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The U.S. CDC published today the Emerging Infectious Diseases, Early Release, Volume 30, Number 4—April 2024, that concluded where feasible, vaccination against hepatitis A, meningococcal disease (IMD), and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

On March 18, 2024, these CDC researchers wrote, 'We provide a descriptive, cross-sectional analysis of the concurrent outbreaks of hepatitis A and IMD in Florida in the context of an ongoing global mpox epidemic that also is disproportionally affecting MSM.'

'Through this analysis, we attempted to identify common and distinct features of each outbreak and synergistic factors that might have affected disease progression and control.'

'We observed a high percentage of concurrent HIV infection among hepatitis A, IMD, and most notably, mpox case-patients.'

The U.S. Food and Drug Administration has approved vaccines that can prevent certain sexually transmitted diseases (STDs) caused by infections from bacteria, viruses, or parasites. Various STD vaccines are available at health clinics and pharmacies in the U.S.

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The Bill & Melinda Gates Medical Research Institute today announced that a Phase 3 clinical trial to assess the efficacy of the M72/AS01E tuberculosis (TB) vaccine candidate is now underway in South Africa.

At full capacity, the trial will include up to 20,000 participants, including people living with HIV, at up to 60 trial sites in seven countries.

If shown to be well-tolerated and effective, M72/AS01E could potentially become the first vaccine to help prevent pulmonary TB in adolescents and adults, the most common form of the disease.

Furthermore, M72/AS01E would be the first new TB vaccine in over a century.

While TB is one of the world’s deadliest infectious diseases, the only available vaccine is Bacille Calmette-Guerin (BCG), which dates back to 1921.

BCG vaccines initially targeted against TB, tuberculosis meningitis, and non-specific protective effects against respiratory tract infections and certain cancers.

Various reports indicate that the BCG vaccine offers inadequate protection for adolescents and adults against the pulmonary form of the disease, which is primarily responsible for transmitting the TB bacterium.

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An observational, cross-sectional cohort study was published on March 5, 2024, investigating the source of an ongoing mpox outbreak in the Democratic Republic of the Congo (DRC).

The study also evaluated how the mpox virus (MPXV) clade I spread in the city of Kamituga. This non-peer-reviewed study included data from 2022 to January 2024.

These researchers reported a staggering 21,630 suspected MPXV cases and 1,003 deaths. Around 85% of the deaths recorded during this period were children under 15 years of age.

This MPXV clade I outbreak marks an important change as transmission routes now appear to be expanding to include heterosexual activity, wrote these researchers.

The DRC reported the first mpox MPXV clade I cases in humans in 1970.

"The mpox situation in the DRC is deeply alarming, and the lack of tests for both mpox and HIV means it's unclear just how bad the mpox situation is and what the underlying comorbidities are," said Dr. Ayoade Alakija, who is Chair of the Board at FIND, in a press release on March 12, 2024.

The May 2022 MPVX clade II global outbreak caused global concern, primarily among men. The outbreak caused 93,497 cases in 118 locations.

As of March 5, 2024, there have been 32,063 confirmed mpox cases and 58 deaths in the U.S.

Throughout the clade II outbreak, the JYNNEOS® ((MVA-BN®, IMVAMUNE®) vaccine has been deployed in most impacted countries.

On December 7, 2023, the U.S. CDC published a Health Alert Network Health Advisory stating that JYNNEOS is expected to have similar vaccine effectiveness (VE) against MPXV clade I, as seen with clade II.

The CDC's vaccine committee reported in October 2023 that JYNNEOS's VE against mpox clade II ranges from 36%–75% for 1-dose vaccination and 66%–89% for 2-dose vaccination. 

The European CDC reported in December 2023 that real-world JYNNEOS VE data is lacking.

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ImmunityBio today announced the recent publication of preclinical data in the online issue of Science, First Release. The data indicate that combination therapy with N-803, an IL-15 superagonist, and broadly neutralizing antibodies may potentially enable the immune system to manage human immunodeficiency virus (HIV) without the need for antiretroviral treatment.

The preclinical non-human primate study funded by the National Institutes of Health and the U.S. National Institute of Allergy and Infectious Diseases demonstrated that using N-803, in combination with broadly neutralizing antibodies (bNAbs), led to sustained viral control after discontinuation of antiretroviral therapy (ART) in ART-suppressed rhesus macaques infected with simian-human immunodeficiency virus AD8 (SHIV-AD8).

Treatment with N-803 and bNAbs led to immune activation and transient viremia but only limited reductions in the SHIV reservoir.

Upon ART discontinuation, all animals experienced viral rebound, followed by long-term virus control for up to 10 months in approximately 70% of those treated with N-803 and bNAbs.

“The viral reservoir in people with HIV is established within the first few days of infection and cannot be eliminated by the body’s immune system or currently available treatments, representing a significant obstacle in curing an established HIV infection,” said James B. Whitney, M.D., study author and researcher at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and Harvard Medical School, in a press release on March 6, 2024.

“When combined with broadly neutralizing antibodies, N-803 has the potential to provide viral control without significant reduction in the viral reservoir, which further suggests that the complete eradication of this reservoir may not be required to induce sustained remission after discontinuing antiretroviral therapy.”

Following on from and directly attributable to these preclinical results, two clinical trials were designed to investigate the ability of N-803 and bNAbs to reduce viral loads in HIV-infected individuals on antiretroviral therapy.

As of March 2024, these clinical studies are actively enrolling participants.

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N-803 IL-15 Superagonist Complex and HIV

N-803 IL-15 Superagonist Complex and HIV Clinical Trials, Dosage, News, Side Effects, Usage

ImmunityBio N-803 is a novel investigational IL-15 superagonist complex (Anktiva®) consisting of an IL-15 mutant (IL-15N72D) bound to an IL-15 receptor α/IgG1 Fc fusion protein. Its proposed mechanism of action is direct specific stimulation of CD8+ T cells and NK cells through beta gamma T-cell receptor binding with a generation of memory T-cells while avoiding T-reg stimulation. N-803 (ALT-803) is designed to have improved pharmacokinetic properties, longer persistence in lymphoid tissues, and enhanced anti-tumor activity compared to native, non-complexed IL-15 in vivo.

Natural killer (NK) cells are dysfunctional in chronic human immunodeficiency virus (HIV) infection as they cannot clear the virus. Researchers hypothesized that an infusion of NK cells, supported by interleukin 2 (IL-2) or IL-15, could decrease virus-producing cells in the lymphatic tissues. A phase 1 clinical study detected a moderate decrease in HIV-producing cells in lymph nodes. All participants in this Phase 1 study experienced a significant reduction in infection levels following treatment with N-803. The approach was well tolerated, with no unexpected adverse events. Tim Schacker, MD, senior author of this paper, and colleagues at the University of Minnesota Medical School are planning a follow-up study with additional participants to investigate these immunotherapies further in HIV-infected individuals. In addition to this study, three clinical trials are underway involving N-803 in HIV Cure-related strategies.

Patrick Soon-Shiong, M.D., Chairman and Global Chief Scientific and Medical Officer at ImmunityBio, commented in a press release, "These data preliminarily appear to validate what we know about the benefit of enhancing NK cell function and the potential utility of N-803 in infectious diseases."

On March 6, 2024, ImmunityBio announced the recent publication of preclinical data in Science, First Release, indicating that combination therapy with N-803 and broadly neutralizing antibodies may potentially enable the immune system to manage HIV without the need for antiretroviral treatment.

Over the last two decades, ImmunityBio's Dr. Patrick Soon-Shiong, M.D., has investigated mechanisms to activate the immune system to attack tumors that can otherwise evade and escape the body's defense mechanisms. To learn more about these studies, please visit our website.

N-803 in HIV Indication

HIV affects tens of millions of people globally and currently has no known cure. One strategy for curing HIV is known as the "kick and kill" approach. The "kick" is to induce HIV out of its latent resting state in T cells, and the "kill" is to remove or kill the infected cells via an immune response or immunotherapy. "The viral reservoir in people with HIV is established within the first few days of infection and cannot be eliminated by the body's immune system or currently available treatments, representing a significant obstacle in curing an established HIV infection," said James B. Whitney, M.D. HIV can disable NK cells—a frontline defense against viral infections—making it difficult to clear the infection. 

A research article published on February 29, 2024, titled' Induction of durable remission by dual immunotherapy in SHIV-infected ART-suppressed macaques' stated, 'complete eradication of the replication-competent viral reservoir is likely not a prerequisite for the induction of sustained remission after discontinuation of ART.'

 A peer-reviewed Research Article published in March 2020, The human IL-15 superagonist N-803 promotes migration of virus-specific CD8+ T and NK cells to B cell follicles but does not reverse latency in ART-suppressed, SHIV-infected macaques, substantiates N-803 as a potent immunotherapeutic candidate capable of activating and directing effector CD8+ T and NK cells to the B cell follicle durincompletell ART suppression, and suggest N-803 must be paired with a bona fide latency-reversing agent in vivo to facilitate immune-mediated modulation of the latent viral reservoir.

In January 2020, a study, 'Robust and persistent reactivation of SIV and HIV by N-803 and depletion of CD8+ cells' results, advanced the understanding of the mechanisms responsible for latency reversal and lentivirus reactivation during ART-suppressed infection.

N-803 in HIV News

March 6, 2024 - James B. Whitney, M.D., study author and researcher at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and Harvard Medical School, commented, "When combined with broadly neutralizing antibodies, N-803 has the potential to provide viral control without significant reduction in the viral reservoir, which further suggests that the complete eradication of this reservoir may not be required to induce sustained remission after discontinuing antiretroviral therapy."

March 5, 2024 - ImmunityBio announced data from a Phase 1 pilot study showed N-803 combined with natural killer cells could have the potential to reduce viral load in people living with HIV.

 September 12, 2023 - The journal Viruses published: IL-15 and N-803 for HIV Cure Approaches.

N-803 in HIV Clinical Trials

All participants in the Phase 1 pilot study (NCT03346499, NCT03899480) experienced a marked decrease in the burden of infection, and the procedures were found to be safe and well-tolerated.

Two Phase 1 clinical trials are investigating N-803 in combination with bNAbs in HIV-infected individuals (ACTG A5386, NCT04340596, and NCT05245292 at Rockefeller University), and a Phase 2 study, sponsored by the Thai Red Cross and the U.S. Military HIV Research Program, is also underway to investigate the effect of combining N-803 with ART during acute HIV infection.

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ImmunityBio has announced that the combination of N-803 and natural killer cells can potentially reduce viral load in people living with human immunodeficiency virus (HIV), per the Phase 1 pilot study data.

Results from this study were published in The Journal of Infectious Diseases in January 2024; researchers at the University of Minnesota Medical School gave six HIV-positive individuals infusions of healthy NK cells from close relatives, along with N-803, to boost NK cell activity. All participants in this Phase 1 study experienced a significant reduction in infection levels following treatment with N-803.

The approach was well tolerated, with no unexpected adverse events.

N-803 is a novel investigational IL-15 superagonist complex with an IL-15 mutant (IL-15N72D) bound to an IL-15 receptor α/IgG1 Fc fusion protein. Its proposed mechanism of action is direct specific stimulation of CD8+ T cells and NK cells through beta gamma T-cell receptor binding with the generation of memory T-cells while avoiding T-reg stimulation.

N-803 is designed to have improved pharmacokinetic properties, longer persistence in lymphoid tissues, and enhanced anti-tumor activity compared to native, non-complexed IL-15 in vivo.

The use of N-803 is investigational. Safety and efficacy have not been established by any Health Authority or Agency, including the U.S. FDA.

Tim Schacker, MD, senior author of this paper, and colleagues are planning a follow-on study with additional participants to investigate these immunotherapies in HIV-infected individuals further.

“Antiretroviral therapies have had a profound impact on society, making it possible for those living with HIV to live longer lives with better outcomes. However, these therapies are not a cure, and still place a significant burden on people living with HIV and the healthcare system,” said Patrick Soon-Shiong, M.D., Chairman and Global Chief Scientific and Medical Officer at ImmunityBio, in a press release on March 5, 2024.

“These data preliminarily validate what we know about the benefit of enhancing NK cell function and the potential utility of N-803 in infectious diseases.”

In addition to this study, three other clinical trials are underway involving N-803 in HIV Cure-related strategies.

Two Phase 1 clinical trials are investigating N-803 in combination with bNAbs in HIV-infected individuals (ACTG A5386, NCT04340596: and NCT05245292 at the Rockefeller University), and a Phase 2 study is also underway to investigate the effect of combining N-803 with ART during acute HIV infection, sponsored by the Thai Red Cross and the U.S. Military HIV Research Program. To learn more about these studies, please visit our website.

HIV affects tens of millions globally and currently has no known cure. HIV can disable NK cells—a frontline defense against viral infections—making it difficult to clear the infection.

One current strategy for curing HIV is known as the “kick and kill” approach. N-803 is under evaluation using this strategy, given the molecule’s ability to activate viral transcription in CD4+ T cells (“kick”) and boost CD8+ and NK cells, crucial for identifying and eliminating infected cells (“kill”), directing them to viral reservoirs.

ImmunityBio’s IL-15 superagonist N-803 (also called Anktiva® and nogapendekin alfa inbakicept)

The cytokine interleukin-15 (IL-15) plays a crucial role in the immune system by affecting the development, maintenance, and function of the natural killer (NK) and T cells.

N-803 is currently being evaluated in adult patients in two clinical NMIBC trials. QUILT-2.005 is investigating the use of N-803 in combination with BCG for patients with BCG-naïve NMIBC; QUILT-3.032 is studying N-803 in combination with BCG in patients with BCG-unresponsive NMIBC CIS and Papillary Disease.

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CytoDyn Inc., a biotechnology company developing leronlimab, a CCR5 antagonist, announced that the U.S. Food and Drug Administration (FDA) has lifted its clinical hold on leronlimab.

According to a press release on February 29, 2024, the Company is now free to proceed with its proposed HIV clinical trial exploring leronlimab and its effects on chronic inflammation.

The FDA placed a partial clinical hold on the Company's HIV program on March 30, 2022.

CytoDyn's CEO, Dr. Jacob Lalezari, commented, "CytoDyn is grateful for the FDA's guidance on our (HIV) protocol, and we are excited to open a new chapter in the development of leronlimab as a therapy that provides clinical benefit by modulating chronic inflammation."

Leronlimab is a humanized monoclonal antibody that is a once-a-week subcutaneous injection that can also be administered intravenously.

However, it is not a traditional HIV vaccine candidate.

It is a competitive rather than allosteric inhibitor of the CCR5 receptor. This mechanism of action of binding competitively to the CCR5 receptor differentiates leronlimab from all other CCR5 antagonists.

The CCR5 receptor is a protein located on the surface of various cells, including white blood cells, stellate cells that produce scar tissue in the liver, and cells that undergo malignant transformation. It is the predominant co-receptor needed for certain strains of HIV to infect healthy T-cells.

The CCR5 receptor serves as a receptor for chemical attractants called chemokines. Chemokines are the key orchestrators of leukocyte trafficking by attracting immune cells to the sites of inflammation.

For HIV, leronlimab is a viral-entry inhibitor, protecting healthy T cells from viral infection by blocking the predominant HIV (R5) subtype from entering those cells. 

Dr. Lalezari plans to host a webcast on Tuesday, March 5, 2024, to provide a Company update. The update will include discussing the Company's clinical trial goals and expectations, upcoming publications, and overall development strategy.

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