抗狂犬病毒中和抗体研究进展

狂犬病是一种人兽共患传染病,人和动物一旦发病后死亡率几乎百分之百,而有效的暴露后预防措施可以将死亡风险降至零。根据WHO推荐的狂犬病暴露后预防方案,一般狂犬病暴露者需要进行疫苗注射,严重者则需在进行疫苗注射的同时注射抗狂犬病毒中和抗体。常用的中和抗体有马抗狂犬病毒免疫球蛋白和人抗狂犬病毒免疫球蛋白,然而两者都存在引起过敏反应或血液疾病的风险。人源抗狂犬病毒中和抗体则因为具有安全性高、成本低、可量产等优点有望代替免疫球蛋白用于暴露后预防。基因工程抗体技术的发展加速了抗体人源化的进程。就抗狂犬病毒中和抗体的发展历程,不同类型中和抗体的优缺点以及中和抗体的未来研究方向作了综述及展望,以期为新一代狂犬疫苗的研发提供参考。     

2566例暴露后狂犬病伤口处置与疫苗应用调查分析

为降低狂犬病的发生,对狂犬病暴露后伤口处置及疫苗使用情况进行研究。对2007年1月1日至7月31日广西玉林市疾病预防控制中心预防医学门诊就诊患者狂犬病暴露后处置情况进行统计分析。在2566例患者中受伤后<24h就诊占80.22%,92.59%病人到门诊进行伤口处理;100%患者接种狂犬疫苗,9.98%的患者进行人狂犬病免疫球蛋白注射。2566例患者无一例发生狂犬病。这与暴露后较及时规范地进行伤口处理、疫苗接种与抗狂犬病血清或人狂犬病免疫球蛋白注射有一定关系。     

应用对流免疫电泳试验作为超免狂犬病血清的鉴定

<正>引言 为严重感染狂犬病的人推荐预防治疗,即联合注射有效疫苗和高效抗狂犬病血清。关于感染后的被动抗体治疗,马源或人源狂犬病抗体都同样有效。虽然在大多数国家仍用马源抗狂犬病血清,但采用同源狂犬病免疫球蛋白有减少过敏与血清病的可能性,且可能比异源制品更为有效。以前,采用小鼠法借制品与国际参考血清(不低于100IU)相对比的中和滴度以测定制品的效力。 以前的研究表明,以抗原-抗体结合反应为基础的对流免疫电泳技术(CIE)在检验狂犬病抗体方面是有价值的。发现这种方     

狂犬病病毒抗体胶体金检测试纸的制备

通过胶体金免疫层析技术建立一种特异、便捷、快速的狂犬病病毒抗体检测方法,对犬等动物免疫狂犬病疫苗后的抗体水平监测提供参考。用醋酸锌沉淀法沉淀狂犬病病毒CVS11,Sepharose 4FF进行层析纯化。用柠檬酸三钠还原法制备的胶体金,标记纯化的狂犬病病毒,喷于试纸的结合释放垫 (金标垫),将SPA (葡萄球菌表面A蛋白) 和纯化的兔抗狂犬病病毒IgG分别喷于试纸的T (检测线) 处和C (对照线) 处,组装试纸条。用制备的试纸条对261份犬血清进行检测,与快速荧光灶抑制试验 (RFFIT) 检测的结果一致;对已知效价的犬狂犬病毒中和抗体 (VNA) 大于0.5 IU,结果为阳性;对狂犬病病毒中和抗体 (VNA) 小于0.5 IU/mL的血清,结果为阴性。制备的狂犬病病毒抗体胶体金检测试纸检测犬血清抗体,具有特异、便捷、快速的特点,能够检测出狂犬病病毒中和抗体大于0.5 IU的血清,适用于临床犬血清抗体水平监测,具有良好的应用前景。     

改良抗体结合实验检测灭活狂犬病疫苗效价

目的:建立抗体结合试验检测狂犬病疫苗(aG株)效价的方法。方法:将待检测疫苗与疫苗标准品梯度稀释后分别加入人抗狂犬病毒免疫球蛋白国家标准品中和1 h,之后加入80%感染剂量的狂犬病毒CVS-11,体外中和1h后接种BSR细胞,培养24 h后免疫荧光染色,在显微镜下观察结果,通过检测剩余病毒量计算待检疫苗的效价,同时与小鼠中和试验法(NIH法)测定狂犬病疫苗效价进行比较。结果:2种方法对8个样品效价的检测结果无显著统计学差异(P=0.997,配对t检验)。结论:初步建立了改良抗体结合试验,可用于狂犬病疫苗中间产品的质量控制。     

用人体细胞制备狂犬病疫苗的进展和远景(续完)

<正>同时使用二倍体细胞疫苗和人狂犬病免疫球蛋白 狂犬病感染后,同时以被动抗体处理。被动抗体的辅助效果,首先在动物模型中被显示出来,然后动物血清被应用于人类。近来为了避免血清病,动物血清由HRIG(人狂犬病免疫球蛋白)所代替,早为人们所知,这种被动抗体与狂犬疫苗同时使用可以抑制免疫反应的效果,所以对HRIG和HDCV联合使用研究特别重要。     

狂犬病免疫球蛋白应用研究进展

中国是全球第二大狂犬病流行国家,每年有数以百万计的狂犬病Ⅲ级暴露案例需要联合应用狂犬病免疫球蛋白和狂犬病疫苗。狂犬病免疫球蛋白价格较昂贵,使用方法较复杂,在狂犬病Ⅲ级暴露后处置中使用率长期以来偏低。降低狂犬病免疫球蛋白的使用剂量可以减少狂犬病Ⅲ级暴露后处置费用。简化狂犬病免疫球蛋白的使用方法可以使狂犬病Ⅲ级暴露后处置更加便于实施。降低狂犬病免疫球蛋白的使用剂量和简化狂犬病免疫球蛋白的使用方法有助于提高狂犬病Ⅲ级暴露后处置中狂犬病免疫球蛋白的使用率。狂犬病免疫球蛋白对狂犬病疫苗免疫效果的影响研究中存在矛盾的结论,探索狂犬病免疫球蛋白影响狂犬病疫苗免疫效应的机制有助于解释狂犬病免疫球蛋白对狂犬病疫苗免疫效果影响的复杂性。本文系统回顾关于狂犬病免疫球蛋白应用研究的进展,以期为制订新的具备实际操作可行性的狂犬病免疫球蛋白应用准则提供参考。     

两种狂犬病毒IgG抗体检测试剂盒的比较

目的了解员工暴露前接种人用狂犬病疫苗后的免疫效果,并对比使用两种不同试剂盒检测抗体阳转率是否存在差异。方法采集员工接种人用狂犬病疫苗(地鼠肾细胞)以及冻干人用狂犬病疫苗(Vero细胞)共计172例,分别使用两种狂犬病毒抗体检测试剂盒(试剂盒A、B)进行检测,统计血清中狂犬病毒Ig G抗体的水平,计算阳转率并比较差异。结果使用试剂盒A检测接种人用狂犬病疫苗(地鼠肾细胞)者血清样本的阳转率为91.7%,接种冻干人用狂犬病疫苗(Vero细胞)者血清样本的阳转率为51.0%;使用试剂盒B检测接种人用狂犬病疫苗(地鼠肾细胞)者血清样本的阳转率为100.0%,接种冻干人用狂犬病疫苗(Vero细胞)者血清样本的阳转率为74.5%。使用试剂盒B检测接种人用狂犬病疫苗(地鼠肾细胞)者血清样本的阳转率比试剂盒A高8.3%,使用试剂盒B检测接种冻干人用狂犬病疫苗(Vero细胞)者血清样本的阳转率比试剂盒A高23.5%。结论两种不同试剂盒上检测的抗体阳转率都反映出人用狂犬病疫苗(地鼠肾细胞)比冻干人用狂犬病疫苗(Vero细胞)的免疫效果好;使用两种不同试剂盒检测抗体阳转率的差异均具有统计学意义。     

狂犬病疫苗接种者血清对狂犬病病毒中和能力研究

狂犬病（Rabies）是由狂犬病病毒属成员（Lyssavirus）引起的人兽共患病,全球99%以上人狂犬病是由该属主要成员狂犬病病毒（Rabies virus,RABV）引起的。近年来,我国RABV毒株多样性明显增多,但是现有狂犬病疫苗对不同毒株（特别是新出现的毒株）免疫保护效果尚不清楚。为研究目前商品化的人用狂犬病疫苗对RABV街毒株是否具备交叉免疫保护能力,本研究通过制备不同进化群、不同宿主来源的3株街毒株GDMMD16、NMALSF01和NeiMeng927A的细胞毒,分别对免疫过aG株和/或PM株狂犬病疫苗的23份人血清进行狂犬病荧光抗体病毒中和实验,结果发现所有血清对GDMMD16、NMALSF01和NeiMeng927A街毒株的中和效价均高于WHO推荐的标准（0.5IU/mL）,表明上述2种商品化的人用狂犬病疫苗对3株RABV街毒株具有保护能力。     

一种人源抗狂犬病病毒单克隆抗体的瞬时表达及性质分析

目的瞬时表达人源重组抗狂犬病病毒单克隆抗体,并对抗体性质进行分析。方法 PCR法扩增抗体轻、重链可变区并分别构建真核表达质粒;瞬时转染HEK293 EBNA1细胞;抗体经亲和纯化后,CE-SDS法分析纯化后抗体单体比例,用快速荧光灶抑制试验(RFFIT)分析抗体体外抗狂犬病病毒中和活性,ELISA分析抗体与3aG、CTN、PV及CVS株的结合。结果提取瞬时表达质粒的A260/280 nm比值在2.0～2.1之间纯化后抗体非还原CE-SDS单体纯度为74.4%;还原CE-SDS抗体轻、重链峰合计占比超过95%;抗体RFFIT体外中和活性为293.37 IU/mL,比活达628.21 IU/mg,抗体与3aG、CTN、PV及CVS株交叉反应均为阳性。结论该株抗体具有较高体外抗狂犬病病毒中和活性,与主要疫苗株均有较强结合。     

重组人抗狂犬病病毒单抗SO57、SOJB对不同狂犬病病毒毒株中和作用的研究

用不同的动物模型研究了具有专利的重组人抗狂犬病病毒单克隆抗体SO57、SOJB对不同狂犬病病毒株的中和作用,100IU/kg的SO57能100%保护被中国街毒株SBD攻击的中国仓鼠;首次用小鼠模型模拟人体被狂犬病病毒攻击后的治疗情况,在小鼠被CVS及中国街毒代表株攻击后,SO57与HRIG具有相近的对小鼠的暴露后保护作用;同时结果显示HRIG对SBD株攻击的保护率不能到达100%,仅使用疫苗是不能对感染病毒的小鼠百分之百的保护;SOJB与SO57 1:1联合使用未显示比SO57单独使用更好的保护效果。SO57极有可能在中国代替HRIG用于狂犬病病毒暴露后治疗。     

Intravenous human rabies immunoglobulin for post-exposure prophylaxis: serum rabies neutralizing antibody concentrations and side-effects

The beneficial effect of passive immunization for post-exposure rabies prophylaxis is associated with the appearance of serum neutralizing antibody (SNA) earlier than occurs with vaccine alone. We compared the SNA response and the side-effects in 30 previously unimmunized healthy volunteers given a commercially available human rabies immunoglobulin (HRIG) intramuscularly (i.m.) or an experimental HRIG prepared by DEAE Sephadex column chromatography, intravenously (i.v.) with or without human diploid-cell culture rabies vaccine (HDCS). The subjects were divided into five equal groups: HDCS alone, HDCS + i.m. HRIG 20 IU/kg (currently recommended), i.v. HRIG alone 15 IU/kg, HDCS + i.v. HRIG 15 IU/kg or HDCS + HRIG 5 IU/kg i.v. plus 10 IU/kg i.m. to simulate local bite wound infiltration. HDCS, 1.0 ml, was injected subcutaneously (s.c.) on days 0, 3, 7, 14 and 28. Only local discomfort at injection sites was observed without differences between groups. SNA was demonstrated in all HRIG recipients at day 1, but the concentrations were higher in those receiving it intravenously. No difference in the SNA response to vaccine was observed between the i.v. and i.m. HRIG groups given the same vaccine lot. It would appear that i.v. HRIG 15 IU/kg can be substituted for i.m. HRIG 20 IU/kg for post-exposure prophylaxis. Since the current regimen is almost 100% protective, there is no way of proving that i.v. HRIG 15 IU/kg is more efficacious. The immediate SNA level and economy are the chief advantages of i.v. HRIG 15 IU/kg.     

Post-exposure Treatment with Anti-rabies VHH and Vaccine Significantly Improves Protection of Mice from Lethal Rabies Infection

Post-exposure prophylaxis (PEP) against rabies infection consists of a combination of passive immunisation with plasma-derived human or equine immune globulins and active immunisation with vaccine delivered shortly after exposure. Since anti-rabies immune globulins are expensive and scarce, there is a need for cheaper alternatives that can be produced more consistently. Previously, we generated potent virus-neutralising VHH, also called Nanobodies, against the rabies glycoprotein that are effectively preventing lethal disease in an in vivo mouse model. The VHH domain is the smallest antigen-binding functional fragment of camelid heavy chain-only antibodies that can be manufactured in microbial expression systems. In the current study we evaluated the efficacy of half-life extended anti-rabies VHH in combination with vaccine for PEP in an intranasal rabies infection model in mice. The PEP combination therapy of systemic anti-rabies VHH and intramuscular vaccine significantly delayed the onset of disease compared to treatment with anti-rabies VHH alone, prolonged median survival time (35 versus 14 days) and decreased mortality (60% versus 19% survival rate), when treated 24 hours after rabies virus challenge. Vaccine alone was unable to rescue mice from lethal disease. As reported also for immune globulins, some interference of anti-rabies VHH with the antigenicity of the vaccine was observed, but this did not impede the synergistic effect. Post exposure treatment with vaccine and human anti-rabies immune globulins was unable to protect mice from lethal challenge. Anti-rabies VHH and vaccine act synergistically to protect mice after rabies virus exposure, which further validates the possible use of anti-rabies VHH for rabies PEP.     

Using Serology to Assist with Complicated Post-Exposure Prophylaxis for Rabies and Australian Bat Lyssavirus

Background

Australia uses a protocol combining human rabies immunoglobulin (HRIG) and rabies vaccine for post-exposure prophylaxis (PEP) of rabies and Australian bat lyssavirus (ABLV), with the aim of achieving an antibody titre of ≥0.5 IU/ml, as per World Health Organization (WHO) guidelines, as soon as possible.

Methodology/Principal Findings

We present the course of PEP administration and serological testing for four men with complex requirements. Following dog bites in Thailand, two men (62 years old, 25 years old) received no HRIG and had delayed vaccine courses: 23 days between dose two and three, and 18 days between dose one and two, respectively. Both seroconverted following dose four. Another 62-year-old male, who was HIV-positive (normal CD4 count), also suffered a dog bite and had delayed care receiving IM rabies vaccine on days six and nine in Thailand. Back in Australia, he received three single and one double dose IM vaccines followed by another double dose of vaccine, delivered intradermally and subcutaneously, before seroconverting. A 23-year-old male with a history of allergies received simultaneous HRIG and vaccine following potential ABLV exposure, and developed rash, facial oedema and throat tingling, which was treated with a parenteral antihistamine and tapering dose of steroids. Serology showed he seroconverted following dose four.

Conclusions/Significance

These cases show that PEP can be complicated by exposures in tourist settings where reliable prophylaxis may not be available, where treatment is delayed or deviates from World Health Organization recommendations. Due to the potentially short incubation time of rabies/ABLV, timely prophylaxis after a potential exposure is needed to ensure a prompt and adequate immune response, particularly in patients who are immune-suppressed or who have not received HRIG. Serology should be used to confirm an adequate response to PEP when treatment is delayed or where a concurrent immunosuppressing medical condition or therapy exists.     

Preparation and identification of anti-rabies virus monoclonal antibodies

To provide a foundation for the development of rapid and specific methods for the diagnosis of rabies virus infection,anti-rabies virus monoclonal antibodies were prepared and rabies virus nucleoprotei...     

狂犬病病毒糖蛋白的杆状病毒表达及其免疫原性研究

构建表达狂犬病病毒SRV9株糖蛋白(GP)的重组杆状病毒,评价其表达出的SRV9株糖蛋白对小鼠免疫效果。将狂犬病病毒SRV9株GP基因的完整开放阅读框克隆入穿梭质粒Bacmid中,构建重组穿梭质粒Bacmid-G,以此转染Sf9细胞。对病变细胞培养物进行电镜观察,获得正确重组杆状病毒后,通过Western-blot、IFA及小鼠免疫实验鉴定表达产物的免疫反应性及免疫原性。正确构建重组穿梭质粒Bacmid-G;获得表达SRV9株糖蛋白的重组杆状病毒,其表达产物具有良好免疫原性;表达产物接种小鼠可诱导其产生抗狂犬病病毒中和抗体,中和抗体达到保护水平的比例为100%。本实验所获得的重组杆状病毒表达出的SRV9株糖蛋白具有较好的免疫原性,可诱导小鼠产生保护性中和抗体,该实验为进一步开发狂犬病亚单位疫苗奠定了基础。     

Correction: Neutralizing Antibody Response after Intramuscular Purified Vero Cell Rabies Vaccination (PVRV) in Iranian Patients with Specific Medical Conditions

Objective

Post exposure prophylaxis using one of the WHO-approved vaccines is the method of choice for preventing rabies. Abnormal immune function in patients with some specific medical conditions, such as pregnancy, chronic hepatitis B virus infection, different types of cancers like lymphoma, diabetes I and II, corticosteroid consumption by patients with rheumatoid arthritis and lupus erythematosus, could impair the immunologic response to various vaccines. The immune response to rabies vaccination has never been examined in patients with any of these described medical conditions. This study purposed to evaluate the neutralyzing antibody response after vaccination with purified Vero cell rabies vaccine (PVRV) according to the WHO-recommended Post–Exposure Prophylaxis (PEP) "ESSEN" regimen.

Methods

Thirty healthy volunteers and 50 volunteers with different medical conditions who were exposed to a suspected rabid animal in the 2nd or 3rd category of exposure received 5 doses of PVRV under the ESSEN protocol. Three blood samples were collected on days 0 (before the first dose), 14, and 35. The anti-rabies antibody titer was measured using the Rapid Fluorescent Foci Inhibition Test (RFFIT) and an ELISA Bio-Rad, Platelia, Rabies II kit.

Results

All subjects reached NAb titers above 0.5 IU/ml by day 14 after vaccination. On day 35 (1 week after receiving the last rabies vaccine), anti-rabies antibodies were in the protective level (>0.5 IU/ml) in both groups. There was no statistically significant difference in anti-rabies antibody response due to the type of exposure (category 2 or 3), and successful seroconversion was confirmed in both groups.

Conclusion

In conclusion, the ESSEN protocol using the PVRV vaccine is sufficient for rabies prophylaxis in patients with specific medical conditions.     

Induction of antigen-specific antibody response in human peripheral blood lymphocytes in vitro by a dog kidney cell vaccine against rabies virus (DKCV)

In the present report an in vitro method for obtaining a secondary human antibody response to a dog kidney cell vaccine against rabies virus (DKCV) is described. Cultures of peripheral blood mononuclear cells from normal rabies-immune and nonimmune donors were stimulated in vitro by DKCV. The production of virus-specific antibody in supernatant fluids was monitored by ELISA. Antibody was produced by lymphocytes from rabies-immune individuals, whereas those of nonimmune subjects consistently failed to produce anti-rabies antibodies after in vitro stimulation with DKCV. The generation of the anti-rabies virus antibody response of lymphocytes stimulated with DKCV was shown to be an antigen-dependent, as well as an antigen-specific process. Optimal antigen-specific responses were observed at relatively low concentrations of antigen (10(-1) to 10(-2) micrograms/culture). At increasing concentrations of antigen in culture (greater than 1 microgram/culture), the anti-rabies virus response was suppressed. Antibody produced upon stimulation was capable of neutralizing rabies virus. The response to rabies virus requires T cell help because lymphocytes depleted of SE rosetting cells did not respond to an antigenic stimulus. Studies in which the same individuals were followed over time showed a sequential development of circulating B cell subsets. The system may provide a model for the study of human B cell differentiation in vivo and in vitro and may be valuable for testing the potency of rabies vaccines in vitro.