In this chapter, we describe a research and development pathway to identify and demonstrate the efficacy of a Neisseria meningitidis non-capsular vaccine, the recently licensed N. meningitidis serogroup B (MnB) vaccine, Trumenba(®). While other approaches have been followed in the identification of a MnB vaccine (Pizza et al. Science 287:1816-1820, 2000), the methods described here reflect the distinctive approach and experiences in discovering and developing Trumenba(®). In contrast to the development and licensure of polysaccharide-conjugate vaccines against meningococcal serotypes A, C, W, and Y, the development of a vaccine to produce broadly protective antibodies against meningococcal serogroup B has proved difficult, due to the antigenic mimicry of the serogroup B polysaccharide capsule, which is composed of polysialic acid structures similar to those expressed on human neuronal cells. Early development efforts for these vaccines failed because the MnB polysaccharide structures resemble autoantigens and thus were poorly immunogenic. The development of an MnB vaccine has therefore focused on non-polysaccharide approaches. It was critical to identify MnB cell surface-exposed antigens capable of inducing a protective response against diverse, circulating strains of invasive MnB to ensure global coverage. Once candidate antigens were identified, it was important to characterize antigenic variation and expression levels, and subsequently to assure that antigens were expressed broadly among diverse clinical isolates. Prior to the initiation of clinical trials in humans, candidate vaccine antigens were tested in functional immunogenicity assays and yielded responses that were correlated with protection from meningococcal disease. These functional immunogenicity assays (serum bactericidal assays using human complement, hSBAs) measure the titer of complement-dependent bactericidal antibodies in serum from immunized test animals using diverse clinical MnB isolates as targets. Following optimization of vaccine antigenic components based on hSBA responses in preclinical models, animal toxicology tests were performed. Initial clinical studies (Phase 1 and 2) subsequently provided data to support (1) safety and immunogenicity of the vaccine formulation, and (2) the dose and schedule. Phase 3 clinical trials were carried out in the target populations to provide the clinical confirmation of safety and efficacy required for vaccine licensure.
Keywords: Clinical development; Factor H-binding protein (fHBP); Genetic conservation; Neisseria meningitidis serogroup B; Serum bactericidal assay (SBA); Surveillance; Vaccine.