Key antigens of Leishmania species identified in the context of host responses in Leishmania-exposed individuals from disease-endemic areas were prioritized for the development of a subunit vaccine against visceral leishmaniasis (VL), the most deadly form of leishmaniasis. Two Leishmania proteins—nucleoside hydrolase and a sterol 24-c-methyltransferase, each of which are protective in animal models of VL when properly adjuvanted— were produced as a single recombinant fusion protein NS (LEISH-F3) for ease of antigen production and broad coverage of a heterogeneous major histocompatibility complex population. When formulated with glucopyranosyl lipid A-stable oil-in-water nanoemulsion (GLA-SE), a Toll-like receptor 4 TH1 (T helper 1) promoting nanoemulsion adjuvant, the LEISH-F3 polyprotein induced potent protection against both L. donovani and L. infantum in mice, measured as significant reductions in liver parasite burdens. A robust immune response to each component of the vaccine with polyfunctional CD4 TH1 cell responses characterized by production of antigen-specific interferon-γ, tumor necrosis factor and interleukin-2 (IL-2), and low levels of IL-5 and IL-10 was induced in immunized mice. We also demonstrate that CD4 T cells, but not CD8 T cells, are sufficient for protection against L. donovani infection in immunized mice. Based on the sum of preclinical data, we prepared GMP materials and performed a phase 1 clinical study with LEISH-F3+GLA-SE in healthy, uninfected adults in the United States. The vaccine candidate was shown to be safe and induced a strong antigen-specific immune response, as evidenced by cytokine and immunoglobulin subclass data. These data provide a strong rationale for additional trials in Leishmania-endemic countries in populations vulnerable to VL.

+T-cell induction via GLA-SE. Thus, we demonstrate that IL-18 and caspase-1/11 are components of the response to immunization with the TLR4 agonist/squalene oil-inwater based adjuvant, GLA-SE, providing implications for other adjuvants that combine oils with TLR agonists. Additional supporting information may be found in the online version of this article at the publisher's web-site Keywords: Adjuvants IntroductionVaccines rely on triggering the innate immune system to generate protective immunity. Many empirically established vaccines serendipitously contain molecules known as pathogen-associated molecular patterns (PAMPs) that engage host-germline encoded receptors, e.g. TLRs, which contribute to their immunogenicity Correspondence: Dr. Anthony L. Desbien e-mail: Anthony.Desbien@IDRI.org [1]. In the case where antigen preparations alone fail to be immunogenic, extrinsic adjuvants, such as alum or oil emulsions, are added to make vaccines effective. Such extrinsic adjuvants were empirically developed and despite their use in billions of vaccine doses, their mechanisms of action are not completely understood [2,3]. Knowledge of the salient attributes of empirical adjuvants would facilitate the design of the next generation of vaccines.In order to function as adjuvants, deliberately incorporated PAMPs require proper formulation [4,5]. For unknown reasons, squalene oil-in-water emulsions (SEs), such as AS02 and MF59, C 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim www.eji-journal.eu 408Anthony L. Desbien et al. Eur. J. Immunol. 2015. 45: 407-417 are excellent formulations for TLR agonists, greatly enhancing the magnitude and quality of the immune response [6][7][8][9][10][11]. While it is clear that squalene emulsions by themselves are potent adjuvants, exactly how they engage the immune system or cooperate with TLR agonists is unclear. The commercial product MF59 is the prototypical squalene adjuvant. MF59 has been shown to activate the innate immune system, alter antigen presentation, and enhance humoral responses [3,[12][13][14]. While these attributes are ostensibly useful for generation of immunity, the specific components of the immune system triggered by squalene emulsions remain to be elucidated. The inflammasome is a pathogen recognition system required for protection against many diseases [15]. Engagement of the inflammasome occurs by diverse stimuli including pathogenand host-derived molecules. Known triggers include cytoplasmic dsDNA as well as aberrantly localized host-derived molecules, referred to as danger-associated molecular patterns [16]. In particular, extracellular ATP acts as a danger-associated molecular pattern, and has been recently demonstrated to contribute to activity of MF59, suggesting that MF59 acts via the inflammasome [17]. Further, the antibody response to immunization with MF59 has been linked to the adapter protein ASC, a component of the inflammasome, but not caspase-1 or NLRP3 (where NLR is nod-like receptor), indicating that adjuvant activity of MF59 is mediated by stil...

Vaccine development for vector-borne pathogens may be accelerated through the use of relevant challenge models, as has been the case for malaria. Because of the demonstrated biological importance of vector-derived molecules in establishing natural infections, incorporating natural challenge models into vaccine development strategies may increase the accuracy of predicting efficacy under field conditions. Until recently, however, there was no natural challenge model available for the evaluation of vaccine candidates against visceral leishmaniasis. We previously demonstrated that a candidate vaccine against visceral leishmaniasis containing the antigen LEISH-F3 could provide protection in preclinical models and induce potent T-cell responses in human volunteers. In the present study, we describe a next generation candidate, LEISH-F3+, generated by adding a third antigen to the LEISH-F3 di-fusion protein. The rationale for adding a third component, derived from cysteine protease (CPB), was based on previously demonstrated protection achieved with this antigen, as well as on recognition by human T cells from individuals with latent infection. Prophylactic immunization with LEISH-F3+formulated with glucopyranosyl lipid A adjuvant in stable emulsion significantly reduced both Leishmania infantum and L. donovani burdens in needle challenge mouse models of infection. Importantly, the data obtained in these infection models were validated by the ability of LEISH-F3+/glucopyranosyl lipid A adjuvant in stable emulsion to induce significant protection in hamsters, a model of both infection and disease, following challenge by L. donovani–infected Lutzomyia longipalpis sand flies, a natural vector. This is an important demonstration of vaccine protection against visceral leishmaniasis using a natural challenge model.

Next-generation rationally-designed vaccine adjuvants represent a significant breakthrough to enable development of vaccines against challenging diseases including tuberculosis, HIV, and malaria. New vaccine candidates often require maintenance of a cold-chain process to ensure long-term stability and separate vials to enable bedside mixing of antigen and adjuvant. This presents a significant financial and technological barrier to worldwide implementation of such vaccines. Herein we describe the development and characterization of a tuberculosis vaccine comprised of both antigen and adjuvant components that are stable in a single vial at sustained elevated temperatures. Further this vaccine retains the ability to elicit both antibody and TH1 responses against the vaccine antigen and protect against experimental challenge with Mycobacterium tuberculosis. These results represent a significant breakthrough in the development of vaccine candidates that can be implemented throughout the world without being hampered by the necessity of a continuous cold chain or separate adjuvant and antigen vials.