interaction with other flaviviruses (pre-existing immunity
TRANSCRIPT
Interaction with other flaviviruses (pre-existing immunity, co-infection, cross-reactivity)
Alan D.T. Barrett Department of Pathology
Sealy Center for Vaccine Development
University of Texas Medical Branch
Galveston TX
Flavivirus genome
50nm particle.
SS, +RNA genome.
10 genes, 3 structural.
Beck, A. Barrett, ADT. (2015) Exp Rev Vaccines. 1-14.
2
Flavivirus E protein epitopes
• Studies with human and mouse polyclonal sera show extensive serologic
cross-reactivities between flaviviruses in terms of physical (ELISA) and
biological (HAI and neutralization) assays
• Studies with mouse, non-human primate, and human monoclonal
antibodies show essentially the same result that all flaviviruses studied to
date have a range of E protein epitopes ranging in flavivirus cross-reactive
(e.g., mab 4G2 or 6B6C-1), to flavivirus intermediate (e.g., mab 1B7), to
serocomplex specific (e.g., DENV-1 to DENV-4; mab MDVP-55A), to
flavivirus species specific (e.g., mab 3H5 that is DENV-2 specific). Strain
specific epitopes are rare.
• Flavivirus infection induces a range of antibodies, including those that
recognize multiple flaviviruses. A second, but different, flavivirus infection
potentiates induction of flavivirus cross-reactive antibodies.
• Most epitopes are “conformational” or “quaternary”. Very few epitopes are
linear. Very few epitopes appear to elicit high titer neutralizing antibodies.
RH: Rabbit hyperimune sera Gould et al., 1985
Reactivity of anti-E protein mouse monoclonal antibodies raised
against YF 17D vaccine with YF and 37 other flaviviruses
RH: Rabbit hyperimune sera Gould et al., 1985
Reactivity of anti-E protein mouse monoclonal antibodies raised
against YF 17D vaccine with YF and 37 other flaviviruses
Reactivity of anti-E and anti-NS1 protein mouse monoclonal
antibodies raised against YF 17D vaccine with different YF strains
Flavivirus NS1 protein
Less flavivirus cross-reactive epitopes than E protein, but some still
identified.
NS1 has been studied as a vaccine “immunogen” but does not induce
neutralizing antibodies only complement fixing antibodies (antibody
dependent cellular cytotoxicity).
NS1 protein is a nonstructural protein that is secreted from cells
during flavivirus infection. Is used as a diagnostic tool for a dengue
infection but is it flavivirus-species specific?
Antibodies to NS1 and NS5 can be used as diagnostic markers of a
flavivirus species-specific infection. Could be very useful for
evaluation of inactivated or subunit vaccines.
Reactivity of anti-NS1 protein mouse monoclonal antibodies raised
against YF 17D vaccine with YF and 37 other flaviviruses
RH: Rabbit hyperimune sera Gould et al., 1985
Reactivity of anti-NS1 protein mouse monoclonal antibodies raised
against YF 17D vaccine with YF and 37 other flaviviruses
RH: Rabbit hyperimune sera Gould et al., 1985
Complexities of evaluating flavivirus immune responses
• Flavivirus serology is a “minefield”. Hard to
serologically identify an infection as due to a
particular flavivirus unless the individual is
flavivirus-naïve.
• Karl Johnson called flaviviruses the “Hall of
Mirrors”
• Challenging to assess and interpret
immunological data due to cross-reactivity.
How do you do a flavivirus neutralization test? • De ja vue!
• Cell type, virus strain, and assay type will influence results.
• Plaque reduction neutralization test (PRNT)
PRNT50?
PRNT60?
PRNT80?
PRNT90?
• Micro-neut
• Flow cytometry
• A standardized, validated assay will be important to quantitate
neutralizing antibodies
Yap Island results and flavivirus vaccines
• If ZIKV is the secondary flavivirus infection, the individual may not
have the highest neutralizing antibody titer to ZIKV as compared to
other flaviviruses.
• The neutralizing antibody titer may be higher against a previous
(primary?) flavivirus infection rather than the most recent
heterologous flavivirus (secondary?) infection.
• Individuals who have been previously vaccinated against yellow
fever, Japanese encephalitis, (candidate) dengue, or tick-borne
encephalitis can have a rapid and high neutralizing antibody titer
following infection by a heterologous flavivirus. Usually, seen with
mosquito-borne flavivirus infections (JE, YF and DEN vaccine).
Vaccine Efficacy, According to Serotype and Age Group.
Hadinegoro SR et al. N Engl J Med 2015;373:1195-1206
Complexities of serologic diagnostics • IgM and neutralizing antibody testing can identify recent ZIKV
infections if the individual is flavivirus-naïve.
• ZIKV (ELISA and PRNT) antibody test results can be difficult to
interpret; particular in secondary flavivius infections (i.e., infection
by a different flavirus to that of the primary infection) because of
serologic cross-reactivity with other flaviviruses.
• Similarly, it is difficult to identify the particular flavivirus infection
when the individual has had a previous flavivirus vaccination (YF
or JE [or DEN?]).
• IgM positive is a presumptive recent flavivirus infection but may
not be flavivirus species specific if the individual has had a
previous flavivirus infection or vaccination. i.e., ZIKV IgM positive
may not be indicative of a recent ZIKV infection.
Conclusions
We have a large “tool box” to measure flavivirus immune responses.
There are approximately 70 flaviviruses, many of which have
extensive serologic cross-reactivity.
Interpretation of flavivirus serology results is complex. This may
make evaluation of some vaccine candidates difficult.
Clinical evaluation of inactivated or subunit vaccines may have
advantages in using serologic evaluation of nonstructural proteins.