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From the Rare Disease TAUG

From Stefan Konermann.

Rare Diseases Therapeutic Area User Guide, section 9.1, In Vivo Gene Therapy (Spinal Muscular Atrophy).

Email from Stephen on 2023-09-01.


RESOLVED  From the Rare Disease TAUG

  • Added to the SDTMIG v4.0.

IN PROGRESS From Stefan Konermann.


This example shows a Sars-CoV-2 vaccine study where the mechanism of delivery for the study vaccine antigenic component is based off of, and enabled by the viral vector technology. In this specific use-case, the transgene encoding the full-length, membrane-bound severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein is incorporated into a recombinant, replication-incompetent Human Adenovirus Type 26 (Ad26) Vector . The Sars-CoV-2 spike protein expressed by the transgene is the antigenic component of this vaccine. The "Ad26.COV2.S" study vaccine is then administered to patients. Neutralizing anti-vector antibodies (i.e. anti-Ad26 vector antibody) are closely monitored at baseline and post-study vaccine exposure visits. This is because the occurrence of the anti-vector antibodies could significantly hinder the Ad26 vector's ability to deliver the Sars-CoV-2 spike protein transgene to target cells, and consequently, either inhibits the planned vaccine therapy, or diminishes the efficacy of the study vaccine after administration.

In other words, the occurrence of the neutralizing anti-vector antibodies in response to the Ad26 vector component of the study vaccine is an "undesired and unwanted" humoral immune response, and is indicated by the ISCAT = ANTI-VECTOR ANTIBODY. In contrast, the neutralizing antibodies developed against the vaccine antigenic component Sars-CoV-2 spike protein, are "desired and wanted" humoral immune response as they are protective to the subject. These records are flagged by the ISCAT = STUDY VACCINE-RELATED IMMUNOGENICITY. The differing values in ISCAT help to make this important distinction.

For other similar examples such as vector-based gene therapies, refer to the "Rare Diseases Therapeutic Area User Guide", section 9.1, In Vivo Gene Therapy (Spinal Muscular Atrophy). Also refer to the SEND Implementation Guide v3.2, IS Example 9 for human coagulation factor IX (hFIX) transgene therapy.

Rows 1-3:Show the quantification of neutralizing antibodies to the Human Adenovirus Type 26 (Ad26) viral vector at baseline (row 1) and after vaccine exposure at visits 1 and 2 (rows 2-3). At baseline, the titer at <1:4 was considered to be negative to the anti-Ad26 vector neutralizing antibodies. Note the ISCAT = ANTI-VECTOR ANTIBODY, shows that these records reflect the 'undesired/unwanted" immune responses elicited by the viral vector component of the study vaccine.
Row 4:Shows the subject is negative to neutralizing antibodies against the Sars-CoV-2 virus at baseline, suggesting there was no prior infection with Sars-CoV-2.
Rows 5-6:Show the quantification of neutralizing antibodies to the Sars-CoV-2 spike protein at visits 1 and 2, after study vaccine exposure. Note the ISCAT = STUDY VACCINE-RELATED IMMUNOGENICITY, shows that these records reflect the "desired/wanted" immune responses elicited by the antigenic component of the study vaccine.

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RowSTUDYIDDOMAINUSUBJIDISSEQISREFIDISTESTCDISTESTISBDAGNTISCATISSCATISTSTDTLISORRESISSTRESCISSTRESNISSTRESUISSPECISMETHODVISITNUMVISITISDTC
1SARS2ISSARS20052112453333MBNABNeutralizing Microbial-induced AntibodyHUMAN ADENOVIRUS TYPE 26 VECTORANTI-VECTOR ANTIBODYHUMORAL IMMUNITY80% NEUTRALIZATION TITER<1:4NEGATIVE

SERUMFLUORESCENT ANTIBODY VIRUS NEUTRALIZATION ASSAY1BASELINE2018-06-20
2SARS2ISSARS20052212453333MBNABNeutralizing Microbial-induced AntibodyHUMAN ADENOVIRUS TYPE 26 VECTORANTI-VECTOR ANTIBODYHUMORAL IMMUNITY80% NEUTRALIZATION TITER1:2101:2101:210titerSERUMFLUORESCENT ANTIBODY VIRUS NEUTRALIZATION ASSAY2VISIT 12018-07-20
3SARS2ISSARS20052312453333MBNABNeutralizing Microbial-induced AntibodyHUMAN ADENOVIRUS TYPE 26 VECTORANTI-VECTOR ANTIBODYHUMORAL IMMUNITY80% NEUTRALIZATION TITER1:808080titerSERUMFLUORESCENT ANTIBODY VIRUS NEUTRALIZATION ASSAY3VISIT 22018-08-20
4SARS2ISSARS20052112456666MBNABNeutralizing Microbial-induced Antibody

SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2

STUDY VACCINE-RELATED IMMUNOGENICITY

HUMORAL IMMUNITY

80% NEUTRALIZATION TITER<1:10NEGATIVE

SERUMMICRONEUTRALIZATION ASSAY1BASELINE2018-06-20
5SARS2ISSARS20052212456666MBNABNeutralizing Microbial-induced Antibody

SARS-COV-2 SPIKE PROTEIN

STUDY VACCINE-RELATED IMMUNOGENICITY

HUMORAL IMMUNITY

80% NEUTRALIZATION TITER1:160160160titerSERUMMICRONEUTRALIZATION ASSAY2VISIT 12018-07-20
6SARS2ISSARS20052312456666MBNABNeutralizing Microbial-induced Antibody

SARS-COV-2 SPIKE PROTEIN

STUDY VACCINE-RELATED IMMUNOGENICITY

HUMORAL IMMUNITY

80% NEUTRALIZATION TITER1:450450450titerSERUMMICRONEUTRALIZATION ASSAY3VISIT 22018-08-20
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The example below shows a use-case of undesired, unwanted cellular immune responses toward a protein therapeutic delivered through the viral vector technology. In this case, T-cell responses to both the viral vector and the therapeutic peptide (which is translated from the transgene delivered by the viral vector), are measured before and after study treatment. The T cell responses to both the vector and the theraptucis peptide are considered as "undesired/unwanted", which are indicated by the ISCAT = VECTOR-INDUCED IMMUNOGENICITY, and ISCAT = ANTIDRUG T CELL-MEDIATED IMMUNOGENICITY.

Additionally, both anti-drug antibodies (ADA) and anti-drug T cell-mediated immunogenicity are considered as "anti-drug immunogenicity".

Rows 1-2:Show the measurement of interferon gamma (ISMSCBCE) cytokine-secreting T cells (ISTEST) at baseline in response to stimulation by the viral vector and the therapeutic peptide (translated from the transgene delivered by the vector) in ISCNDAGT, respectively, prior to study treatment.
Rows 3-4:Show the measurement of interferon gamma (ISMSCBCE) cytokine-secreting T cells (ISTEST) at visit 1 in response to stimulation by the viral vector and the therapeutic peptide (translated from the transgene delivered by the vector) in ISCNDAGT, respectively, after study treatment.

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Row

STUDYID

DOMAIN

USUBJID

ISSEQ

ISREFID

ISTESTCD

ISTEST

ISMSCBCE

ISTSTCNDISCNDAGTISCATISSCAT

ISORRES

ISORRESU

ISSTRESC

ISSTRESN

ISSTRESU

ISSPEC

ISMETHOD

VISITNUMVISIT

ISDTC

1

RSV1230

IS

RSV1230-011

1

13998

CYKSCTCL

Cytokine-secreting T Cells

INTERFERON GAMMAWITH STIMULATING AGENTHUMAN ADENOVIRUS TYPE 26 VECTORVECTOR-INDUCED IMMUNOGENICITYCELLULAR IMMUNITY

5.1

SFC/10^6 PBMC

5.1

5.1

SFC/10^6 PBMC

PERIPHERAL BLOOD MONONUCLEAR CELL

ELISPOT

1BASELINE

2017-05-27

2

RSV1230

IS

RSV1230-011

2

13998

CYKSCTCL

Cytokine-secreting T Cells

INTERFERON GAMMAWITH STIMULATING AGENT

THERAPEUTIC PEPTIDE

ANTIDRUG T CELL-MEDIATED IMMUNOGENICITY

CELLULAR IMMUNITY

7.05

SFC/10^6 PBMC

7.05

7.05

SFC/10^6 PBMC

PERIPHERAL BLOOD MONONUCLEAR CELL

ELISPOT

1BASELINE

2017-05-27

3

RSV1230

IS

RSV1230-011

3

13998

CYKSCTCL

Cytokine-secreting T Cells

INTERFERON GAMMAWITH STIMULATING AGENTHUMAN ADENOVIRUS TYPE 26 VECTORVECTOR-INDUCED IMMUNOGENICITYCELLULAR IMMUNITY

157.8

SFC/10^6 PBMC

157.8

157.8

SFC/10^6 PBMC

PERIPHERAL BLOOD MONONUCLEAR CELL

ELISPOT

2VISIT 1

2017-08-27

4RSV1230ISRSV1230-011413998CYKSCTCLCytokine-secreting T CellsINTERFERON GAMMAWITH STIMULATING AGENTTHERAPEUTIC PEPTIDE

ANTIDRUG T CELL-MEDIATED IMMUNOGENICITY

CELLULAR IMMUNITY295.5

SFC/10^6 PBMC

295.5295.5

SFC/10^6 PBMC

PERIPHERAL BLOOD MONONUCLEAR CELL

ELISPOT2VISIT 12017-08-27
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