The intranasal adjuvant Endocine™ enhances both systemic and mucosal immune responses in aged mice immunized with influenza antigen
© The Author(s). 2017
Received: 13 October 2016
Accepted: 2 February 2017
Published: 3 March 2017
Despite availability of annual influenza vaccines, influenza causes significant morbidity and mortality in the elderly. This is at least in part a result of immunosenescence; the age-dependent decrease in immunological competence that results in greater susceptibility to infections and reduced responses to vaccination. To improve protective immune responses in this age group, new vaccines strategies, such as the use of adjuvants, are needed. Here, we evaluated the mucosal vaccine adjuvant Endocine™, formulated with split influenza antigen and administered intranasally in aged (20-month old) mice. Humoral immune responses were assessed and compared to unadjuvanted intranasal and subcutaneous vaccines. We show that formulation with Endocine™ significantly enhances hemagglutination inhibition (HI) titers, as well as serum IgG and mucosal IgA antibody titers, compared to both types of unadjuvanted vaccines. Thus, our results indicate that intranasal vaccination with Endocine™ is a possible approach for the development of mucosal influenza vaccines for the elderly.
KeywordsEndocine Intranasal vaccination Aged mice Influenza Mucosal adjuvant
Worldwide, annual influenza epidemics are estimated to result in 250 000 to 500 000 deaths and up to 5 million cases of severe illness . Adults 65 years of age and older are particularly vulnerable to complications from influenza infection, and account for 90% of all influenza-associated deaths in the U.S. . Vaccination is the primary strategy to prevent and reduce morbidity and mortality associated with influenza , and the World Health Organization (WHO) recommends annual vaccination for groups at high risk of complications, including the elderly, young children, pregnant women, health-care workers, and individuals with underlying medical conditions . However, it has proven difficult to stimulate potent immune responses in elderly individuals, and studies in mice, ferrets and humans show that antigen-specific immune responses decline with age [4–9]. Accordingly, a quantitative review by Goodwin et al. shows that the clinical vaccine efficacy of injectable influenza vaccines was 17–53% in the elderly  compared to 70–90% in younger adults , and that following influenza vaccination, younger adults had up to 4 times higher antibody levels compared with older adults .
Strategies to augment the immune response in older adults include using alternative routes of vaccine delivery, a higher dose of antigen, or addition of an adjuvant. The Fluzone® High-Dose influenza vaccine (Sanofi Pasteur Inc.) was designed for people 65 years and older, and contains four times the amount of hemagglutinin (HA) contained in standard-dose vaccines [12, 13]. The adjuvanted injectable influenza vaccine Fluad® was developed (by Novartis) for older adults. Both Fluzone® High-Dose and Fluad® have demonstrated enhanced humoral immune responses compared to standard-dose non-adjuvanted vaccines [12–15]. Nevertheless, immunization advisory committees such as the Advisory Committee on Immunization Practices (ACIP) in the U.S., and the National Advisory Committee on Immunization (NACI) in Canada, consider that there is currently insufficient evidence to make a recommendation for their routine use in the elderly population. There is currently only one intranasal influenza vaccine on the western market, which is a live attenuated influenza vaccine (LAIV) called Fluenz®/Flumist® (MedImmune, AstraZeneca). However, LAIV is not licensed for adults >18 years in Europe, and not recommended for individuals ≥50 years in the U.S. It has been speculated that LAIV’s limited efficacy in adults and elderly could be due to its inability to infect individuals with pre-existing immunity [16–18]. Following vaccination with LAIV, viral shedding can occur and there is a possibility that the vaccine strain is transmitted , which could be problematic if LAIV recipients come into contact with severely immunocompromised persons.
Here we sought to evaluate a vaccine based on split influenza antigen together with the lipid-based adjuvant Endocine™ in aged mice. Endocine™ is a mucosal adjuvant that has been shown to be safe and well tolerated in both pre-clinical and clinical studies [20–24]. We have previously demonstrated that vaccines formulated with Endocine™ enhance both humoral and cell-mediated immune responses in mice after intranasal vaccination , and a study in ferrets demonstrated that Endocine™ induces high HI and virus neutralization titers, and fully protects ferrets from virus replication in the lungs . Furthermore, a recent study by Falkeborn et al. showed that an Endocine™-adjuvanted influenza vaccine evoked serum IgG and virus neutralization titers to comparable levels as cholera toxin (CT) in mice, and induced significantly higher serum and mucosal influenza-specific IgA titers than an alum-adjuvanted vaccine administered parenterally . In the current study we tested if Endocine™ could enhance systemic and mucosal humoral immune responses to influenza antigen in aged mice.
Materials and methods
Female BALB/c mice were purchased from Charles River, Germany and used for vaccinations at 2 or 20 months of age. All animal experiments were approved by the regional animal experimental ethics committee in Stockholm (North), Sweden. The study was performed in accordance with institutional guidelines at Adlego Biomedical AB, Stockholm, Sweden.
Antigen and adjuvant
All mice were vaccinated with A/California/07/2009(H1N1)pdm split influenza antigen from season 2012/2013 (kindly provided by Mitsubishi Tanabe Pharma Corporation, Kanagawa, Japan) with or without the adjuvant Endocine™ (Eurocine Vaccines AB, Stockholm, Sweden), except the control groups which received saline. The adjuvant Endocine™ consists of the lipids mono-olein and oleic acid [21, 22, 24].
Vaccination and sampling
Mice (n = 8-11 per group) received 3 μg HA +/- 2% Endocine™ intranasally in 5 μL/nostril, or 50 μL of 3 μg HA subcutaneously in one hind leg. During vaccination, the mice were anaesthetized with isoflurane (IsoFlo® vet, Orion Pharma Animal Health, Sollentuna, Sweden). The mice were immunized three times at three-week intervals (day 0, 21 and 42). Blood samples and nasal lavages were collected one day before each immunization and three weeks after the last immunization at termination. The samples were stored at -20 °C until analysis. After sacrifice, the lungs were removed, put in PBS and frozen at -70 °C.
Determination of influenza-specific antibodies by ELISA
All serum samples were analyzed individually for influenza specific IgG, IgA, and subclass IgG (IgG1, IgG2a) with an enzyme-linked immunosorbent assay (ELISA). The samples were tested against the trivalent split vaccine Inflexal from season 2012/2013 (Cruzell, Madrid, Spain), consisting of A/California/07/2009 (H1N1), A/Victoria/361/2001 (H3N2) and B/Wisconsin/1/2010 influenza strains. Serological responses were measured as previously described  with the exception that the plates were coated with Inflexal at a concentration of 1.5 μg HA/mL. Nasal lavage was also analyzed for nasal IgA against Inflexal. These samples were incubated overnight in +4 °C on the plate and then analyzed as previously described . The lungs were homogenized, flushed with PBS and the solution was collected and centrifuged to remove tissue and cell debris. To analyze total IgA, plates were coated with 1 μg/mL of Goat-anti mouse IgA (MyBiosource.com). The samples were then incubated overnight in +4 °C on the plate. To detect total IgA, Mouse Immunoglobulins AP (DAKO) diluted 1:3,000 and p-nitrophenyl phosphate (pNPP) (Sigma-Aldrich) were used. To analyze influenza specific IgA and IgG in lung homogenate, plates were coated with Inflexal and analyzed as previously described .
Hemagglutination inhibition (HI)
Samples were pooled in each group from each time point except serum samples from day 63 which were analysed individually. Sera were tested in hemagglutination inhibition (HI) as previously described  against pH1N1 A/California/07/09 virus at Viroclinics Biosciences B.V.
Statistical analysis was performed using GraphPad Prism (La Jolla, CA, US). Analysis of immunological parameters was performed using Kruskal-Wallis one-way ANOVA. When significant, Mann-Whitney U-test was applied for comparison between two groups. A p-value of <0.05 was considered statistically significant.
Results and Discussion
Intranasal delivery of an Endocine™-formulated influenza vaccine enhances HI and IgG titers in aged mice
Analysis of influenza-specific IgG in lung homogenates of aged mice revealed that the Endocine™-adjuvanted vaccine generated significantly higher antibody titers than the unadjuvanted intranasal vaccine (Fig. 2c). Overall, our results demonstrate that intranasal delivery of an Endocine™-formulated influenza vaccine can improve vaccine immunogenicity and help overcome the limitations of immunosenescence.
Endocine™ boosts influenza-specific mucosal IgA titers in aged mice
Influenza-specific IgA levels were substantially lower in lung homogenates than in nasal washes, nevertheless, Endocine™-vaccinated mice had significantly higher IgA titers compared to mice immunized intranasally or subcutaneously without adjuvant (Fig. 3b). The total amount of IgA antibodies, not only influenza-specific, was similar in all groups of aged mice, whereas significantly lower levels were detected in the group with young mice (Fig. 3c). This is not completely unexpected, as previous analyses have shown a similar difference in IgA levels between young and older mice in gut tissue [35, 36]. Interestingly, even though the frequency of local mucosal B cells in gut tissue is reduced in elderly mice, the synthesis and secretion of immunoglobulins was shown to be higher in older mice compared to young mice . Taken together, these data indicate that intranasal administration of influenza vaccine adjuvanted with Endocine™ may have advantages over parenteral immunization due to its ability to induce mucosal IgA.
In this study, challenge was not performed, however, a previous study in young mice vaccinated intranasally with influenza and Endocine™ did show reduced levels of viral RNA in the lungs . Furthermore, immunization of 12 month old ferrets with influenza vaccine adjuvanted with Endocine™ induced a broad antibody response and fully protected the animals after challenge with influenza virus . Future studies should explore whether intranasal immunization with Endocine™ confers protection against influenza challenge in aged mice.
The current study is one of few to evaluate the humoral systemic and mucosal immune responses to influenza vaccination in 20-month old mice. We show that it is possible to improve the immune response to an inactivated intranasal vaccine by formulating the vaccine with Endocine™. In addition, the intranasal Endocine™-adjuvanted influenza vaccine improved immune responses (HI titers, serum IgG and mucosal IgA) in aged mice compared to a non-adjuvanted parenteral vaccine.
The authors thank Professor Marie Larsson, Linköping University, Sweden, who provided writing assistance. The authors also thank Mitsubishi Tanabe Pharma Corporation, Kanagawa, Japan, for providing influenza split antigens.
Availability of data and materials
The data supporting the results of this article are included within the article.
AL and AKM conceived and designed the experiments. TF performed the experiments. TF, JH, MO, AL and AKM analyzed the data. JH and AKM contributed reagents/materials/analysis tools. TF, JH, MO, AL and AKM wrote the paper. All authors read and approved the final manuscript.
All authors are affiliated with Eurocine Vaccines AB, Karolinska Institutet Science Park.
Consent for publication
All animal experiments were approved by the regional animal experimental ethics committee in Stockholm (North), Sweden. The study was performed in accordance with institutional guidelines at Adlego Biomedical AB, Stockholm, Sweden.
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- WHO. Influenza (Seasonal). March [cited 2015 18th March]; Available from: http://www.who.int/mediacentre/factsheets/fs211/en/index.html.
- Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–86.View ArticlePubMedGoogle Scholar
- McElhaney JE. Influenza vaccine responses in older adults. Ageing Res Rev. 2011;10:379–88.View ArticlePubMedGoogle Scholar
- Paquette SG, Huang SS, Banner D, Xu L, Leomicronn A, Kelvin AA, et al. Impaired heterologous immunity in aged ferrets during sequential influenza A H1N1 infection. Virology. 2014;464–465:177–83.View ArticlePubMedGoogle Scholar
- Katz JM, Plowden J, Renshaw-Hoelscher M, Lu X, Tumpey TM, Sambhara S. Immunity to influenza: the challenges of protecting an aging population. Immunol Res. 2004;29:113–24.View ArticlePubMedGoogle Scholar
- Siegrist C-A, Aspinall R. B-cell responses to vaccination at the extremes of age. Nat Rev Immunol. 2009;9:185–94.View ArticlePubMedGoogle Scholar
- Murasko DM, Bernstein ED, Gardner EM, Gross P, Munk G, Dran S, et al. Role of humoral and cell-mediated immunity in protection from influenza disease after immunization of healthy elderly. Exp Gerontol. 2002;37:427–39.View ArticlePubMedGoogle Scholar
- Lambert ND, Ovsyannikova IG, Pankratz VS, Jacobson RM, Poland GA. Understanding the immune response to seasonal influenza vaccination in older adults: a systems biology approach. Expert Rev Vaccines. 2012;11:985–94.View ArticlePubMedPubMed CentralGoogle Scholar
- Asanuma H, Hirokawa K, Uchiyama M, Suzuki Y, Aizawa C, Kurata T, et al. Immune responses and protection in different strains of aged mice immunized intranasally with an adjuvant-combined influenza vaccine. Vaccine. 2001;19:3981–9.View ArticlePubMedGoogle Scholar
- Goodwin K, Viboud C, Simonsen L. Antibody response to influenza vaccination in the elderly: a quantitative review. Vaccine. 2006;24:1159–69.View ArticlePubMedGoogle Scholar
- CDC. Prevention and Control of Influenza. Recommendations of the Advisory Committe on Immunization preacties (ACIP). MMWR Morbidity and mortality weekly report 2008 [cited 2014 29 of december]; 57(RR07); 1–60. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm.
- DiazGranados CA, Dunning AJ, Kimmel M, Kirby D, Treanor J, Collins A, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014;371:635–45.View ArticlePubMedGoogle Scholar
- Falsey AR, Treanor JJ, Tornieporth N, Capellan J, Gorse GJ. Randomized, double-blind controlled phase 3 trial comparing the immunogenicity of high-dose and standard-dose influenza vaccine in adults 65 years of age and older. J Infect Dis. 2009;200:172–80.View ArticlePubMedGoogle Scholar
- Frey SE, Reyes MR, Reynales H, Bermal NN, Nicolay U, Narasimhan V, et al. Comparison of the safety and immunogenicity of an MF59(R)-adjuvanted with a non-adjuvanted seasonal influenza vaccine in elderly subjects. Vaccine. 2014;32:5027–34.View ArticlePubMedGoogle Scholar
- Minutello M, Senatore F, Cecchinelli G, Bianchi M, Andreani T, Podda A, et al. Safety and immunogenicity of an inactivated subunit influenza virus vaccine combined with MF59 adjuvant emulsion in elderly subjects, immunized for three consecutive influenza seasons. Vaccine. 1999;17:99–104.View ArticlePubMedGoogle Scholar
- Powers DC, Fries LF, Murphy BR, Thumar B, Clements ML. In elderly persons live attenuated influenza A virus vaccines do not offer an advantage over inactivated virus vaccine in inducing serum or secretory antibodies or local immunologic memory. J Clin Microbiol. 1991;29:498–505.PubMedPubMed CentralGoogle Scholar
- DiazGranados CA, Denis M, Plotkin S. Seasonal influenza vaccine efficacy and its determinants in children and non-elderly adults: a systematic review with meta-analyses of controlled trials. Vaccine. 2012;31:49–57.View ArticlePubMedGoogle Scholar
- Monto AS, Ohmit SE, Petrie JG, Johnson E, Truscon R, Teich E, et al. Comparative efficacy of inactivated and live attenuated influenza vaccines. N Engl J Med. 2009;361:1260–7.View ArticlePubMedGoogle Scholar
- Block SL, Yogev R, Hayden FG, Ambrose CS, Zeng W, Walker RE. Shedding and immunogenicity of live attenuated influenza vaccine virus in subjects 5–49 years of age. Vaccine. 2008;26:4940–6.View ArticlePubMedGoogle Scholar
- Falkeborn T, Brave A, Larsson M, Akerlind B, Schroder U, Hinkula J. Endocine, N3OA and N3OASq; Three Mucosal Adjuvants That Enhance the Immune Response to Nasal Influenza Vaccination. PLoS One. 2013;8:e70527.View ArticlePubMedPubMed CentralGoogle Scholar
- Petersson P, Hedenskog M, Alves D, Brytting M, Schroder U, Linde A, et al. The Eurocine L3 adjuvants with subunit influenza antigens induce protective immunity in mice after intranasal vaccination. Vaccine. 2010;28:6491–7.View ArticlePubMedGoogle Scholar
- Maltais AK, Stittelaar KJ, Kroeze EJ, van Amerongen G, Dijkshoorn ML, Krestin GP, et al. Intranasally administered Endocine formulated 2009 pandemic influenza H1N1 vaccine induces broad specific antibody responses and confers protection in ferrets. Vaccine. 2014;32:3307–15.View ArticlePubMedGoogle Scholar
- Hinkula J, Falkeborn T, Pauksens K, Maltais A-K, Lindberg A, Stittelaar K ea. A nasal influenza vaccine with unique safety profile and robust immunogenic properties. Abstract for the 4th International conference on: Modern Vaccines Adjuvant and Delivery Systems, Copenhagen; 2012.
- Brekke K, Lind A, Holm-Hansen C, Haugen IL, Sorensen B, Sommerfelt M, et al. Intranasal Administration of a Therapeutic HIV Vaccine (Vacc-4x) Induces Dose-Dependent Systemic and Mucosal Immune Responses in a Randomized Controlled Trial. PLoS One. 2014;9:e112556.View ArticlePubMedPubMed CentralGoogle Scholar
- Falkeborn T. Comparison of the Mucosal Adjuvant Endocine™ with Two Well-Known Adjuvants: Cholera Toxin and Alum. J J Vaccine Vaccination. 2015;1(1):6.Google Scholar
- Palmer D, Doyle W, Coleman M, Schild G. Haemagglutination inhibition test. In: Immunology series 6. Advanced laboratory techniques for influenza diagnosis. Procedural guide. Atlanta: US Department of Health, Education, and Welfare; 1975. p. 25–62.
- Higgins DA, Carlson JR, Van Nest G. MF59 adjuvant enhances the immunogenicity of influenza vaccine in both young and old mice. Vaccine. 1996;14:478–84.View ArticlePubMedGoogle Scholar
- Schneider-Ohrum K, Giles BM, Weirback HK, Williams BL, DeAlmeida DR, Ross TM. Adjuvants that stimulate TLR3 or NLPR3 pathways enhance the efficiency of influenza virus-like particle vaccines in aged mice. Vaccine. 2011;29:9081–92.View ArticlePubMedGoogle Scholar
- Guebre-Xabier M, Hammond SA, Ellingsworth LR, Glenn GM. Immunostimulant patch enhances immune responses to influenza virus vaccine in aged mice. J Virol. 2004;78:7610–8.View ArticlePubMedPubMed CentralGoogle Scholar
- Riedl K, Riedl R, von Gabain A, Nagy E, Lingnau K. The novel adjuvant IC31 strongly improves influenza vaccine-specific cellular and humoral immune responses in young adult and aged mice. Vaccine. 2008;26:3461–8.View ArticlePubMedGoogle Scholar
- Reber AJ, Chirkova T, Kim JH, Cao W, Biber R, Shay DK, et al. Immunosenescence and Challenges of Vaccination against Influenza in the Aging Population. Aging Dis. 2012;3:68–90.PubMedGoogle Scholar
- Toapanta FR, Ross TM. Impaired immune responses in the lungs of aged mice following influenza infection. Respir Res. 2009;10:112.View ArticlePubMedPubMed CentralGoogle Scholar
- Powers DC. Effect of age on serum immunoglobulin G subclass antibody responses to inactivated influenza virus vaccine. J Med Virol. 1994;43:57–61.View ArticlePubMedGoogle Scholar
- Asanuma H, Zamri NB, Sekine S, Fukuyama Y, Tokuhara D, Gilbert RS, et al. A novel combined adjuvant for nasal delivery elicits mucosal immunity to influenza in aging. Vaccine. 2012;30:803–12.View ArticlePubMedGoogle Scholar
- McDonald KG, Leach MR, Huang C, Wang C, Newberry RD. Aging impacts isolated lymphoid follicle development and function. Immunity Ageing. 2011;8:1.View ArticlePubMedPubMed CentralGoogle Scholar
- Senda S, Cheng E, Kawanishi H. Aging-associated changes in murine intestinal immunoglobulin A and M secretions. Scand J Immunol. 1988;27:157–64.View ArticlePubMedGoogle Scholar