Univ. (NL) Chair Artemis Wildlife Health Institute (Europe) Chair zoonoses centre Hannover TiHo (D) CSO Viroclinics-Bioein Sciences BV (NL) Board member Protein Sciences (USA) Chair ESWI (Europe)

2 Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi Arabia. Zaki et al., NEJM 2012 MERS-CoV cases per country: WHO October 2013 A total of >150 cases reported of which approximately 50 % fatal Limited human-to-human transmission

3 Influenza A viruses Subtype divisions of influenza A viruses made on basis of HA (1-16) and NA (1-9) antigens (all found in migratory birds) Genomic nucleic acid consists of H17/18 N10/11 8 RNA segments, allowing gene reassortment during mixed infection Virulence of influenza virus in birds depends on presence of presence of series of basic amino acids adjacent to cleavage site of the HA polypeptide (H5 and H7 subtypes only)

4 De Jong et al., Nature 1997 Claas & Osterhaus, Nat.Med 1998 Fouchier et al., J Virol., 2005 Munster et al., EID., 2005 Olsen et al., Science., 2006 Aquatic wild birds Influenza A virus reservoir H17/18 N10/11

5 Avian influenza A virus surveillance - HA and NA subtypes - Fouchier et al., J Virol., 2005 Munster et al., Emerg Inf Dis., 2005 Olsen et al., Science., 2006 H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 H16 N1 X X X X N2 X X X X X X X X X N3 X X X X X X X N4 X X N5 X X X X X N6 X X X X X X X X N7 X X X X X N8 X X X X X X X N9 X X X X X X X Subtypes detected in wild birds globally Subtypes detected in wild birds in our own studies (Northern Europe)

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7 Clinical disease in diving ducks only (Keawcharoen et al Emerg Infect Dis) Species No. Mild Severe inoculated signs signs Tufted duck Pochard Mallard Teal Wigeon Gadwall IHC H&E no spreading? spreading?

8 Pathology: naturally and experimentally HPAI-H5N1 infected cats Kuiken et al., Science (2004); Keawcharoen et al.,eid (2004); Rimmelzwaan et al. Am. J. Pathol. (2006) Kuiken et al., Nature 2006 Severe necrosis and inflammation in: Lung Brain Heart Kidney Liver Small intestine Adrenal gland Humans Diarrhea, virus in feces Encephalitis, virus in CSF Apisarnthanarak et al, EID 2004, 10:1321; De jong et al, N Eng J Med 2005, 352:686

9 Human cases since December update March 12, Azerbaijan Bangladesh Cambodia China Djibouti Egypt Indonesia Iraq Laos Myanmar Nigeria Pakistan Thailand Turkey Vietnam Total Laboratory confirmed cases Deaths To date: Number of cases Cumulative number of cases Cases Fatal cases Year CFR: 59%!

10 Attachment to upper or lower respiratory tract Seasonal H3N2 Pandemic H1N1 HPAIV H5N1 van Riel et al.,science 2006 van Riel et al., Am J Pathol 2007 van Riel et al., Am J Pathol 2009 van Riel et al., Am J Pathol 2010 van Riel et al.,plos Path transmission HPAIV H5N1

11 Transmission set up - Ferrets - - Munster et al., Science 2009 Herfst et al., Science 2012 Russel et al., Science 2012 Imai et al., Nature 2012

12 Virus passaging in ferrets (P1 to P10, passages 1 to 10). S Herfst et al. Science 2012;336: Published by AAAS

13 Airborne transmission of A/H5N1 viruses in ferrets S Herfst et al. Science 2012;336:

14 Epidemiological curve of confirmed cases for influenza A (H7N9) reported to WHO, by day, 2013 Today: 138 cases, 45 deaths Gao et al., 2013

15 Continuous pandemic threat: - Avian H7N9 viruses - Source: WHO

16 A(H7N9) virus mutations - Mammalian adaptation? - Kageyama et al. Eurosurv Adaptation markers in bold Adaptation markers associated with airborne transmission of A/H5N1 circled

17 A(H7N9) virus & antiviral drugs - A single case of resistance (Shanghai) - H7N9 Known NAI resistance K M (µm) a Neuraminidase inhibitor susceptibility a 50% inhibitor constant (nm) Oseltamivir (Tamiflu) Zanamivir (Relenza) Anhui/1/13 E119 R ± ± ± 0.02 Shanghai/1/13 E K > ± 1.14 (x10 3) 28.1 ± 5.0 a 50% inhibitor constants (IC50) were determined in duplo. Michaelis-Menton constants (K M ) were performed in triplicates using MUNANA as a substrate. Synthetic HA/NA genes from Richard Webby, St Jude Data by Erhard van der Vries

18 HPAI-H5N1 vs LPAI-H7N9 viruses and human disease (major pointers) H5N1 H7N9 H/LPAI HPAI LPAI Origin/source poultry birds (poultry, quail, pigeon?) Clades numerous one/few Start Spread Eurasia/Africa China (Taiwan) Speed slower (650/10yrs) faster (130/3months) Timing (?) October-April February-? Hospitalized (n) Deaths (n) 380 (~55%) 45 (~30%) Median age (y) ~25 ~60 Sex prevalence (male?) male

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20 Amsterdam 1957

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22 H7N9 replication pathological changes in the lungs of ferrets Munster et al., Science 2009 Del Giudice et al., Science TM 2009 Chutinimitkul et al., J.Virol 2010 Herfst et al., Vet.Pathol Bosch et al., J.Virol Kreijtz et al., J.Gen.Virol v.d.brand et al., JID 2010 v.d.brand et al., J.Virol 2010 v.d.brand et al., J.Virol 2011 Bodewes et al.,am J Pathol Kreijtz et al., Vaccine 2013

23 Prolonged influenza A/H1N1 virus infection H275Y H275Y H275Y H275Y H275Y van der Vries et al PLoS Path

24 van der Vries et al PLoS Path Prolonged shedding and rapid emergence of resistance Immunocompetent Immunocompromised Immunocompromised + Oseltamivir Nose Throat Nose Throat Nose Throat

25 Distribution of VE point estimates according to alternative outcome definitions. Beyer et al., 2013 Vaccine: Cochrane revisited

26 Pandemic influenza vaccines - Key issues - Efficacy/safety clinical trials with prototype vaccines Production capacity limited Response time!! >6 months

27 Virus titer (Log TCID 50 /gr with CI95) Viral load in the lungs by culture Day 4 post-challenge (A/The Netherlands/602/09) 7.0 6/6 6/ / /6 0/5 1/5 0/6 0/ x 15 µg Non-adj 2x 15 µg 1x 3.75 µg 2x 3.75 µg 1x 1.9 µg 2x 1.9 µg 2x 1.9 µg AS03 A AS03 A AS03 A AS03 A AS03 A AS03 B 2x PBS

28 Heterosubtypic immunity - Putative correlates of protections, antibodies other than HI - M2-specific antibodies M2 protein is relatively conserved Minor antigen on virus particles, expressed on virus-infected cells Protective effect has been demonstrated in animal models After hyper-immunization or passive administration of M2-specific antibodies HA-stem specific antibodies Relatively conserved Protective effect demonstrated after hyperimmunization or passive administration Cytotoxic T lymphocytes to conserved proteins e.g. NP and M1. Transfer of post-infection serum to naive recipient mice does not confer heterosubtypic immunity: No major role for antibodies to NA, M2, NP or HA stem

29 Influenza proteins as targets for future vaccine development HA NA M2e NP M1 NS1 PB1 PB2 PA Multimeric presentation? Conserved stem epitopes? Adjuvant use? Vector use? Antibody induction (HAI, VN, ADCC:,HA,NA, M2e) T cell induction (CD4; CD8, CTL, Th, T reg; NP, M1, NS1, PB1, PB2 and PA) Protection in ferrets Clinical testing

30 MVA as a vector for flu vaccines Preclinical testing MVA-based vaccines -H5N1: Mice, macaques (H1N1): Ferrets - Kreijtz et al. J. Inf. Dis. 2007, 195: Kreijtz et al. PLoS One. 2009, 12;4(11):e7790 Kreijtz et al. J. Inf. Dis. 2009, 199: Kreijtz et al. J. Gen. Virol. 2010, 91: Phase I/IIa human trial

31 Gross pathology Reduction of virus replication -lungs- A/VN/1194/04 A/IND/5/05 Kreijtz et al. J. Inf. Dis. 2008

32 CONCLUSIONS: NEW INFLUENZA A VIRUSES identified with increasing frequency in animals and humans due to a complex mix of predisposing factors due to more advanced molecular techniques in our changing and globalizing society new influenza viruses are regularly introduced from the avian/swine world

33 CONCLUSIONS: NEW INFLUENZA A VIRUSES identified with increasing frequency in animals and humans due to a complex mix of predisposing factors due to more advanced molecular techniques in our changing and globalizing society new influenza viruses are regularly introduced from the avian/swine world International collaboration and coordination using all available technology (classical and novel!!!) are of key importance for their future control!!!

34 Influenza research at Erasmus MC - The team leaders - Prof. R. Fouchier Prof. T. Kuiken Prof. M. Koopmans Prof. C. Boucher Mol.Virology Pathology Epidemiology Antiviral research Drs A. van der Eijk / P. Fraaij Clinical research Prof. G. Rimmelzwaan Dr. B. Haagmans Drs. M. Schutten / S.Pas Dr. A. Andeweg Dr. J. Kreijtz Dr. K.Stittelaar VCB Viro-Immunology Viro-pathogenesis Diagnostics Genomics Vaccinology Animal models EU FP7: NOVAFLU; FLUBIRD; ERC; ARCAS: FLUPIG; EMPERIE; ANTIGONE. NIAID: CEIRS. NWO: VIRGO; FES.