Salmonella Typhi Vi O-Acetyl Pectin-rEPA Conjugate Vaccine
Salmonella Typhi Vi O-Acetyl Pectin-rEPA Conjugate Vaccine
This study will evaluate a new (conjugate) vaccine for typhoid fever, which remains a serious
 disease especially difficult to treat in developing countries. Salmonella typhi, the bacteria
 causing typhoid fever, have become resistant to several antibiotics increasing the difficulty
 of treating the disease. The disease may have serious complications effecting bones, brain,
 and intestines, with permanent injury or death. Methods to control typhoid fever, such as a
 sanitary water and food supply, along with effective sewage treatment, are not likely to be
 available soon in those countries.

 NIH scientists developed a vaccine called Vi, made of a polysaccharide (a chain of linked
 sugars) from the surface of Salmonella typhi, the bacteria that cause typhoid fever. It has
 been approved by the World Health Organization and is licensed in 94 countries. It is
 effective in adults but not in young children. Clinical trials have shown that chemically
 binding the Vi to a protein to form a "conjugate vaccine" has improved and extended its
 efficacy to children (conjugate vaccines to other bacteria, notably meningitis causing
 bacteria have been used extensively and successfully). Now NIH scientists have developed
 another vaccine for typhoid fever - using a polysaccharide from fruit, known as pectin. The
 pectin has been chemically treated so that it resembles Vi. The treated pectin, O-acetyl
 pectin, is bound to a protein; exoprotein A, (rEPA). The result is a conjugate, as was formed
 for Vi. Similarly to the Vi conjugate it induces antibodies against Salmonella typhi in
 laboratory animals. If the O-acetyl pectin conjugate proves successful, it will be evaluated
 in children ages 5 to 14 years old and in infants, toward using it with routine vaccines for
 infants.

 Volunteers ages 18 to 45 who do not have an allergy to fruit pectin and who have not been
 vaccinated against nor had typhoid fever within the last 5 years may be eligible for this
 study.

 Volunteers will undergo several tests at their first visit to the clinic for this study. A
 blood sample (about 2/3 of an ounce) will be taken to test for HIV, hepatitis B and C,
 complete blood count, liver functions, blood chemistry and pregnancy in women of childbearing
 age. The blood sample will also be tested for antibodies to Vi, rEPA (the protein of the
 conjugate), and pectin. There will also be a urine collection for testing. If the laboratory
 tests are acceptable, volunteers will be asked to return to the clinic on a...
Typhoid fever remains a common, serious and increasingly difficult to treat disease in
 developing countries. Control measures, such as safe drinking water, and food, and effective
 sewage, are not likely to be available soon in many of these countries. In the early 1990's
 most Salmonella typhi from the Mekong Delta region were resistant to chloramphenicol and
 ampicillin and treatment required new antibiotics such as ciprofloxacin. Now, resistance of
 S. typhi has spread to ciprofloxacin.

 There are three licensed vaccines for typhoid fever. The whole cell parenteral and the oral
 attenuated vaccines confer only incomplete immunity of limited duration and cannot be
 incorporated into the routine vaccination of infants. S. typhi capsular polysaccharide (Vi)
 is safe, easily standardized and only one injection confers about 70% immunity in individuals
 greater than 5 years of age for at least 3 years. Its immunogenicity is lesser in 2-4
 year-olds and it does not elicit protective antibody levels in children less than 2
 years-old. Vi does not elicit a booster response at any age (age-related T-cell independent
 antibody response).

 The immunogenicity of Vi is improved by covalently binding it to a protein to form a
 conjugate. Vi conjugates were safe and more immunogenic than Vi in adults, in 5-14 year-olds
 and in children 2-4 year-olds, and showed 90% efficacy in the 2-5 year olds for 47 months.

 O-acetyl pectin mimics the antigenic properties of Vi. Although not immunogenic alone,
 O-acetyl pectin when conjugated induces serum Vi antibodies with booster responses in mice
 and in guinea pigs albeit at slightly lower levels than Vi conjugates in mice. Double
 immunodiffusion against mouse anti-Vi revealed antigenic identity between O-acetyl pectin and
 Vi conjugates.

 There are advantages to using pectin as the polysaccharide component of conjugate vaccines
 for typhoid. Pectin is abundant, has no LPS and requires a simple chemical modification to
 prepare its di-O-acetyl derivative. Our yields of O-acetyl pectin-rEPA were similar to those
 of Vi-rEPA. Because it may not be reliable to extrapolate data from animals to humans and
 especially to infants, we propose clinical evaluation of O-acetyl pectin bound to the
 recombinant protein A of Pseudomonas aeruginosa (rEPA).
-  INCLUSION CRITERIA:

 To be eligible, volunteers must be 18 to 45 years old, who

 1. are not participating in or plan to participate in another research protocol during
 the next three months;

 2. have not been vaccinated against typhoid fever or had typhoid fever within the last 5
 years;

 3. are not regularly taking a prescription drug for chronic medical condition;

 4. have no history of allergy to fruit or fruit pectin;

 5. are not pregnant or intend to become pregnant during the study period of 6 months;

 6. Whose HIV, HBsAg and HCV tests must be found negative and laboratory tests of liver
 function, blood chemistry, complete blood count and urine must show no clinically
 significant abnormality or pregnancy.