Subunit vaccine

The first certified subunit vaccine by clinical trials on humans is the hepatitis B vaccine, containing the surface antigens of the hepatitis B virus itself from infected patients and adjusted by newly developed technology aiming to enhance the vaccine safety and eliminate possible contamination through individuals plasma. == Mechanism ==

Subunit vaccines contain fragments of the pathogen, such as protein or polysaccharide, whose combinations are carefully selected to induce a strong and effective immune response. Because the immune system interacts with the pathogen in a limited way, the risk of side effects is minimal. An effective vaccine would elicit the immune response to the antigens and form immunological memory that allows quick recognition of the pathogens and quick response to future infections. A drawback is that the specific antigens used in a subunit vaccine may lack pathogen-associated molecular patterns which are common to a class of pathogen. These molecular structures may be used by immune cells for danger recognition, so without them, the immune response may be weaker. Another drawback is that the antigens do not infect cells, so the immune response to the subunit vaccines may only be antibody-mediated, not cell-mediated, and as a result, is weaker than those elicited by other types of vaccines. To increase immune response, adjuvants may be used with the subunit vaccines, or booster doses may be required. == Types ==

Protein subunit A protein subunit is a polypeptide chain or protein molecule that assembles (or "coassembles") with other protein molecules to form a protein complex. Large assemblies of proteins such as viruses often use a small number of types of protein subunits as building blocks. A key step in creating a recombinant protein vaccine is the identification and isolation of a protein subunit from the pathogen which is likely to trigger a strong and effective immune response, without including the parts of the virus or bacterium that enable the pathogen to reproduce. Parts of the protein shell or capsid of a virus are often suitable. The goal is for the protein subunit to prime the immune system response by mimicking the appearance but not the action of the pathogen. Another protein-based approach involves self‐assembly of multiple protein subunits into a virus-like particle (VLP) or nanoparticle. The purpose of increasing the vaccine's surface similarity to a whole virus particle (but not its ability to spread) is to trigger a stronger immune response. Protein subunit vaccines are generally made through protein production, manipulating the gene expression of an organism so that it expresses large amounts of a recombinant gene. Protein-based vaccines are being used for hepatitis B and for human papillomavirus (HPV). Protein-based vaccines for COVID-19 tend to target either its spike protein or its receptor binding domain. As of 2021, the most researched vaccine platform for COVID-19 worldwide was reported to be recombinant protein subunit vaccines. Polysaccharide subunit Vi capsular polysaccharide vaccine (ViCPS) against typhoid caused by the Typhi serotype of Salmonella enterica. Instead of being a protein, the Vi antigen is a bacterial capsule polysacchide, made up of a long sugar chain linked to a lipid. Capsular vaccines like ViCPS tend to be weak at eliciting immune responses in children. Making a conjugate vaccine by linking the polysacchide with a toxoid increases the efficacy. Conjugate vaccine A conjugate vaccine is a type of vaccine which combines a weak antigen with a strong antigen as a carrier so that the immune system has a stronger response to the weak antigen. Peptide subunit A peptide-based subunit vaccine employs a peptide instead of a full protein. Peptide-based subunit vaccine mostly used due to many reasons,such as, it is easy and affordable for massive production. Adding to that, its greatest stability, purity and exposed composition. Three steps occur leading to creation of peptide subunit vaccine; • Epitope recognition • Epitope optimization • Peptide immunity improvement == Features ==

When compared with conventional attenuated vaccines and inactivated vaccines, recombinant subunit vaccines have the following special characteristics: • They contain clearly identified compositions which greatly reduces the possibility of presence of undesired materials within the vaccine. • Their pathogenicities are minimized as only fragments of the pathogen are present in the vaccine which cannot invade and multiply within the human body. • They have better safety profiles and are suitable to be administered to immunocompromised patients. • Patients will have to receive booster doses to maintain long-term immunity. • Selection of appropriate cell lines for the cultivation of subunits is time-consuming because microbial proteins can be incompatible to certain expression systems. == Pharmacology ==

Vaccination is a potent way to protect individuals against infectious diseases. Active immunity can be acquired artificially by vaccination as a result of the body's own defense mechanism being triggered by the exposure of a small, controlled amount of pathogenic substances to produce its own antibodies and memory cells without being infected by the real pathogen. The processes involved in primary immune response are as follows: • Pre-exposure to the antigens present in vaccines elicits a primary response. After injection, antigens will be ingested by antigen-presenting cells (APCs), such as dendritic cells and macrophages, via phagocytosis. • Following antigen processes by APCs, antigens will bind to either MHC class I receptors or MHC class II receptors on the cell surface of the cells based on their compositional and structural features to form complexes. • Cytotoxic CD8+ cells can directly destroy the infected cells containing the antigens that were presented to them by the APCs by releasing lytic molecules, while helper CD4+ cells are responsible for the secretion of cytokines that activates B cells and cytotoxic T cells. • B cells can undergo activation in the absence of T cells via the B cell receptor signalling pathway. Isotype switching can take place during B cell development for the formation of different antibodies, including IgG, IgE and IgA. • Memory B cells and T cells are formed post-infection. == Manufacturing ==

The manufacturing process of recombinant subunit vaccines are as follows: • Identification of immunogenic subunit • Subunit expression and synthesis • Extraction and purification • Addition of adjuvants or incorporation to vectors • Formulation and delivery. Identification of immunogenic subunit Candidate subunits will be selected primarily by their immunogenicity. To be immunogenic, they should be of foreign nature and of sufficient complexity for the reaction between different components of the immune system and the candidates to occur. Candidates are also selected based on size, nature of function (e.g. signalling) and cellular location (e.g. transmembrane). Bacterial cells Bacterial cells are widely used for cloning processes, genetic modification and small-scale productions. Escherichia coli (E. Coli) is widely utilised due to its highly explored genetics, widely available genetic tools for gene expression, accurate profiling and its ability to grow in inexpensive media at high cell densities. E. Coli is mostly appropriate for structurally simple proteins owing to its inability to carry out post-translational modifications, lack of protein secretary system and the potential for producing inclusion bodies that require additional solubilisation. Regarding application, E.Coli is being utilised as the expression system of the dengue vaccine. Yeast Yeast matches bacterial cells' cost-effectiveness, efficiency and technical feasibility. which may trigger cellular conformational stress responses. Such responses may result in failure in reaching native protein conformation, implying potential reduction of serum half-life and immunogenicity. However, efficacy of mammalian cells may be limited by epigenetic gene silencing and aggresome formation (recombinant protein aggregation). Similar to mammalian cells, proteins expressed are mostly soluble, accurately folded, and biologically active. However, it has slower growth rate and requires higher cost of growth medium than bacteria and yeast, and confers toxicological risks. However, the final extraction and purification process undertaken highly depends on the chosen expression system. Please refer to subunit expression and synthesis for more insights. Addition of adjuvants Adjuvants are materials added to improve immunogenicity of recombinant subunit vaccines. Adjuvants increase the magnitude of adaptive response to the vaccine and guide the activation of the most effective forms of immunity for each specific pathogen (e.g. increasing generation of T cell memory). Addition of adjuvants may confer benefits including dose sparing and stabilisation of final vaccine formulation. and poly-lactic-co-glycolic acid (PLGA) Subunits may either be inserted within the carrier or genetically engineered to be expressed on the surface of the vectors for efficient presentation to the mucosal immune system. == Advantages and disadvantages ==

Advantages • Cannot revert to virulence meaning they cannot cause the disease they aim to protect against • Safe for immunocompromised patients • Can withstand changes in conditions (e.g. temperature, light exposure, humidity) Disadvantages • Reduced immunogenicity compared to attenuated vaccines • Require adjuvants to improve immunogenicity • Often require multiple doses ("booster" doses) to provide long-term immunity • Can be difficult to isolate the specific antigen(s) which will invoke the necessary immune response • It is not easy to supervise conjugation chemistry which leads to noncontinuous variation == Adverse effects and contraindications ==

Recombinant subunit vaccines are safe for administration. However, mild local reactions, including induration and swelling of the injection site, along with fever, fatigue and headache may be encountered after vaccination. Occurrence of severe hypersensitivity reactions and anaphylaxis is rare, but can possibly lead to deaths of individuals. Adverse effects can vary among populations depending on their physical health condition, age, gender and genetic predisposition. Recombinant subunit vaccines are contraindicated to people who have experienced allergic reactions and anaphylaxis to antigens or other components of the vaccines previously. Furthermore, precautions should be taken when administering vaccines to people who are in diseased state and during pregnancy, in which their injections should be delayed until their conditions become stable and after childbirth respectively. == Licensed vaccines ==

Hepatitis B ENGERIX-B (produced by GSK) and RECOMBIVAX HB (produced by merck) are two recombinant subunit vaccines licensed for the protection against hepatitis B. Both contain HBsAg harvested and purified from Saccharomyces cerevisiae and are formulated as a suspension of the antigen adjuvanted with alum. Antibody concentration ≥10mIU/mL against HBsAg are recognized as conferring protection against hepatitis B infection. Human Papillomavirus (HPV) Cervarix, GARDASIL and GARDASIL9 are three recombinant subunit vaccines licensed for the protection against HPV infection. They differ in the strains which they protect the patients from as Cervarix confers protection against type 16 and 18, Gardasil confers protection against type 6, 11, 16 and 18, and Gardasil 9 confers protection against type 6, 11, 16, 18, 31, 33, 45, 52, 58 respectively. The vaccines contain purified VLP of the major capsid L1 protein produced by recombinant Saccharomyces cerevisiae. It has been shown in a 2014 systematic quantitative review that the bivalent HPV vaccine (Cervarix) is associated with pain (OR 3.29; 95% CI: 3.00–3.60), swelling (OR 3.14; 95% CI: 2.79–3.53) and redness (OR 2.41; 95% CI: 2.17–2.68) being the most frequently reported adverse effects. For Gardasil, the most frequently reported events were pain (OR 2.88; 95% CI: 2.42–3.43) and swelling (OR 2.65; 95% CI: 2.0–3.44). Gardasil was discontinued in the U.S. on May 8, 2017, after the introduction of Gardasil 9 and Cervarix was also voluntarily withdrawn in the U.S. on August 8, 2016. Influenza Flublok Quadrivalent is a licensed recombinant subunit vaccine for active immunisation against influenza. It contains HA proteins of four strains of influenza virus purified and extracted using the Baculovirus-insect expression system. The four viral strains are standardised annually according to United States Public Health Services (USPHS) requirements. Herpes Zoster SHINGRIX is a licensed recombinant subunit vaccine for protection against Herpes Zoster, whose risk of developing increases with decline of varicella zoster virus (VZV) specific immunity. The vaccine contains VZV gE antigen component extracted from CHO cells, which is to be reconstituted with adjuvant suspension AS01B. COVID-19 NUVAXOVID is a recombinant subunit vaccine licensed for the prevention of SARS-CoV-2 infection. Market authorization was issued on 20 December 2021. The vaccine contains the SARS-CoV-2 spike protein produced using the baculovirus expression system, which is eventually adjuvanted with the Matrix M adjuvant. == History ==

While the practice of immunisation can be traced back to the 12th century, in which ancient Chinese at that time employed the technique of variolation to confer immunity to smallpox infection, the modern era of vaccination has a short history of around 200 years. It began with the invention of a vaccine by Edward Jenner in 1798 to eradicate smallpox by injecting relatively weaker cowpox virus into the human body. The middle of the 20th century marked the golden age of vaccine science. Rapid technological advancements during this period of time enabled scientists to cultivate cell culture under controlled environments in laboratories, subsequently giving rise to the production of vaccines against poliomyelitis, measles and various communicable diseases. Conjugated vaccines were also developed using immunologic markers including capsular polysaccharide and proteins. Creation of products targeting common illnesses successfully lowered infection-related mortality and reduced public healthcare burden. Emergence of genetic engineering techniques revolutionised the creation of vaccines. By the end of the 20th century, researchers had the ability to create recombinant vaccines apart from traditional whole-cell vaccine, for instance Hepatitis B vaccine, which uses the viral antigens to initiate immune responses. As the manufacturing methods continue to evolve, vaccines with more complex constitutions will inevitably be generated in the future to extend their therapeutic applications to both infectious and non-infectious diseases, in order to safeguard the health of more people. == Future directions ==

Recombinant subunit vaccines are used in development for tuberculosis, dengue fever, feline leukaemia and COVID-19. Subunit vaccines are not only considered effective for SARS-COV-2, but also as candidates for evolving immunizations against malaria, tetanus, salmonella enterica, and other diseases. COVID-19 Research has been conducted to explore the possibility of developing a heterologous SARS-CoV receptor-binding domain (RBD) recombinant protein as a human vaccine against COVID-19. The theory is supported by evidence that convalescent serum from SARS-CoV patients have the ability to neutralise SARS-CoV-2 (corresponding virus for COVID-19) and that amino acid similarity between SARS-CoV and SARS-CoV-2 spike and RBD protein is high (82%). == References ==