Use of Calcium Channel Blockers in Cardiovascular Risk Reduction

Cardiovascular disease (CVD) is a continuum that begins with the presence of several risk factors for CVD, including smoking, hypertension, obesity, diabetes mellitus, and high levels of cholesterol, and if unaddressed can result in premature death, ischemic heart disease, stroke, congestive heart failure, and end-stage renal disease. Hypertension is associated with a significant increase in cardiovascular (CV) morbidity and mortality, raising the risk of stroke, myocardial infarction, heart failure, kidney disease, and peripheral arterial disease. In Latin America, the prevalence of hypertension and other CV risk factors has become similar to that seen in more developed countries, increasing the proportion of the population at high risk for CVD and congestive heart failure; however, it is hypertension that is a key driving force behind CV risk in Latin America. Despite the existence of a wide range of antihypertensive agents, BP control and reductions in CV risk remain poor in Latin America and in Hispanics living in the US. Ethnic differences in treatment rates and disease awareness have been well documented. Studies have shown that calcium channel blockers (CCBs; calcium channel antagonists) are at least as effective in reducing BP and improving the CV risk profile as other classes of antihypertensive agents when administered as monotherapy. CCBs have also been shown to be effective when administered as part of combination therapy in both low- and high-risk hypertensive patients, suggesting that CCBs can easily be combined with other antihypertensive classes in order to achieve BP control and CV risk reduction. In patients with hypertension, coronary artery disease, and high cholesterol, CCBs have been associated with beneficial effects on a range of other aspects of the CV continuum, including the vasculature, coronary calcification, and progression of atherosclerosis. CCBs have also been shown to preserve renal function. Unlike diuretics and β-adrenoreceptor antagonists, CCBs are metabolically neutral, inducing minimal changes in serum lipids and decreasing the incidence of new-onset diabetes compared with other antihypertensive agents. CCBs are well tolerated when administered as monotherapy or combination therapy, with long-acting formulations minimizing adverse events even further compared with short-acting formulations. These characteristics make CCBs an attractive option for the treatment of hypertension and CV risk in Latin America, which remain significant health issues in this region.     

大流行流感疫苗研发问题

 自2003年以来,已有250多人感染H5N1禽流感,均导致了严重的疾病和/或50%以上死亡率.合法和非法的家禽流动可携带高致病性H5N1病毒跨越长距离,从而使病毒在宽广的地域中传播.除了疫苗接种者的免疫状况以外,疫苗类型、抗原含量、接种方式、接种剂次及佐剂的使用都将影响疫苗的免疫应答.政府、疫苗生产企业和研究机构应该联合起来进行基础研究和临床试验,以决定能诱导最适免疫应答的疫苗配方、浓度和接种剂次.急需抓紧时间制备合适的大流行流感疫苗.     

流行性感冒疫苗市场浅析

流行性感冒简称流感,是由流感病毒引起的急性呼吸道传染病。据2002年世界卫生组织(WHO)公布的数据,全球每年流感病例数约为6～12亿(发病率约为10%～20%),因此而死亡的人数可高达50万。美国计划免疫咨询委员会(ACIP)推荐以下人群定期接种流感疫苗:年龄介于6～23个月之间的儿童以及50岁以上的老年人群;流感相关并发症高危人群;与流感高危患者密切接触的家人及医务工作者。美国目前使用的流感疫苗主要有两大类,一类是三价流感灭活疫苗(TIVs),另一类是流感减毒活疫苗(LAIVs)。TIVs是目前市场上最常用的流感疫苗,按照其不同的制造工艺,流…     

全球流感疫苗市场仍多变局

流感疫苗市场是一个备受考验的市场，种种原因使得生产厂家难以制定生产计划。而流感高峰期的疫苗市场就更难预测，几乎完全取决于政府储备和合同供应。     

Development of a Stable Liquid Formulation for Live Attenuated Influenza Vaccine

Live attenuated influenza vaccine (LAIV) is considered one of the most effective vaccines and can be manufactured quickly and inexpensively to counter seasonal or pandemic influenza. Lyophilization is widely used in vaccine production. However, it requires a longer production cycle and large-scale equipment, thus posing a considerable financial burden for developing countries. A potential solution is the development of liquid LAIV, which can increase the yield and reduce the cost of production. In this study, influential factors of LAIV, such as potential stabilizing excipients and pH, were optimized by an orthogonal design. We found that pH is the most critical factor for the stability of LAIV; salt concentration and initial virus titer are also important for LAIV stability. With these data, we developed a liquid formulation consisting of 2.5% sucrose, 0.1% monosodium glutamate, 1% arginine, and 0.5% human serum albumin, with pH ranging from 6.2 to 6.9 (optimum pH 6.5-6.7), for optimal production of monovalent or trivalent LAIVs. This liquid formulation has the potential to considerably improve vaccine production capacity to compensate for the immense shortfall in influenza vaccines globally.     

亚单位流感疫苗中裂解剂检测方法的改进

目的 改进检测亚单位流感疫苗中裂解剂(壬苯醇醚-9)含量的HPLC方法.方法 以C4柱(Thermo BioBasic-4)代替药典使用的C18柱(Thermo BDS Hypersil C18),改变相应流动相比例.结果 C4柱保留时间仅3.27～3.34min,杂峰少,易积分,在5～2500tg·mL-1范围内线性关系良好,回收率约为100％,日内精密度和日间精密度均小于3％.结论 C4柱与C18柱相比更快速准确,更适用于实验室对裂解剂含量的常规检测.     

Statistical Analysis of Influenza Vaccine Lot Consistency Studies

This paper presents an integrated statistical approach to the analysis of influenza vaccine lot consistency studies in which three lots are compared. The approach ensures that the overall Type I error rate (i.e., the probability of wrongly concluding that the lots are similar) is controlled. It is argued that the optimum efficacy measure is the geometric mean titer. The approach is demonstrated using data from a randomized, double-blind lot consistency study in which three consecutive production lots of Solvay Pharmaceutical' new, virosomal subunit influenza vaccine Invivac ® were compared.     

Preparation of Highly Concentrated Influenza Vaccine for Use in Novel Delivery Approaches

Vaccine antigens are usually available only as dilute solutions, which are difficult to formulate into various novel delivery systems, which often require highly concentrated antigens. To address this problem, we have utilized tangential flow filtration (TFF), a simple and scalable process to prepare highly concentrated vaccine antigens. Here, we describe the optimization of TFF to concentrate hemagglutinin (HA) of egg-derived influenza antigens, from 2008 to 2009 seasonal vaccine, to concentrations up to 28 mg/mL. Concentrated antigen was evaluated by single radial immunodiffusion and reversed-phase high-performance liquid chromatographic analysis for the estimation of the HA content and a range of assays including size exclusion, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and bicinchoninic acid assay for protein characterization. In addition, the concentrated antigens retained their immunogenicity, confirmed by the induction of immune responses comparable to that of unprocessed antigen in a mouse model. The liquid concentrates were stable for up to 4 weeks, which could allow subsequent formulation into novel delivery technologies. Hence, we have used influenza HA to demonstrate that the fast, robust, and scalable approach of TFF can be used to concentrate antigens for use in novel delivery approaches. Moreover, the concentration process could be applicable for a variety of antigens and a wide range of novel vaccine delivery applications.     

我国疫苗风险管理模式探讨

药品风险管理是围绕药品安全性问题开展的,通过上市前研究或上市后不良反应监测,完成药品风险评估、风险控制、风险审核和风险沟通的系统过程.疫苗作为一种特殊的药品,其风险管理尤为重要.本文分析了我国疫苗不良反应监测的现状及存在的问题,并参考国际先进经验,对我国疫苗风险管理模式进行了探讨.     

昔布类药物的心血管风险评价

昔布类药物是一类新型非甾体解热镇痛抗炎药,能选择性抑制环氧酶-2（COX-2）,而对环氧酸-1（COX-1）影响较小。因较COX-1抑制剂的胃肠道不良反应小,该类产品自1998年问世后的5年间拥有很高的商业价值,在非甾体解热镇痛抗炎药的市场中占有较大份额。但2004年9月,美国默沙东公司突然主动宣布从全球撤回罗非昔布（rofecoxib）,引发了学术界对选择性COX-2抑制剂心血管安全性问题的关注。     

Physicochemical Characterization of Influenza Viral Vaccine Loaded Surfactant Vesicles

The goal of this study was to develop nonionic surfactant vesicles of influenza antigen for nasal mucosal delivery. The study describes the encapsulation of viral influenza vaccine antigen in nonionic surfactant vesicles using dehydration-rehydration technique and investigation of the influence of the varying proportion of surfactant, cholesterol, and dicetyl phosphate on the morphology, particle size, entrapment efficiency, and in vitro antigen release from surfactant vesicles. The stability of the antigen was studied using SDS-polyacrylamide gel electrophoresis and immunoblotting. The effect of cholesterol concentration and the method of lyophilization on antigen loading and in vitro release of antigen from surfactant vesicles also were studied.     

三种流感疫苗对H7N9禽流感病毒的免疫交叉反应

目的 评价季节性流感疫苗对H7 N9禽流感病毒的免疫效果.方法 使用3种季节性流感疫苗对受试者进行免疫接种,受试者于免疫前及免疫后21 d采集血样.应用微量血凝抑制试验(HI)对血清进行抗体检测.结果 在接种流感疫苗前,接种3种不同季节性流感疫苗的A、B、C组针对H7N9型毒株抗体几何平均滴度(GMT)均为血清1:5.0稀释阴性,保护抗体阳性率均为0.疫苗免疫后21 d,276例受试者中检测到6例受试者H7N9型毒株HI抗体结果 达到1:40阳转标准,阳转率为2.2%,A、B和C组各有2例(2.2%)、1例(1.1%)和3例(3.3%)H7N9型毒株HI抗体阳转.3组抗体阳转率差异无统计学意义(P=0.789).H7N9型抗体阳转率、GMT增长倍数、抗体保护率均未达到欧盟标准和美国食品药品管理局标准.结论 接种季节性流感疫苗不能为人群提供针对H7 N9禽流感病毒的免疫保护.     

Development of Stable Influenza Vaccine Powder Formulations: Challenges and Possibilities

Influenza vaccination represents the cornerstone of influenza prevention. However, today all influenza vaccines are formulated as liquids that are unstable at ambient temperatures and have to be stored and distributed under refrigeration. In order to stabilize influenza vaccines, they can be brought into the dry state using suitable excipients, stabilizers and drying processes. The resulting stable influenza vaccine powder is independent of cold-chain facilities. This can be attractive for the integration of the vaccine logistics with general drug distribution in Western as well as developing countries. In addition, a stockpile of stable vaccine formulations of potential vaccines against pandemic viruses can provide an immediate availability and simple distribution of vaccine in a pandemic outbreak. Finally, in the development of new needle-free dosage forms, dry and stable influenza vaccine powder formulations can facilitate new or improved targeting strategies for the vaccine compound. This review represents the current status of dry stable inactivated influenza vaccine development. Attention is given to the different influenza vaccine types (i.e. whole inactivated virus, split, subunit or virosomal vaccine), the rationale and need for stabilized influenza vaccines, drying methods by which influenza vaccines can be stabilized (i.e. lyophilization, spray drying, spray-freeze drying, vacuum drying or supercritical fluid drying), the current status of dry influenza vaccine development and the challenges for ultimate market introduction of a stable and effective dry-powder influenza vaccine.     

Enhanced Stability of Inactivated Influenza Vaccine Encapsulated in Dissolving Microneedle Patches

Purpose

This study tested the hypothesis that encapsulation of influenza vaccine in microneedle patches increases vaccine stability during storage at elevated temperature.

Methods

Whole inactivated influenza virus vaccine (A/Puerto Rico/8/34) was formulated into dissolving microneedle patches and vaccine stability was evaluated by in vitro and in vivo assays of antigenicity and immunogenicity after storage for up to 3 months at 4, 25, 37 and 45°C.

Results

While liquid vaccine completely lost potency as determined by hemagglutination (HA) activity within 1–2 weeks outside of refrigeration, vaccine in microneedle patches lost 40–50% HA activity during or shortly after fabrication, but then had no significant additional loss of activity over 3 months of storage, independent of temperature. This level of stability required reduced humidity by packaging with desiccant, but was not affected by presence of oxygen. This finding was consistent with additional stability assays, including antigenicity of the vaccine measured by ELISA, virus particle morphological structure captured by transmission electron microscopy and protective immune responses by immunization of mice in vivo.

Conclusions

These data show that inactivated influenza vaccine encapsulated in dissolving microneedle patches has enhanced stability during extended storage at elevated temperatures.

     

大流行流感疫苗研发和质量管理中一些问题的探讨

季节性流感疫苗是公认的预防流行性感冒的有力武器,主要预防人流感病毒同型变异株造成的流行和感染.而大流行流感通常由新的流感病毒亚型引起,因此,大流行流感疫苗是一种全新的预防性疫苗.比较季节性流感和大流行流感的产生原因,进而从毒种制备、生产基质、抗原含量、佐剂、免疫效果评价、质控方法、生物安全等各个方面阐述大流行流感疫苗研制中面临的技术问题,同时介绍国外在质量管理方面的技术法规.     

基于真实世界的四价流感疫苗不良反应信号挖掘研究

目的挖掘四价流感疫苗的不良反应信号,为临床安全接种流感疫苗提供参考。方法利用报告比值比(ROR)法和比例报告比值比(PRR)法对美国疫苗不良事件报告系统(VAERS) 2013年至2018年的疫苗不良反应报告进行分析。结果 ROR法共得到222个信号,取信号较强的前50个不良反应信号,其中47个未在四价流感疫苗说明书中出现。结论四价流感疫苗的不良反应信号发生频次较高的集中在全身性损害,相关性较高的集中在肌肉与骨骼肌损害、中枢及外周神经系统损伤,尤其是颜面部外周神经损伤等。临床接种疫苗后,应及时关注接种者的面部外周神经损伤和肌肉骨骼肌损害的发生。     

Stability Kinetics of Influenza Vaccine Coated onto Microneedles During Drying and Storage

Purpose  

This study sought to determine the effects of microneedle coating formulation, drying time and storage time on antigen stability and in vivo immunogenicity of influenza microneedle vaccines.