JP4827726B2 - 複数の髄膜炎菌血清群に対する注射可能ワクチン - Google Patents
複数の髄膜炎菌血清群に対する注射可能ワクチン Download PDFInfo
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- JP4827726B2 JP4827726B2 JP2006502485A JP2006502485A JP4827726B2 JP 4827726 B2 JP4827726 B2 JP 4827726B2 JP 2006502485 A JP2006502485 A JP 2006502485A JP 2006502485 A JP2006502485 A JP 2006502485A JP 4827726 B2 JP4827726 B2 JP 4827726B2
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Description
本発明は、ワクチンの分野(特に、細菌性髄膜炎に対するワクチンの分野)にある。
本発明は、N.meningitidisの血清群A、血清群C、血清群W135および血清群Yのうちの少なくとも2種由来の莢膜サッカリドを含有する注射可能免疫原性組成物を提供し、この莢膜サッカリドは、キャリアタンパク質に結合されるか、および/またはオリゴサッカリドであり、そして、この組成物は、用量あたり50μg以下の髄膜炎菌サッカリドを含有する。
本発明の組成物は、N.meningitidisの血清群A、血清群C、血清群W135および血清群Yのうちの少なくとも2種(すなわち、2種、3種または4種)由来の莢膜サッカリドを含有する。本発明の組成物は、好ましくは、少なくとも血清群C、血清群W135および血清群Y(すなわち、非MenAサッカリド)由来のN.meningitidisサッカリドを含有する。実際の免疫原性(例えば、ELISA力価)は減少され得るが、個々のサッカリド抗原の防御効力が、それらを組み合わせることにより除去されないことが好ましい。
髄膜炎菌莢膜ポリサッカリドは、代表的に、(例えば、陽イオン界面活性剤を用いた)ポリサッカリド沈殿、エタノール分別、(タンパク質を除去するための)冷フェノール抽出および(LPSを除去するための)超遠心の工程を包含するプロセスにより調製される[例えば、参考文献15]。
本発明のいくつかの組成物は、血清群B N.meningitidis由来の抗原を含有する。血清群A、血清群C、血清群W135および血清群Yとは異なり、MenBの莢膜サッカリドは、その自己抗原に対する類似性に起因して、ヒトにおける免疫原としての使用のために適切ではない。サッカリド抗原が、MenBのために使用される場合、従って、改変されたサッカリド(例えば、サッカリドのシアル酸残基のN−アセチル基が、N−アシル基で置換された改変されたサッカリド)を使用することが必要である。適切なN−アシル基は、C1〜C8アシル基(例えば、N−プロピオニル)である[20]。しかし、サッカリド抗原を使用することよりも、ポリペプチド抗原を使用することが好ましい。
上記組成物がH.influenzae B型抗原を含む場合、それは、代表的に、Hib莢膜サッカリド抗原である。H.influenzae b由来のサッカリド抗原は、周知である。
上記組成物が、S.pneumoniae抗原を含む場合、それは、代表的に、好ましくは、キャリアタンパク質に結合された莢膜サッカリド抗原である[例えば、参考文献57〜59]。S.pneumoniaeの1種より多くの血清型由来のサッカリドを含有することが好ましい。例えば、23種の異なる血清型由来のポリサッカリドの混合物が、広範に使用されており、5種と11種との間の異なる血清群由来のポリサッカリドを有する結合体ワクチンも同様である[60]。例えば、PrevNarTM[61]は、7種の血清型(4、6B、9V、14、18C、19Fおよび23F)由来の抗原を含有し、各々のサッカリドは、個々に、還元的アミノ化によりCRM197に結合され、0.5ml用量あたり2μgの各々のサッカリド(4μgの血清型6B)を有し、そして、結合体は、リン酸アルミニウムアジュバントに吸着される。本発明の組成物は、好ましくは、少なくとも血清型6B、血清型14、血清型19Fおよび血清型23Fを含有する。結合体は、リン酸アルミニウムに吸着され得る。
本発明の組成物がMenAサッカリド抗原を含有する場合、この抗原は、好ましくは、天然のサッカリドのヒドロキシル基の1つ以上が保護基により置換されている、改変されたサッカリドである[19]。この改変は、加水分解に対する耐性を改善し、そして、上記血清群A抗原が、凍結乾燥を必要とすることなく、液体形態で保存され、そして使用され得ることを意味する。
各々のZ基は、OHまたは上に定義されるような保護基より独立して選択され;そして
各々のQ基は、OHまたは上に定義されるような保護基より独立して選択され;
Yは、OHまたは上に定義されるような保護基より選択され;
Eは、Hまたは窒素保護基であり;
そして、ここで、Q基の約7%より多く(例えば、8%、9%、10%以上)は、保護基である。
莢膜サッカリドは、一般的に、オリゴサッカリドの形態で使用される。これらは、精製莢膜ポリサッカリドの(例えば、加水分解による)フラグメント化により都合よく形成され、通常、その後に、所望される大きさのフラグメントが精製される。
本発明の組成物における莢膜サッカリドは、通常、キャリアタンパク質に結合される。一般的に、結合は、サッカリドをT非依存性抗原からT依存性抗原へと変換することにより、サッカリドの免疫原性を増強し、従って、免疫記憶を開始させる。結合は、小児ワクチンのために特に有用であり[例えば、参考文献74]、そして周知の技術である[例えば、参考文献44〜52などに概説される]。
本発明の組成物は、N.meningitidisの血清群A、血清群C、血清群W135および血清群Yの少なくとも2種由来の莢膜サッカリドを含有する。上記サッカリドは、好ましくは、別個に調製され(任意のフラグメント化、結合などを含む)、次いで、混合されて本発明の組成物を与える。
本発明の組成物は、種々の方法において提示され、パッケージングされ得る。
上記組成物は、一般的に、1つ以上のアジュバントを含む。上記アジュバントは、それらが混合されて本発明の組成物を形成する前および/または後にサッカリドに添加され得るが、異なるサッカリドの混合前に、アジュバントとサッカリド抗原とを合わせることが好ましい。
本発明におけるアジュバントとしての使用のために適切な無機質含有組成物としては、無機塩(例えば、アルミニウム塩およびカルシウム塩)が挙げられる。本発明は、無機塩(例えば、水酸化物(例えば、オキシヒドロキシド)、ホスフェート(例えば、ヒドロキシホスフェート、オルトホスフェート)、スルフェートなど)[例えば、参考文献112の第8章および第9章を参照のこと]、または異なる無機化合物の混合物を含み、上記組成物は、任意の適切な形態(例えば、ゲル、結晶、非晶質など)をとり、そして、吸着が好ましい。上記無機質含有組成物はまた、無機塩の粒子として処方され得る[113]。
本発明におけるアジュバントとしての使用のために適切な油エマルジョン組成物としては、スクアレン−水エマルジョン(例えば、MF59)が挙げられる[参考文献112の第10章;参考文献114もまた参照のこと。](5%スクアレン、0.5%Tween 80および0.5%Span 85、マイクロフルイダイザー(microfluidizer)を用いて、サブミクロン粒子に処方される)。完全フロイントアジュバント(CFA)および不完全フロイントアジュバント(IFA)もまた、使用され得る。
サポニン処方物はまた、本発明においてアジュバントとして使用され得る。サポニンは、広範な植物種の樹皮、葉、茎、根および花においてさえ見られる、ステロールグリコシドおよびトリテルペノイドグリコシドの不均一な群である。Quillaia saponaria(モリナの木(Molina tree))の樹皮由来のサポニンは、アジュバントとして広範に研究されている。サポニンはまた、Smilax ornata(サルサパリラ(sarsaprilla))、Gypsophilla paniculata(ブライドベール(brides veil))およびSaponaria officianalis(サボンソウ(soap root))から市販品として得られ得る。サポニンアジュバント処方物としては、精製された処方物(例えば、QS21)および液体処方物(例えば、ISCOM)が挙げられる。QS21は、StimulonTMとして市販される。
ビロソームおよびウイルス様粒子(VLP)はまた、本発明においてアジュバントとして使用され得る。これらの構造は、一般的に、必要に応じてリン脂質と組み合わされるかまたはリン脂質とともに処方されたウイルス由来の1つ以上のタンパク質を含む。それらは、一般的に、非病原性、非複製性であり、そして、一般的に、あらゆる天然ウイルスゲノムを含まない。上記ウイルスタンパク質は、ウイルス全体から、組換え的に生成されるかまたは単離され得る。ビロソームまたはVLPにおける使用のために適切なこれらのウイルスタンパク質としては、インフルエンザウイルス由来のタンパク質(例えば、HAまたはNA)、B型肝炎ウイルス由来のタンパク質(例えば、コアタンパク質またはカプシドタンパク質)、E型肝炎ウイルス由来のタンパク質、麻疹ウイルス由来のタンパク質、シンドビスウイルス由来のタンパク質、ロタウイルス由来のタンパク質、口蹄疫ウイルス由来のタンパク質、レトロウイルス由来のタンパク質、ノーウォークウイルス由来のタンパク質、ヒトパピローマウイルス由来のタンパク質、HIV由来のタンパク質、RNAファージ由来のタンパク質、Qβファージ由来のタンパク質(例えば、コートタンパク質)、GAファージ由来のタンパク質、frファージ由来のタンパク質、AP205ファージ由来のタンパク質およびTy由来のタンパク質(例えば、レトロトランスポゾンTyタンパク質p1)が挙げられる。VLPは、参考文献122〜127においてさらに議論されている。ビロソームは、例えば、参考文献128においてさらに議論されている。
本発明における使用のために適切なアジュバントは、細菌誘導体または微生物誘導体(例えば、腸内細菌リポ多糖類(LPS)の無毒性誘導体、リピドA誘導体、免疫刺激オリゴヌクレオチドならびにADPリボシル化トキシンおよびそれらの無毒性誘導体)を含む。
本発明におけるアジュバントとしての使用のために適切なヒト免疫刺激因子としては、サイトカイン(例えば、インターロイキン(例えば、IL−1、IL−2、IL−4、IL−5、IL−6、IL−7、IL−12[161]など)[162]、インターフェロン(例えば、インターフェロン−γ)、マクロファージコロニー刺激因子および腫瘍壊死因子)が挙げられる。
生体接着因子および粘膜接着因子はまた、本発明におけるアジュバントとして使用され得る。適切な生体接着因子としては、エステル化ヒアルロン酸マイクロスフェア[163]または粘膜接着因子(例えば、ポリ(アクリル酸)、ポリビニルアルコール、ポリビニルピロリドン、ポリサッカリドおよびカルボキシメチルセルロースの架橋誘導体)が挙げられる。キトサンおよびその誘導体はまた、本発明におけるアジュバントとして使用され得る[164]。
微粒子はまた、本発明におけるアジュバントとして使用され得る。生分解性かつ無毒性の材料(例えば、ポリ(α−ヒドロキシ酸)、ポリヒドロキシ酪酸、ポリオルトエステル、ポリ無水物、ポリカプロラクトンなど)と、ポリ(ラクチド−グリコリド)とから形成される微粒子(すなわち、直径約100nm〜約150μm、より好ましくは、直径約200nm〜約30μm、そして、最も好ましくは、直径約500nm〜約10μmの粒子)が、好ましく、必要に応じて、処理されて、(例えば、SDSによる)負に荷電した表面または(例えば、カチオン性洗剤(例えば、CTAB)による)正に荷電した表面を有する。
アジュバントとしての使用のために適切なリポソーム処方物の例は、参考文献165〜167に記載されている。
本発明における使用のために適切なアジュバントとしては、ポリオキシエチレンエーテルおよびポリオキシエチレンエステルが挙げられる[168]。このような処方物としては、オクトキシノールと組み合わせたポリオキシエチレンソルビタンエステル界面活性剤[169]および少なくとも1つのさらなる非イオン性界面活性剤(例えば、オクトキシノール)と組み合わせたポリオキシエチレンアルキルエーテル界面活性剤またはポリオキシエチレンアルキルエステル界面活性剤[170]が、さらに挙げられる。好ましいポリオキシエチレンエーテルは、以下の群より選択される:ポリオキシエチレン−9−ラウリルエーテル(laureth 9)、ポリオキシエチレン−9−ステオリルエーテル、ポリオキシエチレン−8−ステオリルエーテル、ポリオキシエチレン−4−ラウリルエーテル、ポリオキシエチレン−35−ラウリルエーテルおよびポリオキシエチレン−23−ラウリルエーテル。
PCPP処方物は、例えば、参考文献171および172において記載されている。
本発明におけるアジュバントとしての使用のために適切なムラミルペプチドの例としては、N−アセチル−ムラミル−L−トレオニル−D−イソグルタミン(thr−MDP)、N−アセチル−ノルムラミル−L−アラニル−D−イソグルタミン(nor−MDP)およびN−アセチルムラミル−L−アラニル−D−イソグルタミニル−L−アラニン−2−(1’,2’−ジパルミトイル−sn−グリセロ−3−ヒドロキシホスホリルオキシ)−エチルアミン(MTP−PE)が挙げられる。
本発明におけるアジュバントとしての使用のために適切なイミダゾキノロン化合物の例としては、参考文献173および174にさらに記載される、Imiquamodおよびその相同体(例えば、「Resiquimod 3M」)が挙げられる。
−ジフテリア抗原(例えば、ジフテリアトキソイド)[例えば、参考文献180の第3章]
−破傷風抗原(例えば、破傷風トキソイド)[例えば、参考文献180の第4章]
−B.pertussis由来の百日咳ハロトキシン(PT)および糸状赤血球凝集素(FHA)(必要に応じて、また、ペルタクチンならびに/または凝集原2および凝集原3と組み合わせて)[例えば、参考文献181および182]
−細胞性破傷風抗原
−A型肝炎ウイルス由来の抗原(例えば、不活性化ウイルス)[例えば、183,184]
−B型肝炎ウイルス由来の抗原(例えば、表面抗原および/またはコア抗原)[例えば、184,185]、表面抗原は、好ましくは、リン酸アルミニウムに吸着される[186]
−N.meningitidis血清群B微小小胞[187]、「天然OMV」[188]、小水胞または外膜小胞[例えば、参考文献189〜190,191,192,193,194など]の調製物。これらは、例えば、免疫原性を増強する(例えば、過剰発現免疫原)、毒性を減少する、莢膜ポリサッカリド合成を阻害する、PorA発現をダウンレギュレートするなどのために、遺伝的に操作されている細菌から調製され得る[195〜196,197,198]。それらは、過剰水胞化(hyperblebing)株から調製され得る[199〜200,201,202]。非病原性ナイセリア属由来の小胞が、含まれ得る[203]。OMVは、洗剤を使用することなく調製され得る[204,205]。OMVは、それらの表面に、非ナイセリア属タンパク質を発現し得る[206]。OMVは、LPS欠失であり得る。OMVはまた、組換え抗原と混合され得る[189,207]。異なるクラスI外膜タンパク質サブタイプを有する細菌由来の小胞が、使用され得る(例えば、各々3種のサブタイプを示す2種の異なる遺伝的に操作された小胞集団を使用する6種の異なるサブタイプ[208,209]、または各々3種のサブタイプを示す3種の異なる遺伝的に操作された小胞集団を使用する9種の異なるサブタイプなど)。有用なサブタイプとしては、以下が挙げられる:P1.7,16;P1.5−1,2−2;P1.19,15−1;P1.5−2,10;P1.12−1,13;P1.7−2,4;P1.22,14;P1.7−1,1;P1.18−1,3,6。
本発明の組成物は、免疫原性である。好ましい免疫原性組成物は、ワクチンである。本発明に従うワクチンは、予防的(すなわち、感染を防ぐため)または治療的(すなわち、感染後の疾患処置のため)のいずれかであり得るが、代表的に、予防的である。
本発明の組成物は、注射可能である。
本発明は、患者において免疫応答を上昇させる方法を提供し、この方法は、本発明の組成物を患者に注射する工程を包含する。上記免疫応答は、好ましくは、髄膜炎菌疾患に対して防御的であり、そして、体液性免疫応答および/または細胞性免疫応答を含み得る。上記患者は、好ましくは、小児である。
本発明の組成物における使用のためのポリペプチドの発現が、天然宿主(例えば、N.meningitidisまたはS.pneumoniae)において行われ得る一方で、好ましくは、異種宿主が使用される。上記異種宿主は、原核生物(例えば、細菌)であっても真核生物であってもよい。E.coliが好ましいが、他の適切な宿主としては、Bacillus subtilis、Vibrio cholerae、Salmonella typhi、Salmonella typhimurium、Neisseria lactamica、Neisseria cinerea、Mycobacteria(例えば、M.tuberculosis)、酵母などが挙げられる。
用語「含む(comprising)」とは、「含む(including)」および「なる(consisting)」を意味する(例えば、Xを「含む」組成物は、Xのみからなり得るか、またはさらなる何かを含み得る(例えば、X+Y))。
(1.ヒト筋内投与のための髄膜炎菌サッカリド組成物)
MenC、MenW135、MenYおよび必要に応じて、MenA由来のオリゴサッカリド結合体を、参考文献7に開示されるように調製した。これらを、以下の6つの組成物の各々0.5ml用量を調製するために使用した(0.5ml用量あたりの量)。
ヒトの用途のための結合体を、2つの別個のバイアルに調製した。バイアル1は、スクロースおよびリン酸二水素化カリウムと一緒に、MenA結合体の凍結乾燥粉末を含んでいた。バイアル2は、塩化ナトリウム、ポリソルベート80、リン酸ナトリウム緩衝液、および必要に応じて、懸濁して存在するリン酸アルミニウムアジュバントと一緒に、MenC結合体、MenW135結合体およびMenY結合体を含んでいた。使用前に、バイアル1を、バイアル2からの0.6mlの液体で再構成し、投与のために利用可能な0.5mlを与えた。
莢膜ポリサッカリドを、MenAから精製し、そして、加水分解してMenAオリゴサッカリドを得た。上記ポリサッカリド(2g)を、50℃で、50mM酢酸ナトリウム緩衝液(pH4.75)中、10mg/mLのポリサッカリド濃度で、4時間加水分解した[73]。加水分解後、その溶液をロータリーエバポレーションにより乾燥した。
−オリゴサッカリドフラグメントを与えるためのポリサッカリドの加水分解
−上記オリゴサッカリドフラグメントの大きさ分類
−上記大きさ分類されたオリゴサッカリドの末端アルデヒド基の還元的アミノ化
−CDI反応前のFmoc基による末端−NH2基の保護
−DMA反応の間の−NH2基の内因性脱保護
−SIDEA(N−ヒドロキシスクシンイミドアジピン酸)による末端−NH2基の活性化
−CRM197タンパク質への共有結合。
上に記載されるように、凍結乾燥MenA結合体の再構成前に、MenB抗原ΔG287−953(配列番号7)、936−ΔG741(配列番号8)およびNadA(配列番号2)を、最も多い用量の液体C−W135−Y混合物に添加して、用量あたり最終濃度20μgの3種のポリペプチドの各々を与えた。従って、再構成されたワクチンは、以下の抗原を含む:
上に記載されるように、凍結乾燥MenA結合体の再構成前に、肺炎球菌結合体抗原を、中間の用量の液体C−W135−Y混合物に添加して、用量あたり最終濃度2μgの各々の血清型(血清型6Bについては2つ)を与える。従って、再構成されたワクチンは、以下の抗原を含む:
Claims (22)
- 注射可能免疫原性組成物であって、該組成物が、Neisseria meningitidisの血清群A、血清群C、血清群W135および血清群Y由来の莢膜サッカリドを含有し、(i)該莢膜サッカリドが、キャリアタンパク質に結合され該4種の血清群の各々についての別々の結合体を与え、(ii)血清群A、血清群C、血清群W135および血清群Yの髄膜炎菌結合体が、2:1:1:1のサッカリド重量比で存在し、かつ(iii)該組成物は、用量あたり10μgと25μgとの間の総量の髄膜炎菌莢膜サッカリドを含有する、組成物。
- 請求項1に記載の組成物であって、前記4種の結合体の各々が、1:5までのサッカリド:タンパク質比(w/w)を有する、組成物。
- 請求項2に記載の組成物であって、各用量が、前記血清群A、血清群C、血清群W135および血清群Yの4種の髄膜炎菌結合体の約5μgまたは10μgの各サッカリドを含有する、組成物。
- 請求項1〜3のいずれかに記載の組成物であって、前記結合体における前記キャリアタンパク質が、ジフテリアトキソイドである、組成物。
- 請求項1〜4のいずれかに記載の組成物であって、塩化ナトリウムを含む、組成物。
- 請求項1〜5のいずれかに記載の組成物であって、0.5mlの用量の組成物。
- 請求項1〜6のいずれかに記載の組成物であって、前記N.meningitidisの血清群A由来の莢膜サッカリドが、改変された血清群A莢膜サッカリドであり、ここで、1つ以上のヒドロキシル基が、保護基により置換されている、組成物。
- 請求項1〜7のいずれかに記載の組成物であって、以下:(a)N.meningitidisの血清群B;(b)Haemophilus influenzae B型;および/または(c)Streptococcus pneumoniaeのうちの1種以上由来の抗原をさらに含有する、組成物。
- 請求項8に記載の組成物であって、H.influenzae B型から防御する抗原をさらに含有する、組成物。
- 請求項8または請求項9に記載の組成物であって、N.meningitidisの血清群Bから防御する1種以上の抗原をさらに含有する、組成物。
- 請求項10に記載の組成物であって、前記1種以上の抗原が、被験体への投与後、該被験体における抗体応答を誘導し得、該抗体応答が、N.meningitidis血清群Bの超毒性系統A4、超毒性系統ET 5および系統3のうちの2つ以上に対して殺菌性である、組成物。
- 請求項10または請求項11に記載の組成物であって、前記1種以上の抗原が、以下の5種の抗原:(1)配列番号2と80%以上の相同性を有する、オリゴマー形態の「NadA」タンパク質;(2)配列番号3と80%以上の相同性を有する、「741」タンパク質;(3)配列番号4と80%以上の相同性を有する、「936」タンパク質;(4)配列番号5と80%以上の相同性を有する、「953」タンパク質;および(5)配列番号6と80%以上の相同性を有する、「287」タンパク質を含有する、組成物。
- 請求項12に記載の組成物であって、該組成物が、配列番号2のアミノ酸配列を含む第1のポリペプチド、配列番号7のアミノ酸配列を含む第2のポリペプチドおよび配列番号8のアミノ酸配列を含む第3のポリペプチドを含有する、組成物。
- 請求項1〜13のいずれかに記載の組成物であって、S.pneumoniaeから防御する1種以上の抗原をさらに含有する、組成物。
- 請求項14に記載の組成物であって、前記1種以上の抗原が、S.pneumoniae由来の莢膜サッカリドを含有する、組成物。
- 請求項15に記載の組成物であって、S.pneumoniaeの5種〜11種の間の異なる血清型由来の莢膜サッカリドを含有する、組成物。
- 請求項14に記載の組成物であって、前記1種以上の抗原が、S.pneumoniae由来のポリペプチドを含有する、組成物。
- 請求項1〜請求項17のいずれかに記載の組成物であって、該組成物中の髄膜炎菌サッカリド抗原が、キャリアタンパク質に結合されたオリゴサッカリドである、組成物。
- 請求項18に記載の組成物であって、該組成物中のサッカリド抗原が、CRM197タンパク質、H.influenzaeのプロテインD、破傷風トキソイドまたはジフテリアトキソイドに結合されたオリゴサッカリドである、組成物。
- 請求項1〜請求項19のいずれかに記載の組成物であって、該組成物が、アルミニウム塩アジュバントをさらに含有する、組成物。
- 患者において免疫応答を生じるための組成物であって、請求項1〜20のいずれか1項に記載の組成物を含む、組成物。
- (i)N.meningitidisの血清群A、血清群C、血清群W135および血清群Yの4種全て由来の結合した莢膜サッカリド、ならびに、(ii)以下:(a)N.meningitidis血清群B;(b)Haemophilus influenzae B型;および/または(c)Streptococcus pneumoniaeのうちの1種以上由来の抗原の、細菌性髄膜炎の予防および/または処置のための注射可能薬剤の製造における、使用であって、(x)該結合した莢膜サッカリドが、キャリアタンパク質に結合され該4種の血清群の各々についての別々の結合体を与え、(y)血清群A、血清群C、血清群W135および血清群Yの髄膜炎菌結合体が、2:1:1:1のサッカリド重量比で存在し、かつ(z)該組成物は、用量あたり10μgと25μgとの間の総量の髄膜炎菌莢膜サッカリドを含有する、使用。
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JP2002503705A (ja) * | 1998-02-23 | 2002-02-05 | コノート ラボラトリーズ リミテッド | 複数種オリゴ糖の糖接合体型の細菌性髄膜炎ワクチン |
JP2002540075A (ja) * | 1999-03-19 | 2002-11-26 | スミスクライン ビーチャム バイオロジカルズ ソシエテ アノニム | ワクチン |
WO2001037863A2 (en) * | 1999-11-29 | 2001-05-31 | Chiron Spa | Compositions comprising neisseria meningitidis antigens from serogroups b and c as well as a further antigen |
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