title: Safety and immunogenicity trial in adult volunteers of a human papillomavirus 16 L1 virus-like particle vaccine.
abstract: BACKGROUND
  Studies in animal models have shown that systemic immunization with a papillomavirus virus-like particle (VLP) vaccine composed of L1, a major structural viral protein, can confer protection against subsequent experimental challenge with the homologous virus. Here we report results of a double-blind, placebo-controlled, dose-escalation trial to evaluate the safety and immunogenicity of a human papillomavirus (HPV) type 16 (HPV16) L1 VLP vaccine in healthy adults.
  
  
  METHODS
  Volunteers were given intramuscular injections with placebo or with 10- or 50-microg doses of HPV16 L1 VLP vaccine given without adjuvant or with alum or MF59 as adjuvants at 0, 1, and 4 months. All vaccine recipients were monitored for clinical signs and symptoms for 7 days after each inoculation. Immune responses were measured by an HPV16 L1 VLP-based enzyme-linked immunosorbent assay (ELISA) and by an HPV16 pseudovirion neutralization assay. The antibody titers were given as the reciprocals of the highest dilution showing positive reactivity in each assay. All statistical tests were two-sided.
  
  
  RESULTS
  The prevaccination geometric mean ELISA titer for six seropositive individuals was 202 (range, 40--640). All vaccine formulations were well tolerated, and all subjects receiving vaccine seroconverted. Serum antibody responses at 1 month after the third injection were dose dependent in recipients of vaccine without adjuvant or with MF59 but were similar at both doses when alum was the adjuvant. With the higher dose, the geometric means of serum ELISA antibody titers (95% confidence intervals) to purified VLP 1 month after the third injection were as follows: 10,240 (1499 to 69 938) without adjuvant, 10,240 (1114 to 94 145) with MF59, and 2190 (838 to 5723) with alum. Responses of subjects within each group were similar. Neutralizing and ELISA antibody titers were highly correlated (Spearman correlation =.85), confirming that ELISA titers are valid proxies for neutralizing antibodies.
  
  
  CONCLUSIONS
  The HPV16 L1 VLP vaccine is well tolerated and is highly immunogenic even without adjuvant, with the majority of the recipients achieving serum antibody titers that were approximately 40-fold higher than what is observed in natural infection.
authors.affiliation: Center for Immunization Research, Department of International Medicine, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Harro
authors.forename: Y Y
authors.initials: YY
authors.lastname: Pang
authors.forename: R B
authors.initials: RB
authors.lastname: Roden
authors.forename: A
authors.initials: A
authors.lastname: Hildesheim
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
authors.forename: M J
authors.initials: MJ
authors.lastname: Reynolds
authors.forename: T C
authors.initials: TC
authors.lastname: Mast
authors.forename: R
authors.initials: R
authors.lastname: Robinson
authors.forename: B R
authors.initials: BR
authors.lastname: Murphy
authors.forename: R A
authors.initials: RA
authors.lastname: Karron
authors.forename: J
authors.initials: J
authors.lastname: Dillner
authors.forename: J T
authors.initials: JT
authors.lastname: Schiller
authors.forename: D R
authors.initials: DR
authors.lastname: Lowy
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000328:Adult; D000534:Alum Compounds / Q000008:administration & dosage; D000914:Antibodies, Viral / Q000097:blood*; D016367:Baculoviridae; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007136:Immunoglobulins / Q000097:blood; D007273:Injections, Intramuscular; D008297:Male; D027383:Papillomaviridae / Q000276:immunology*; D053918:Papillomavirus Vaccines; D011136:Polysorbates / Q000008:administration & dosage; D011994:Recombinant Proteins; D012016:Reference Values; D013185:Squalene / Q000008:administration & dosage; D014765:Viral Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology*
chemical_list: D000276:Adjuvants, Immunologic; D000534:Alum Compounds; D000914:Antibodies, Viral; D007136:Immunoglobulins; C089950:MF59 oil emulsion; D053918:Papillomavirus Vaccines; D011136:Polysorbates; D011994:Recombinant Proteins; D014765:Viral Vaccines; C041524:aluminum sulfate; D013185:Squalene