Winsnes R, Sesardic D, Daas A, Behr-Gross M-E
Norwegian Medicines Agency (NoMA), Oslo, Norway.
Pharmeuropa Bio. 2004 Jan;2003(2):35-68.
A collaborative study on the evaluation of an alternative functional assay, the Vero cell method, to the Ph. Eur. in vivo challenge procedures for potency determination of diphtheria toxoid in 6 different combined vaccines was initiated in January 2001. The study was an extension of a previous study for the validation of serological methods for potency testing of tetanus toxoid vaccines for human use. To allow interim evaluation of test results and to monitor study progress, the project was divided into three consecutive phases. The results of Phase I and II studies are presented in this report. Pre-validation (Phase I) study, performed in two laboratories, indicated that comparable diphtheria potency estimates were obtained in the Ph. Eur. direct intradermal challenge assay in guinea pigs, in Vero cell assay and in indirect ELISA for five vaccines of different potencies (range of estimates: ca. 20-200 IU/ml). The correlation coefficients between the challenge assay and the Vero cell assay corresponded to those between the challenge assay and ELISA, confirming that the antibodies play an important role in protection and that predominantly protective/neutralising antibodies are present in guinea pigs, at the time point investigated. It was observed, for Vero cell assays, that about 16-35 (9-28 in Phase II study) fold lower titre of individual serum samples were obtained when using equine, rather than guinea pig reference serum. The study also provided preliminary information that sera from the same guinea pigs may be used for potency determination of both diphtheria and tetanus toxoid components of vaccines. In Phase II, another five laboratories analysed a subset of the vaccines included in Phase I study plus an additional vaccine. Four laboratories performed the lethal challenge assay and one laboratory carried out the intradermal challenge assay. All laboratories also performed the Vero cell assay and both ELISA for diphtheria antitoxin and ELISA for tetanus antitoxin. One laboratory also performed the tetanus ToBI assay. The correlation coefficient (r) between Vero cell assay and ELISA for diphtheria antitoxin ranged from 0.76 to 0.91 in the different laboratories. The correlation between diphtheria serological assays and challenge assays were confirmed satisfactory as ca. 90 per cent of serum-estimates lead to correct prediction of mortality. All laboratories had identical rankings of the vaccines in all serological assays and in the valid challenge assays. The ranking order was identical to assumed/provided potency for the highest and the lowest vaccine. Two of the vaccines had an inversion in some assays and laboratories. As these two vaccines have almost identical potencies in all assays, these inversions are not significant. As the vaccine doses were optimised for the diphtheria component, serum anti-tetanus toxoid/toxin activities varied widely between the vaccines, making it questionable to apply a parallel line model to calculate exact potencies. However, the dose levels used showed a clear regression and good linearity in general. DTaP vaccines containing the IPV component did not always meet the present Ph. Eur. requirements in the serological assays. It should be further investigated in the Phase III study if this is a general feature of such combined vaccines. Preliminary investigations on samples from two laboratories indicate that the neutralising activity of type 1, 2 and 3 polioviruses can also be detected, in a dose-dependent way. Further studies are in progress with serum samples from other laboratories. In the light of results obtained in the first two phases, it is recommended to proceed with Phase III study to investigate reliability of the in vitro assays. In Phase III it will also be further investigated whether the serological assays for D and T components are suitable for the control of the multi-component vaccines currently marketed in Europe.
2001年1月启动了一项合作研究,旨在评估一种替代功能测定法(Vero细胞法),以替代欧洲药典中用于测定6种不同联合疫苗中白喉类毒素效力的体内攻击程序。该研究是先前一项关于人用破伤风类毒素疫苗效力测试血清学方法验证研究的扩展。为了能够对测试结果进行中期评估并监测研究进展,该项目分为三个连续阶段。本报告介绍了第一阶段和第二阶段研究的结果。在两个实验室进行的预验证(第一阶段)研究表明,对于五种不同效力的疫苗(估计范围:约20 - 200 IU/ml),在欧洲药典的豚鼠直接皮内攻击试验、Vero细胞试验和间接ELISA中获得了可比的白喉效力估计值。攻击试验与Vero细胞试验之间的相关系数与攻击试验与ELISA之间的相关系数相对应,证实了抗体在保护中起重要作用,并且在所研究的时间点,豚鼠体内主要存在保护性/中和性抗体。对于Vero细胞试验,观察到当使用马血清而非豚鼠参考血清时,单个血清样本的滴度大约低16 - 35倍(第二阶段研究中为9 - 28倍)。该研究还提供了初步信息,即来自同一只豚鼠的血清可用于测定疫苗中白喉和破伤风类毒素成分的效力。在第二阶段,另外五个实验室分析了第一阶段研究中包含的部分疫苗以及一种额外的疫苗。四个实验室进行了致死性攻击试验,一个实验室进行了皮内攻击试验。所有实验室还进行了Vero细胞试验以及白喉抗毒素ELISA和破伤风抗毒素ELISA。一个实验室还进行了破伤风ToBI试验。在不同实验室中,Vero细胞试验与白喉抗毒素ELISA之间的相关系数(r)在0.76至0.91之间。白喉血清学试验与攻击试验之间的相关性得到确认,令人满意,因为约90%的血清估计值能够正确预测死亡率。在所有血清学试验和有效的攻击试验中,所有实验室对疫苗的排名相同。排名顺序与最高和最低效力疫苗的假定/给定效力相同。其中两种疫苗在某些试验和实验室中出现了排名颠倒。由于这两种疫苗在所有试验中的效力几乎相同,这些颠倒并不显著。由于疫苗剂量是针对白喉成分进行优化的,不同疫苗之间血清抗破伤风类毒素/毒素活性差异很大,因此应用平行线模型计算确切效力存在疑问。然而,所使用的剂量水平总体上显示出明显的回归和良好的线性关系。含有IPV成分的DTaP疫苗在血清学试验中并不总是符合现行欧洲药典的要求。在第三阶段研究中应进一步调查这是否是此类联合疫苗的普遍特征。对来自两个实验室的样本进行的初步调查表明,1型、2型和3型脊髓灰质炎病毒的中和活性也可以以剂量依赖的方式检测到。正在对来自其他实验室的血清样本进行进一步研究。根据前两个阶段获得的结果,建议进行第三阶段研究以调查体外试验的可靠性。在第三阶段,还将进一步研究D和T成分的血清学试验是否适用于控制目前在欧洲市场上销售的多成分疫苗。