Universal flu vaccine

Influenza vaccines are required every year due to the diversity of flu viruses and variable efficacy of vaccines to prevent them. By creating a universal vaccine the need to recreate a yearly shot is eliminated. The efficacy of a vaccine refers to the protection among a broad variety of influenza strains. Events such as antigenic shift have created pandemic strains such as the H1N1 outbreak in 2009. The research required every year to isolate a potential popular viral strain and create a vaccine to defend against it is a six month long process. During that time the virus can mutate making the vaccines less effective.[4]

High risk populations including the elderly and those with chronic disease often have limited immunity towards the flu from vaccines. The vaccines have been proven to be 30% to 70% effective in preventing hospitalization from the flu or pneumonia.

On average influenza vaccine efficacy is 60% among the general population that receive yearly vaccinations.

A universal vaccine could be reproduced at high levels and eliminate availability and supply issues of current vaccines.[5] There is conflicting evidence on whether it would cut costs.[6]

Influenza A is involved in most strains of the flu. It is an enveloped RNA virus. It has a protein membrane containing the glycoproteins hemagglutinin (HA) and neuraminidase (NA) which are used by the virus to enter a host cell and to release itself and its copies from the host cell. Each strain of the influenza virus has a different pattern of glycoproteins; the glycoproteins themselves have variability as well.[7]

A prototype for a universal flu vaccine. The blue protein scaffold supports eight green influenza hemagglutinin proteins arrayed to present antibody binding sites

In 2008, Acambis announced work on a universal flu vaccine (ACAM-FLU-ATM) based on the less variable M2 protein component of the flu virus shell.[8] See also H5N1 vaccines.

In 2009, the Wistar Institute in Pennsylvania received a patent for using "a variety of peptides" in a flu vaccine, and announced it was seeking a corporate partner.[9]

In 2010, the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. NIH announced a breakthrough; the effort targets the stem, which mutates less often than the head of the viral HA.[10]

By 2010 some universal flu vaccines had started clinical trials.

• BiondVax identified 9 conserved epitopes of the influenza virus and combined them into a recombinant protein called Multimeric-001.[11][12] To date (August 2020), all seven of Biondvax's completed phase 2 human trials have demonstrated safety and significant levels of immunogenicity. More recently, Biondvax (NASDAQ:BVXV) has completed the second year of a two year, more than 12,400 participant pivotal phase 3 study of Multimeric-001, its candidate universal influenza vaccine. Biondvax expects results of its phase 3 trial between end of September and end of October 2020. Should it be successful, as have all seven previous phase 2 trials, it will be brought to market early next year (2021). Production of the Multimeric-001 is at their manufacturing plant in Jerusalem.
• ITS's fp01[13] includes 6 peptide antigens to highly conserved segments of the PA, PB1, PB2, NP & M1 proteins, and has started phase I trials.

DNA vaccines, such as VGX-3400X (aimed at multiple H5N1 strains), contain DNA fragments (plasmids).[14][15] Inovio's SynCon DNA vaccines include H5N1 and H1N1 subtypes.[16]

Other companies pursuing the vaccine as of 2009 and 2010 include Theraclone,[17] VaxInnate,[18] Crucell NV,[19] Inovio Pharmaceuticals,[14] Immune Targeting Systems (ITS)[20] and iQur.[21]

In 2019, Distributed Bio completed pre-clinical trials of a vaccine that consists of computationally selected distant evolutionary variants of hemagglutinin epitopes and is expected to begin human trials in 2021.[22]

In recent years, research has concerned use of an antigen for the flu hemagglutinin (HA) stem. Based on the results of animal studies, a universal flu vaccine may use a two-step vaccination strategy: priming with a DNA-based HA vaccine, followed by a second dose with an inactivated, attenuated, or adenovirus-vector-based vaccine.[23]

Some people given a 2009 H1N1 flu vaccine have developed broadly protective antibodies, raising hopes for a universal flu vaccine.[24][25][26]

A 'vaccine'/antigen based on the hemagglutinin (HA) stem was the first to induce 'broadly neutralizing' antibodies to both HA-group 1 and HA-group 2 influenza in mice.[27]

In July 2011, researchers created an antibody, which targets a protein found on the surface of all influenza A viruses called haemagglutinin.[28][29][30] FI6 is the only known antibody that binds (its neutralizing activity is controversial) to all 16 subtypes of the influenza A virus hemagglutinin and might be the lynchpin for a universal influenza vaccine.[28][29][30] The subdomain of the hemagglutinin that is targeted by FI6, namely the stalk domain, was actually successfully used earlier as universal influenza virus vaccine by Peter Palese's research group at Mount Sinai School of Medicine.[31]

Other vaccines are polypeptide based.[32]

A study from the Albert Einstein College of Medicine, where researchers deleted gD-2 from the herpes virus, which is responsible for HSV microbes entering in and out of cells showed as of May 1st, 2018 the same vaccine can be used in a modified way to contain hemagglutinin and invoke a special ADCC immune response.[33]

The Washington University School of Medicine in St.Louis and the Icahn School of Medicine in Mount Sinai in New York are using the glycoprotein neuraminidase as a targeted antigen in their research. Three monoclonal antibodies (mAB) were sampled from a patient infected with influenza A H3N2 virus. The antibodies were able to bind to the neuraminidase active site neutralizing the virus across multiple strains. The site remains the same with minimal variability across most of the flu strains. In trials using mice all three antibodies were effective across multiple strains, one antibody was able to protect the mice from all 12 strains tested including human and non-human flu viruses. All mice used in the experiments survived even if the antibody was not administered until 72 hours after the time of infection.[34]

Simultaneously the NIAID is working on a peptide vaccine that is starting human clinical trials in the 2019 flu season. The study will include 10,000 participants who will be monitored for two flu seasons. The vaccine will show efficacy if it is able to reduce the number of influenza cases in all strains.[35]

In 2019-2020, a vaccine candidate from Peter Palese's group at Mount Sinai Hospital emerged from a phase 1 clinical trial with positive results. By vaccinating twice with hemagglutinins that have different "heads" but the same membrane-proximal "stalk", the immune system is directed to focus its attention on the conserved stalk. [36][37]