Abstract
Staphylococcus aureus is a leading pathogen in surgical site, intensive care unit, and skin infections, as well as healthcare-associated pneumonias. These infections are associated with an enormous burden of morbidity, mortality, and increase of hospital length of stay and patient cost. S. aureus is impressively fast in acquiring antibiotic resistance, and multidrug-resistant strains are a serious threat to human health. Due to resistance or insufficient effectiveness, antibiotics and bundle measures leave a tremendous unmet medical need worldwide. There are no licensed vaccines on the market despite the significant efforts done by public and private initiatives. Indeed, vaccines tested in clinical trials in the last two decades have failed to show efficacy. However, they targeted single antigens and contained no adjuvants and efficacy trials were performed in severely ill subjects. Herein, we provide a comprehensive evaluation of potential target populations for efficacy trials taking into account key factors such as population size, incidence of S. aureus infection, disease outcome, primary endpoints, as well as practical advantages and disadvantages. We describe the whole-blood assay as a potential surrogate of protection, and we show the link between phase III clinical trial data of failed vaccines with their preclinical observations. Finally, we give our perspective on how new vaccine formulations and clinical development approaches may lead to successful S. aureus vaccines.
Abbreviations
- BSI:
-
Bloodstream infection
- CA:
-
Community acquired
- CAI:
-
Community acquired infection
- CA-SSTI:
-
Community acquired skin and soft tissue infection
- ClfA:
-
Clumping factor A
- CP:
-
Capsular polysaccharide
- Csa1A:
-
Conserved staphylococcal antigen 1A
- CT:
-
Cardiothoracic
- EPA:
-
Enterotoxin protein A
- ESRD:
-
End-stage renal disease
- EsxAB:
-
Ess extracellular A and B
- FhuD2:
-
Ferric hydroxamate uptake D2
- HA:
-
Hospital acquired
- HAI:
-
Hospital acquired infection
- HCA:
-
Healthcare associated
- Hla:
-
Alpha hemolysin
- HlgAB/ HlgCB:
-
Gamma hemolysin AB/CB
- LukED:
-
Leukocidins E and D
- ICU:
-
Intensive care unit
- IsdB:
-
Iron-surface determinant B
- MntABC:
-
ATP-binding cassette (ABC)
- MntC:
-
Manganese transport protein C
- MRSA:
-
Methicillin-resistant Staphylococcus aureus
- MSSA:
-
Methicillin-sensitive Staphylococcus aureus
- NEAT:
-
NEAr iron transporter
- NS:
-
Neurosurgical
- OP:
-
Orthopaedic
- OPA:
-
Opsonophagocytic Assay
- PMN:
-
Polymorphonuclear cells
- PVL:
-
Panton–Valentine leukocidin
- SA-SSTI:
-
Staphylococcus aureus skin and soft tissue infection
- SpA:
-
Staphylococcal protein A
- SSI:
-
Surgical site infection
- SSTI:
-
Skin and soft tissue infection
- Th1:
-
T helper cell 1
- Th17:
-
T helper cell 17
- TLR7:
-
Toll-like receptor 7
- TT:
-
Tetanus toxoid
- WBA:
-
Whole-blood assay
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Acknowledgments
We thank Giorgio Corsi for artwork and Proinnsias Fox at GSK for critical reading of the manuscript.
Funding
GSK funded all costs associated with the development and the publishing of the present manuscript.
Declaration of interest
Reuben Olaniyi is the recipient of a GSK fellowship from the Ph.D. programme in biochemistry and molecular biology of the University of Siena. Clarissa Pozzi is an employee of GVGH (GSK Vaccines Institute for Global Health). When the manuscript was written, Lassi Liljeroos was a post-doc researcher at GSK with a Marie Curie fellowship funded by a European Union FP7 Framework Programme FP7-PEOPLE-2013-IEF Grant (623168). Fabio Bagnoli, Ilaria Galgani, and Rino Rappuoli are employees of GSK Vaccines. Fabio Bagnoli owns patents on S. aureus vaccine candidates. Fabio Bagnoli and Rino Rappuoli own GSK stocks. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
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Clarissa Pozzi, Reuben Olaniyi, Lassi Liljeroos, Ilaria Galgani, Rino Rappuoli and Fabio Bagnoli were involved in the conception and design of the manuscript. All authors were involved in writing the manuscript or revising it critically for important intellectual content. All authors approved the manuscript before it was submitted.
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Pozzi, C., Olaniyi, R., Liljeroos, L., Galgani, I., Rappuoli, R., Bagnoli, F. (2016). Vaccines for Staphylococcus aureus and Target Populations. In: Bagnoli, F., Rappuoli, R., Grandi, G. (eds) Staphylococcus aureus. Current Topics in Microbiology and Immunology, vol 409. Springer, Cham. https://doi.org/10.1007/82_2016_54
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