U.S. patent application number 12/718091 was filed with the patent office on 2010-09-02 for method of immunization against the 4 dengue serotypes.
This patent application is currently assigned to SANOFI PASTEUR SA. Invention is credited to Veronique Barban, Remi Forrat, Bruno Guy, Jean Lang.
Application Number | 20100221285 12/718091 |
Document ID | / |
Family ID | 37866217 |
Filed Date | 2010-09-02 |
United States Patent
Application |
20100221285 |
Kind Code |
A1 |
Barban; Veronique ; et
al. |
September 2, 2010 |
Method of Immunization Against the 4 Dengue Serotypes
Abstract
The invention relates to a method for inducing a homologous
protection against the 4 dengue serotypes in a patient, comprising
the sequential administration, to said patient, (i) of a dose of a
vaccinal dengue virus of a first serotype and of a dose of a
vaccinal dengue virus of a second serotype, and (ii) of a dose of a
vaccinal dengue virus of a third serotype and of a dose of a
vaccinal dengue virus of a fourth serotype, in which the vaccinal
dengue viruses (ii) are administered at least 30 days and at most 1
year after administration of the vaccinal viruses (i).
Inventors: |
Barban; Veronique;
(Craponne, FR) ; Forrat; Remi; (Serezin du Rhone,
FR) ; Guy; Bruno; (Lyon, FR) ; Lang; Jean;
(Moins, FR) |
Correspondence
Address: |
MCDONNELL BOEHNEN HULBERT & BERGHOFF LLP
300 S. WACKER DRIVE, 32ND FLOOR
CHICAGO
IL
60606
US
|
Assignee: |
SANOFI PASTEUR SA
Lyon cedex
FR
|
Family ID: |
37866217 |
Appl. No.: |
12/718091 |
Filed: |
March 5, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11776816 |
Jul 12, 2007 |
7718357 |
|
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12718091 |
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60829361 |
Oct 13, 2006 |
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Current U.S.
Class: |
424/218.1 |
Current CPC
Class: |
A61K 39/12 20130101;
A61P 31/14 20180101; Y02A 50/30 20180101; A61K 2039/5252 20130101;
A61K 2039/70 20130101; A61P 31/12 20180101; A61K 2039/545 20130101;
A61P 37/04 20180101; Y02A 50/386 20180101; C12N 2770/24134
20130101; A61K 2039/5254 20130101; A61K 39/00 20130101 |
Class at
Publication: |
424/218.1 |
International
Class: |
A61K 39/12 20060101
A61K039/12 |
Foreign Application Data
Date |
Code |
Application Number |
Jul 12, 2006 |
FR |
06 06324 |
Claims
1. A vaccinal dengue virus kit comprising four different vaccinal
dengue virus serotypes, wherein a) each vaccinal dengue virus
serotype is in a separate dosage form; b) two of the four vaccinal
dengue virus serotypes are combined in a single dosage form; or c)
two of the four vaccinal dengue virus serotypes are combined in a
first dosage form and the other two of the four dengue virus
serotypes are combined in a second dosage form.
2. The vaccinal dengue virus kit according to claim 1 wherein the
vaccinal dengue viruses serotypes are each present in the dosage
forms in a range of from 10.sup.3 to 10.sup.5 CCID.sub.50.
3. The vaccinal dengue virus kit as claimed in claim 1 comprising
two dosage forms, wherein two of the four serotypes are combined in
a first dosage form and the other two of the four serotypes are
combined in a second dosage form.
4. The vaccinal dengue virus kit according to claim 1, wherein one
of the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV1 strain and of a CYD DEN-1.
5. The vaccinal dengue virus kit according to claim 1 wherein one
of the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV2 strain and of a CYD DEN-2.
6. The vaccinal dengue virus kit according to claim 1 wherein one
of the vaccinal dengue virus serotypes is the VDV1 strain and
another vaccinal dengue virus serotype is the VDV2 strain.
7. The vaccinal dengue virus kit according to claim 1 wherein one
of the vaccinal dengue virus serotypes is CYD DEN-1 and another
vaccinal dengue virus serotype is CYD DEN-2 strain.
8. The dengue virus kit according to claim 1 wherein one of the
vaccinal dengue virus serotypes is a CYD DEN-3.
9. The dengue virus kit according to claim 1 wherein one of the
vaccinal dengue virus serotypes is a CYD DEN-4.
10. The dengue virus kit according to claim 1 comprising the
vaccinal dengue viruses CYD DEN1, CYD DEN2, CYD DEN3, and CYD DEN4,
wherein each of the CYD DEN1 and CYD DEN2 serotypes are in a dosage
form where each is the only dengue virus serotype in the dosage
form or the two are combined together in a single dosage form, and
wherein each of the CYD DEN3 and CYD DEN4 serotypes are in a dosage
form where each is the only dengue virus serotype in the dosage
form or the two are combined together in a single dosage form.
11. A kit comprising two different vaccinal dengue virus serotypes,
wherein a) each vaccinal dengue virus serotype is in a separate
dosage form; or b) both vaccinal dengue virus serotypes are
combined in a single dosage form.
12. The vaccinal dengue virus kit according to claim 11 wherein the
vaccinal dengue viruses serotypes are each present in the dosage
forms in a range of from 10.sup.3 to 10.sup.5 CCID.sub.50.
13. The vaccinal dengue virus kit as claimed in claim 11 comprising
two dosage forms, wherein the two serotypes are combined in a
single dosage form.
14. The vaccinal dengue virus kit according to claim 11, wherein
one of the vaccinal dengue virus serotypes is selected from the
group consisting of the VDV1 strain and of a CYD DEN-1.
15. The vaccinal dengue virus kit according to claim 11 wherein one
of the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV2 strain and of a CYD DEN-2.
16. The vaccinal dengue virus kit according to claim 11 wherein one
of the vaccinal dengue virus serotypes is the VDV1 strain and the
other vaccinal dengue virus serotype is the VDV2 strain.
17. The vaccinal dengue virus kit according to claim 11 wherein one
of the vaccinal dengue virus serotypes is CYD DEN-1 and the other
vaccinal dengue virus serotype is CYD DEN-2 strain.
18. The vaccinal dengue virus kit according to claim 11 wherein one
of the vaccinal dengue virus serotypes is a CYD DEN-3.
19. The vaccinal dengue virus kit according to claim 11 wherein one
of the vaccinal dengue virus serotypes is a CYD DEN-4.
21-33. (canceled)
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] The invention relates to a method for inducing a homologous
protection against the 4 dengue serotypes in a patient, comprising
the sequential administration, to said patient, (i) of a dose of a
vaccinal dengue virus of a first serotype and of a dose of a
vaccinal dengue virus of a second serotype, and (ii) of a dose of a
vaccinal dengue virus of a third serotype and of a dose of a
vaccinal dengue virus of a fourth serotype, in which the vaccinal
dengue viruses (ii) are administered at least 30 days and at most 1
year after administration of the vaccinal dengue viruses (i).
[0003] 2. Summary of the Related Art
[0004] Dengue diseases are caused by four viruses of the flavivirus
genus, of the serological type, which are similar but distinct from
an antigenic point of view (Gubler et al., 1988 In: Epidemiology of
arthropod-borne viral disease. Monath TPM, editor, Boca Raton (FL):
CRC Press: 223-60; Kautner et al., 1997, J. of Pediatrics,
131:516-524; Rigau-Perez et al., 1998, Lancet; 352: 971-977; Vaughn
et al., 1997, J Infect Dis; 176: 322-30). Infection with a dengue
serotype can produce a clinical disease spectrum ranging from a
nonspecific viral syndrome to a severe hemorrhagic disease which is
fatal. The incubation period of dengue fever after a mosquito bite
is approximately 4 days (ranging from 3 to 14 days). Dengue fever
is characterized by a biphasic fever, headaches, pain in various
parts of the body, prostration, eruptions, lymphadenopathy and
leukopenia (Kautner et al., 1997, J. of Pediatrics, 131:516-524;
Rigau-Perez et al., 1998, Lancet; 352: 971-977). The viremia period
is the same as for febrile diseases (Vaughn et al., 1997, J.
Infect. Dis.; 176: 322-30). Recovery from dengue fever occurs after
7 to 10 days, but there is usually a prolonged asthenia. Decreases
in leukocyte and platelet count are common.
[0005] Hemorrhagic dengue is a severe febrile disease characterized
by anomalies in homeostasis and an increase in vascular
permeability which can result in hypovolemia and in hypotension
(dengue with shock syndrome) often complicated by severe internal
hemorrhaging. The mortality rate of hemorrhagic dengue can be up to
10% without treatment, but is 1% in most centers with experience in
treatment (WHO technical Guide, 1986. Dengue haemorrhagic fever:
diagnosis, treatment and control, p1-2. World Health Organization,
Geneva, Switzerland).
[0006] The routine laboratory diagnosis of dengue is based on
isolation of the virus and/or detection of antibodies specific for
the dengue virus.
[0007] Dengue is the second most common tropical infectious disease
after malaria, more than half the world's population (2.5 billion)
living in regions where there is a risk of epidemic transmission.
Each year, cases of dengue are estimated at 50-100 million, cases
of patients hospitalized for hemorrhagic dengue at 500 000, and the
number of deaths at 25 000. Dengue is endemic in Asia, in the
Pacific region, in Africa, in Latin America and in the Caribbean.
More than 100 tropical countries are endemic for dengue virus
infections and hemorrhagic dengue has been documented in 60 of
these countries (Gubler, 2002, TRENDS in Microbiology. 10:100-103;
Monath, 1994, Proc. Natl. Acad. Sci.; 91: 2395-2400). A certain
number of well-described factors appear to be involved in dengue:
population growth; unplanned and uncontrolled urbanization, in
particular in combination with poverty; an increase in air travel;
the lack of effective control of mosquitoes and the deterioration
of hygiene infrastructures and of public health (Gubler, 2002,
TRENDS in Microbiology. 10:100-103). Individuals who travel and
expatriates are increasingly warned about dengue (Shirtcliffe et
al., 1998, J. Roy. Coll. Phys. Lond.; 32: 235-237). Dengue has
constituted one of the main causes of febrile diseases in American
troops during deployments in tropical zones endemic for dengue
(DeFraites et al., 1994, MMWR 1994; 43: 845-848).
[0008] The viruses are maintained in a cycle which involves humans
and Aedes aegypti, a domestic mosquito which bites during the day,
and which prefers to feed off humans. The infection in humans is
initiated by injection of the virus while an infected Aedes aegypti
mosquito feeds on the blood. The virus in the saliva is deposited
mainly in the extravascular tissues. The first category of cells
infected after inoculation are dendritic cells, which then migrate
to the lymph nodes (Wu et al., 2000, Nature Med.; 7:816-820). After
an initial replication in the skin and in the lymph nodes, the
virus appears in the blood during the acute febrile phase,
generally for 3 to 5 days.
[0009] Monocytes and macrophages are, with dendritic cells, among
the first targets of the dengue virus. Protection against a
homotypic reinfection is complete and probably lasts for a
lifetime, but crossprotection between the various dengue types
lasts less than a few weeks to a few months (Sabin, 1952, Am. J.
Trop. Med. Hyg.; 1: 30-50). Consequently, an individual can
experience an infection with a different serotype. A second
infection with dengue is in theory a risk factor for developing a
severe dengue disease. However, hemorrhagic dengue is
multifactorial: these factors include the strain of the virus
involved, and also the age, the immune status and the genetic
predisposition of the patient. Two factors play a major role in the
occurrence of hemorrhagic dengue: rapid viral replication with a
high viremia (the severity of the disease being associated with the
level of viremia; Vaughn et al., 2000, J. Inf. Dis.; 181: 2-9) and
a substantially inflammatory response with the release of high
levels of inflammatory mediators (Rothman and Ennis, 1999,
Virology; 257: 1-6). There is no specific treatment against dengue.
The treatment for dengue fever is symptomatic with confinement to
bed, control of the fever and of the pain with antipyretics and
analgesics, and adequate fluid intake. The treatment for
hemorrhagic dengue requires equilibration of fluid losses,
replacement of clotting factors and heparin infusion.
[0010] Preventive measures are currently based on controlling the
vector and taking personal protection steps which are difficult to
implement and expensive. No vaccine against dengue has been
approved at this time. Given that the four dengue serotypes are in
circulation in the world and since they have been reported as being
involved in cases of dengue hemorrhagic fever, immunization should
ideally confer protection against the four serotypes of the dengue
virus.
[0011] Sequential immunization strategies have previously been
implemented with the aim of inducing a heterologous protection
among the various dengue serotypes.
[0012] Thus, Price (1968, Am. J. Epid., 88:392-397) has described a
method of sequential immunization against dengue comprising a
series of two infections with dengue serotype 1 and then with
dengue serotype 2, which conferred protection in a challenge test
with dengue serotype 3 or 4.
[0013] Whitehead et al. (1970, Am. J. Trop. Med. Hyg., 19:94-102)
sought to determine the influence of a sequential monovalent
infection with two or three of the four dengue serotypes, on the
conferred heterologous immunity. Gibbons were thus initially
infected with a dengue virus serotype 1, 2, 3 or 4. Following a
second infection with a heterologous serotype, a variable viremia
was detected which was dependent on the sequence of infection and
in particular on the serotype used for the first infection. More
specifically, a second viremia appeared in gibbons initially
infected with serotype 2, 3 or 4 and then challenged with serotype
1, 2 or 4.
[0014] Scherer et al. (1972, Am. J. Epid., 95:67-79) described a
sequential monovalent infection comprising a first infection with
one of the four dengue serotypes, followed by a second infection,
or even a third infection, with a homologous or heterologous
serotype. The proposed schemes did not make it possible to obtain a
satisfactory protection against a challenge with a heterologous
serotype.
[0015] Halstead et al. (1973, Am. J. Trop. Med. Hyg., 22:365-374)
evaluated, in monkeys, a method of sequential immunization against
dengue comprising a series of two, three or four monovalent
infections with heterologous dengue serotypes 1 to 4. The authors
concluded that a protection against a subsequent infection could be
obtained with the immunization sequence consisting of serotypes 1,
2 then 4, followed by a challenge with serotype 3. Bivalent
immunization is neither described nor suggested. Furthermore, the
authors advise against sequential immunizations due to their
laborious nature and to the random nature of the results
generated.
[0016] Halstead et al. (1973, Am. J. Trop. Med. Hyg., 22:375-381)
also found that a bivalent immunization with two heterologous
dengue serotypes did not protect, or only partially protected,
against an infection with a third dengue serotype.
SUMMARY OF THE INVENTION
[0017] In the context of the present invention, the objective is to
induce a homologous protection against the 4 dengue serotypes. The
inventors demonstrated that it is possible to generate an immune
response comprising antibodies which neutralize the 4 serotypes
when the latter are administered sequentially in pairs.
[0018] The inventors have in particular shown that a DEN-1,2
bivalent immunization followed two months later by a DEN-3,4
bivalent immunization induces high responses against the four
serotypes in all the monkeys immunized. The immune response thus
generated is quantitatively and qualitatively greater (covers all
the serotypes).
DETAILED DESCRIPTION OF THE INVENTION
[0019] According to a first subject, the present invention
therefore relates to vaccinal compositions comprising (i) a dose of
a vaccinal dengue virus of a first serotype and a dose of a
vaccinal dengue virus of a second serotype, and (ii) a dose of a
vaccinal dengue virus of a third serotype and a dose of a vaccinal
dengue virus of a fourth serotype, as a combination vaccinal
composition against dengue for sequential administration, in which
the vaccinal dengue viruses (ii) are administered at least 30 days
and at most 1 year after the administration of the vaccinal dengue
viruses (i).
[0020] According to one embodiment of the vaccinal compositions
according to the invention, the vaccinal viruses (ii) are
administered 30 days to 3 months after the administration of the
vaccinal viruses (i).
[0021] According to another specific embodiment of the vaccinal
compositions according to the invention, the vaccinal viruses (ii)
are administered 30 days after the administration of the vaccinal
viruses (i).
[0022] According to another embodiment of the vaccinal compositions
according to the invention, the vaccinal dengue viruses (i) are
administered in the form of a bivalent vaccinal composition.
[0023] According to another embodiment of the vaccinal compositions
according to the invention, the vaccinal dengue viruses (ii) are
administered in the form of a bivalent vaccinal composition.
[0024] According to one specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 1 is selected from the group consisting of the VDV1 strain
and of a Chimerivax.TM. DEN-1.
[0025] According to another specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 2 is selected from the group consisting of the VDV2 strain
and of a Chimerivax.TM. DEN-2.
[0026] According to another specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 1 is the VDV1 strain and said vaccinal dengue virus
serotype 2 is the VDV2 strain.
[0027] According to another specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 1 is a Chimerivax.TM. DEN-1 and said vaccinal dengue virus
serotype 2 is a Chimerivax.TM. DEN-2.
[0028] According to another specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 3 is a Chimerivax.TM. DEN-3.
[0029] According to another specific embodiment of the vaccinal
compositions according to the invention, said vaccinal dengue virus
serotype 4 is a Chimerivax.TM. DEN-4.
[0030] According to another specific embodiment of the vaccinal
compositions according to the invention, the first and second
serotypes are, respectively, CYD DENT and CYD DEN2 and the third
and fourth serotypes are, respectively, CYD DEN3 and CYD DEN 4.
[0031] According to another specific embodiment of the vaccinal
compositions according to the invention, the doses of vaccinal
dengue viruses serotypes 1, 2, 3 and 4 are each within a range of
from 10.sup.3 to 10.sup.5 CCID.sub.50.
[0032] A subject of the invention is also the use of a vaccinal
dengue virus of a third serotype and of a vaccinal dengue virus of
a fourth serotype, for the manufacture of a dengue vaccine intended
to be administered to a patient who has received, at least 30 days
and at most 1 year beforehand, a dose of a vaccinal dengue virus of
a first serotype and a dose of a vaccinal dengue virus of a second
serotype.
[0033] According to another specific embodiment of the use
according to the invention, the third and fourth serotypes are
administered in the form of a bivalent vaccinal composition.
[0034] According to another specific embodiment of the use
according to the invention, the first and second serotypes are
administered in the form of a bivalent vaccinal composition.
[0035] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 1
is selected from the group consisting of the VDV1 strain and a
Chimerivax.TM. DEN-1.
[0036] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 2
is selected from the group consisting of the VDV2 strain and a
Chimerivax.TM. DEN-2.
[0037] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 1
is the VDV1 strain and said vaccinal dengue virus serotype 2 is the
VDV2 strain.
[0038] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 1
is a Chimerivax.TM. DEN-1 and said vaccinal dengue virus serotype 2
is a Chimerivax.TM. DEN-2.
[0039] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 3
is a Chimerivax.TM. DEN-3.
[0040] According to another specific embodiment of the use
according to the invention, said vaccinal dengue virus serotype 4
is a Chimerivax.TM. DEN-4.
[0041] According to another specific embodiment of the use
according to the invention, the first and second serotypes are,
respectively, CYD DENT and CYD DEN2 and the third and fourth
serotypes are, respectively, CYD DEN3 and CYD DEN4.
[0042] According to another specific embodiment of the use
according to the invention, the third and fourth serotypes are
administered 30 days to 3 months after the administration of the
first and second serotypes.
[0043] According to another specific embodiment of the use
according to the invention, the third and fourth serotypes are
administered 30 days after the administration of the first and
second serotypes.
[0044] According to another specific embodiment of the use
according to the invention, the doses of vaccinal dengue viruses
serotypes 1, 2, 3 and 4 are each within a range of from 10.sup.3 to
10.sup.5 CCID.sub.50.
[0045] According to another aspect, the invention comprises a
vaccinal dengue virus kit comprising four different vaccinal dengue
virus serotypes, wherein [0046] a) each vaccinal dengue virus
serotype is in a separate dosage form; [0047] b) two of the four
vaccinal dengue virus serotypes are combined in a single dosage
form; or [0048] c) two of the four vaccinal dengue virus serotypes
are combined in a first dosage form and the other two of the four
dengue virus serotypes are combined in a second dosage form.
[0049] Preferably, the vaccinal dengue viruses serotypes are each
present in the dosage forms in a range of from 10.sup.3 to 10.sup.5
CCID.sub.50.
[0050] Also preferably, the vaccinal dengue virus kit comprises two
dosage forms, wherein two of the four serotypes are combined in a
first dosage form and the other two of the four serotypes are
combined in a second dosage form.
[0051] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV1 strain and of a CYD DEN-1.
[0052] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV2 strain and of a CYD DEN-2.
[0053] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is the VDV1 strain and another
vaccinal dengue virus serotype is the VDV2 strain.
[0054] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is CYD DEN-1 and another
vaccinal dengue virus serotype is CYD DEN-2 strain.
[0055] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is a CYD DEN-3.
[0056] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is a CYD DEN-4.
[0057] In one embodiment of this aspect of the invention, the
dengue virus kit comprises the vaccinal dengue viruses CYD DEN.TM.,
CYD DEN2, CYD DEN3, and CYD DEN4, wherein each of the CYD DEN.TM.
and CYD DEN2 serotypes are in a dosage form where each is the only
dengue virus serotype in the dosage form or the two are combined
together in a single dosage form, and wherein each of the CYD DEN3
and CYD DEN4 serotypes are in a dosage form where each is the only
dengue virus serotype in the dosage form or the two are combined
together in a single dosage form.
[0058] According to another aspect, the invention comprises a kit
comprising two different vaccinal dengue virus serotypes, wherein
[0059] a) each vaccinal dengue virus serotype is in a separate
dosage form; or [0060] b) both vaccinal dengue virus serotypes are
combined in a single dosage form.
[0061] Preferably in this aspect of the invention, the vaccinal
dengue viruses serotypes are each present in the dosage forms in a
range of from 10.sup.3 to 10.sup.5 CCID.sub.50.
[0062] Also preferably in this aspect of the invention, the two
serotypes are combined in a single dosage form.
[0063] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV1 strain and of a CYD DEN-1.
[0064] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is selected from the group
consisting of the VDV2 strain and of a CYD DEN-2.
[0065] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is the VDV1 strain and the
other vaccinal dengue virus serotype is the VDV2 strain.
[0066] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is CYD DEN-1 and the other
vaccinal dengue virus serotype is CYD DEN-2 strain.
[0067] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is a CYD DEN-3.
[0068] In some embodiments of this aspect of the invention, one of
the vaccinal dengue virus serotypes is a CYD DEN-4.
[0069] In another aspect, the invention comprises a method of
preventing or inhibiting a dengue virus infection comprising:
[0070] a) in a first administration administering to a subject an
effective amount of a first and second vaccinal dengue virus
serotype; and [0071] b) in a second administration administering to
the subject an effective amount of a third and fourth vaccinal
dengue virus serotype
[0072] wherein [0073] i) the first, second, third, and fourth
vaccinal dengue virus serotypes are each different one from
another; [0074] ii) the second administration occurs from about 30
days to about 1 year after the first administration; [0075] iii)
each vaccinal dengue virus serotypes is administered in an amount
that is sufficient to induce a homologous immune response; [0076]
iv) the first and second serotypes are administered in separate
dosages forms or together in a single dosage form; and [0077] v)
the third and fourth serotypes are administered in separate dosages
forms or together in a single dosage form.
[0078] In some embodiments of this aspect of the invention, the
third and fourth serotypes are administered in a single dosage
form.
[0079] In some embodiments of this aspect of the invention, the
first and second serotypes are administered in a single dosage
form.
[0080] In some embodiments of this aspect of the invention, the
first or second vaccinal dengue virus serotype is selected from the
group consisting of the VDV1 strain and of a CYD DEN-1.
[0081] In some embodiments of this aspect of the invention, the
first or second vaccinal dengue virus serotype is selected from the
group consisting of the VDV2 strain and of a CYD DEN-2.
[0082] In some embodiments of this aspect of the invention, the
first vaccinal dengue virus serotype is the VDV1 strain and the
second vaccinal dengue virus serotype is the VDV2 strain.
[0083] In some embodiments of this aspect of the invention, the
first vaccinal dengue virus serotype is a CYD DEN-1 and the second
vaccinal dengue virus serotype 2 is a CYD DEN-2.
[0084] In some embodiments of this aspect of the invention, the
third vaccinal dengue virus serotype is a CYD DEN-3.
[0085] In some embodiments of this aspect of the invention, the
fourth vaccinal dengue virus serotype 4 is a CYD DEN-4.
[0086] In some embodiments of this aspect of the invention, first
and second serotypes are CYD DENT and CYD DEN2 and the third and
fourth serotypes are CYD DEN3 and CYD DEN4.
[0087] In some embodiments of this aspect of the invention, the
third and fourth serotypes are administered 30 days to 3 months
after the administration of the first and second serotypes.
[0088] In some embodiments of this aspect of the invention, the
third and fourth serotypes are administered 30 days after the
administration of the first and second serotypes.
[0089] In some embodiments of this aspect of the invention, the
dosage forms comprise the vaccinal dengue viruses serotypes in a
range of from 10.sup.3 to 10.sup.5 CCID.sub.50.
[0090] The invention will be described in further detail in the
description which follows.
DEFINITIONS
[0091] "Dengue viruses" or "DENs" are positive, single-stranded RNA
viruses belonging to the Flavivirus genus of the flaviviridae
family. The genomic RNA contains a type I cap at the 5' end but
lacks a poly-A tail at the 3' end. The genomic organization
consists of the following elements: 5' noncoding region (NCR),
structural proteins (capsid (C), premembrane/membrane (prM/M),
envelope (E)) and nonstructural proteins
(NS1-NS2A-NS2B-NS3-NS4A-NS4B-NS5), and 3' NCR. The genomic viral
RNA is associated with the capsid proteins so as to form a
nucleocapsid. As for the other flaviviruses, the DEN viral genome
encodes an uninterrupted coding region which is translated into a
single polyprotein.
[0092] "VDV" or "Vero dengue vaccine" denotes a live attenuated
dengue viral strain adapted on Vero cells and capable of inducing a
specific humoral response, including the induction of neutralizing
antibodies, in primates and in particular in humans.
[0093] "VDV-1" is a strain obtained from a wild-type strain DEN-1
16007 which was subjected to 11 passages on PDK cells (DEN-1
16007/PDK11), which was then amplified on Vero cells at 32.degree.
C., and the RNA of which was purified and transfected into Vero
cells. The VDV-1 strain has 14 additional mutations compared to the
vaccinal strain DEN-1 16007/PDK13 (13 passages on PDK--Primary Dog
Kidney--cells). The DEN-1 16007/PDK13 strain, also called "LAV1",
was described in patent application EP1159968 in the name of
Mahidol University and was deposited with the Collection Nationale
de Cultures de Microorganismes (CNCM) [National Collection of
Microorganism Cultures] under the number 1-2480. The complete
sequence of the VDV-1 strain is given in the sequence SEQ ID NO:1.
Said strain can be readily reproduced from said sequence. A method
of preparation and the characterization of the VDV-1 strain have
been described in the International patent application filed under
the names of Sanofi-Pasteur and of the Center for Disease Control
and Prevention under the number PCT/IB 2006/001313.
[0094] "VDV-2" is a strain obtained from a wild-type strain DEN-2
16681 which was subjected to 50 passages on PDK cells (DEN-2
16681/PDK50), and plaque-purified, and the RNA of which was
extracted and purified before being transfected into Vero cells.
The VDV-2 strain was then obtained by plaque-purification and
amplification on Vero cells. The VDV-2 strain has 10 additional
mutations compared with the vaccinal strain DEN-2 16681/PDK53 (53
passages on PDK cells), 4 mutations of which are silent. The DEN-2
16681/PDK53 strain, also called "LAV2", was described in patent
application EP1159968 in the name of Mahidol University and was
deposited with the Collection Nationale de Cultures de
Microorganismes (CNCM) under the number 1-2481. The complete
sequence of the VDV-2 strain is shown in the sequence SEQ ID NO:2.
The VDV-2 strain can be readily reproduced from said sequence. A
method of preparation and of characterization of the VDV-2 strain
has been described in the International patent application filed in
the names of Sanofi-Pasteur and of the Center for Disease Control
and Prevention under the number PCT/IB 2006/001513.
[0095] As used herein the terms "ChimeriVax.TM. dengue" and "CYD"
are equivalent and denote a chimeric yellow fever (YF) virus which
comprises the backbone of a YF virus in which the sequences
encoding the premembrane and envelope proteins have been replaced
with those of a DEN virus. The term "CYD-1 or CYD DEN1" is thus
used to describe a chimeric YF virus containing the prM and E
sequences of a dengue serotype 1 strain (DEN-1). The term "CYD-2 or
CYD DEN2" is used to describe a chimeric YF virus containing the
prM and E sequences of a DEN-2 strain. The term "CYD-3 or CYD DEN3"
is used to describe a chimeric YF virus containing the prM and E
sequences of a DEN-3 strain. The term "CYD-4 or CYD DEN4" is used
to describe a chimeric YF virus containing the prM and E sequences
of a DEN-4 strain. The preparation of these ChimeriVax.TM. or CYD
dengues has been described in detail in International patent
applications WO 98/37911 and WO 03/101397, to which reference may
be made for a precise description of the method for preparing them.
The chimeras described in the examples were generated using the prM
and E sequences derived from the DENT PUO359, DEN2 PR 159, DEN3
PaH881 and DEN4 TVP 980 strains. Any strain of the dengue virus
could be used in the context of the present invention for the
construction of the chimeras.
[0096] Preferably, the chimeric YF virus comprises the backbone of
an attenuated yellow fever strain YF17D (Theiler M, and Smith HH
(1937) J Exp. Med 65, p 767-786.) (YF17D/DEN-1, YF17D/DEN-2,
YF17D/DEN-3, YF17D/DEN-4 virus). Examples of YF17D strains which
can be used include YF17D204 (YF-Vax.RTM., Sanofi-Pasteur,
Swifwater, Pa., USA; Stamaril.RTM., Sanofi-Pasteur, Marcy l'Etoile,
France; ARILVAX.TM., Chiron, Speke, Liverpool, UK; FLAVIMUN.RTM.,
Berna Biotech, Bern, Switzerland); YF17D-204 France (X15067,
X15062); YF17D-204,234 US (Rice et al., 1985, Science,
229:726-733), or else related strains YF17DD (Genbank accession
number U17066), YF17D-213 (Genbank accession number U17067) and the
YF17DD strains described by Galler et al. (1998, Vaccines
16(9/10):1024-1028). Any other yellow fever virus strain
sufficiently attenuated for use in humans can be used.
[0097] A "monovalent" vaccine contains a single dengue virus
serotype. A "bivalent" vaccine contains two different dengue virus
serotypes. A "trivalent" vaccine contains three different dengue
virus serotypes. A "tetravalent" vaccine contains four different
dengue virus serotypes.
[0098] The term "patient" denotes an individual (child or adult)
who may be infected with dengue, in particular an individual at
risk of infection, such as, for example, an individual who travels
in regions where dengue is present or an inhabitant of these
regions.
Sequential Immunization
[0099] The inventors have shown that the administration of the 4
serotypes in the form of two sequential bivalent administrations
makes it possible to obtain an effective homologous protection
against the 4 serotypes. The method according to the present
invention is therefore most particularly valuable in the context of
an immunization strategy against dengue.
[0100] The inventors therefore propose a method for inducing a
neutralizing antibody response against the 4 dengue serotypes in a
patient, comprising the sequential administration, to said patient,
(i) of a dose of a vaccinal dengue virus of a first serotype and of
a dose of a vaccinal dengue virus of a second serotype, and (ii) of
a dose of a vaccinal dengue virus of a third serotype and of a dose
of a vaccinal dengue virus of a fourth serotype, in which the
vaccinal dengue viruses (ii) are administered at least 30 days and
at most 3 months after administration of the vaccinal dengue
viruses (i). The administration of the first and second serotypes
can be in separate dosages forms or a single, combined dosage form.
Similarly, the administration of the third and fourth serotypes can
be in separate dosages forms or a single, combined dosage forms. As
used herein a "dosage form" is a composition comprising a dengue
serotype together with a pharmaceutically acceptable carrier,
diluent, or excipient. The pharmaceutically acceptable carrier,
diluent, or excipient can be any known in the art that is suitable
for combination with a vaccinal dengue virus.
[0101] The vaccinal dengue virus is intended to mean any viral form
of dengue virus that is able to induce a specific homologous immune
response. Preferably such vaccinal dengue virus can be used in the
context of an immunization program in humans against an infection
with a dengue virus.
[0102] By vaccinal dengue virus we mean an inactivated virus, an
attenuated virus, as well as recombinant proteins such as the
envelope proteins of the dengue virus. A vaccinal virus is
"inactivated" if it is no longer able to replicate on permissive
cells.
[0103] A vaccinal virus is "attenuated" if after growth at
37.degree. C. or 39.degree. C. on Huh-7, VERO and/or C6/C36. Such a
vaccinal virus shows a maximal titer that is at least 10 times less
than the maximal titer of the wild type in the same culture
condition, using the same titration method.
[0104] A vaccinal virus showing a decreased growth on at least one
of the 3 cell types identified above is deemed to be attenuated
within the framework of the present invention.
[0105] A vaccinal virus usable in humans shows a positive benefit
to risk ratio, which will generally satisfy regulatory requirements
for obtaining market authorization.
[0106] A vaccinal dengue virus for use in the invention is
preferably attenuated to such an extent that it does not induce the
disease in humans. Advantageously, such a vaccinal virus results
only in side effects that are at most of moderate intensity (i.e.,
medium to low, or even zero) in the majority of individuals
vaccinated, while at the same time maintaining its ability to
induce a homologous neutralizing antibody response.
[0107] Non-limiting example of vaccinal dengue virus to be used in
the present invention include, but are not limited to, inactivated
dengue virus, attenuated dengue virus such as attenuated strains
VDV1, VDV2, strains described in, for example, WO 02/66621, WO
00/57904, WO 00/57908, WO 00/57909, WO00/57910, WO 02/0950075, and
WO 02/102828 and chimeras.
[0108] Chimeric viruses show the attenuated features of the
attenuated virus as defined above.
[0109] Any chimera virus expressing the envelope protein of a
dengue virus and inducing an immune response comprising antibody
neutralizing the serotype from which the protein comes from can be
used in the present invention. Non-limiting examples include, for
example, chimeras Chimerivax' dengues as described, for example, in
patent application WO 98/37911, and the dengue/dengue chimeras as
described, for example, in patent applications WO 96/40933 and WO
01/60847.
[0110] The vaccinal dengue virus serotype 1 can, for example, be
the vaccinal strain VDV1 or a Chimerivax.TM. DEN-1, in particular a
YF17D/DEN-1 virus, or else a DEN-1 16007/PDK13 strain. The vaccinal
dengue virus serotype 2 can, for example, be the vaccinal strain
VDV2 or a Chimerivax.TM. DEN-2, in particular a YF17D/DEN-2 virus,
or else a DEN-2 16681/PDK53 virus. The vaccinal dengue virus
serotype 3 can be a Chimerivax.TM. DEN-3, in particular a
YF17D/DEN-3 virus. The vaccinal dengue virus serotype 4 can be a
Chimerivax.TM. DEN-4, in particular a YF17D/DEN-4 virus. It can
also be a "LAV4" or "DEN-4 1036/PDK48" strain, i.e. a DEN-4 1036
strain attenuated by 48 passages on PDK cells. This strain was
described in patent application EP1159968 in the name of Mahidol
University and was deposited with the Collection Nationale de
Cultures de Microorganismes (CNCM) under the number 1-2483.
[0111] Each Chimerivax.TM. monovalent vaccinal dengue virus
(serotypes 1, 2, 3 and 4) was prepared by amplification of each
serotype on Vero cells. More specifically, the four viruses are
produced separately on adherent Vero cells in serum-free medium.
The viral harvest, clarified to remove the cell debris by
filtration, is then concentrated and purified by ultrafiltration
and chromatography in order to remove the DNA of the host cells.
After the addition of a stabilizer, the vaccinal strains are stored
in frozen or lyophilized form before use, and then reconstituted
extemporaneously. The same method is applied for the four
chimeras.
[0112] The VDV1 and 2 strains are prepared by amplification on Vero
cells. The viruses produced are harvested and clarified to remove
the cell debris by filtration. The DNA is digested by enzymatic
treatment. The impurities are eliminated by ultrafiltration. The
infectious titers can be increased by means of a method of
concentration. After the addition of a stabilizer, the strains are
stored in a lyophilized or frozen form before use, and then
reconstituted extemporaneously.
[0113] The multivalent compositions are obtained by simple mixing
of the monovalent compositions.
[0114] According to the present invention, the 4 dengue serotypes
can be administered in any order provided that they are
administered in pairs sequentially, within a period of 30 days to 1
year, such as 30 days, 45 days, 60 days, 3 months, 6 months, 9
months and 1 year, being observed, advantageously a period of 30
days to 3 months, in particular a period of 1 to 2 months, being
observed between the two series of administrations.
[0115] The method according to the present invention can therefore
be implemented with the embodiments described below: [0116] (i)
serotypes 1 and 2; (ii) serotypes 3 and 4; or [0117] (i) serotypes
1 and 3; (ii) serotypes 2 and 4; or [0118] (i) serotypes 1 and 4;
(ii) serotypes 2 and 3; or [0119] (i) serotypes 2 and 3; (ii)
serotypes 1 and 4; or [0120] (i) serotypes 2 and 4; (ii) serotypes
1 and 3; or [0121] (i) serotypes 3 and 4; (ii) serotypes 1 and
2.
[0122] According to specific embodiments the present invention
therefore covers the following schemes: [0123] (i) CYD DEN-1 and
CYD DEN-2; (ii) CYD DEN-3 and CYD DEN-4 [0124] (i) CYD DEN-1 and
CYD DEN-3; (ii) CYD DEN-2 and CYD DEN-4 [0125] (i) CYD DEN-1 and
CYD DEN-4; (ii) CYD DEN-2 and CYD DEN-3 [0126] (i) CYD DEN-2 and
CYD DEN-3; (ii) CYD DEN-1 and CYD DEN-4 [0127] (i) CYD DEN-2 and
CYD DEN-4; (ii) CYD DEN-1 and CYD DEN-3 [0128] (i) CYD DEN-3 and
CYD DEN-4; (ii) CYD DEN-1 and CYD DEN-2 [0129] (i) VDV-1 and CYD
DEN-2; (ii) CYD DEN-3 and CYD DEN-4 [0130] (i) VDV-1 and CYD DEN-3;
(ii) CYD DEN-2 and CYD DEN-4 [0131] (i) VDV-1 and CYD DEN-4; (ii)
CYD DEN-2 and CYD DEN-3 [0132] (i) CYD DEN-2 and CYD DEN-3; (ii)
VDV-1 and CYD DEN-4 [0133] (i) CYD DEN-2 and CYD DEN-4; (ii) VDV-1
and CYD DEN-3 [0134] (i) CYD DEN-3 and CYD DEN-4; (ii) VDV-1 and
CYD DEN-2 [0135] (i) CYD DEN-1 and VDV-2; (ii) CYD DEN-3 and CYD
DEN-4 [0136] (i) CYD DEN-1 and CYD DEN-3; (ii) VDV-2 and CYD DEN-4
[0137] (i) CYD DEN-1 and CYD DEN-4; (ii) VDV-2 and CYD DEN-3 [0138]
(i) VDV-2 and CYD DEN-3; (ii) CYD DEN-1 and CYD DEN-4 [0139] (i)
VDV-2 and CYD DEN-4; (ii) CYD DEN-1 and CYD DEN-3 [0140] (i) CYD
DEN-3 and CYD DEN-4; (ii) CYD DEN-1 and VDV-2 [0141] (i) VDV-1 and
VDV-2; (ii) CYD DEN-3 and CYD DEN-4 [0142] (i) VDV-1 and CYD DEN-3;
(ii) VDV-2 and CYD DEN-4 [0143] (i) VDV-1 and CYD DEN-4; (ii) VDV-2
and CYD DEN-3 [0144] (i) VDV-2 and CYD DEN-3; (ii) VDV-1 and CYD
DEN-4 [0145] (i) VDV-2 and CYD DEN-4; (ii) VDV-1 and CYD DEN-3
[0146] (i) CYD DEN-3 and CYD DEN-4; (ii) VDV-1 and VDV-2.
[0147] In the context of the present invention, the term "dose of
vaccinal virus" is intended to mean a composition comprising an
"immunoeffective amount" of the vaccinal virus, i.e. an amount of
virus sufficient to induce a homologous neutralizing antibody
response, which can be demonstrated, for example, by means of the
seroneutralization test as described below in example 1. A serum is
considered to be positive for the presence of neutralizing
antibodies when the neutralizing antibody titer thus determined is
greater than or equal to 1:10.
[0148] Vaccinal strain amounts are commonly expressed in terms of
viral plaque-forming units (PFU) or of 50% tissue culture
infectious dose (TCID.sub.50), or else of 50% cell culture
infectious dose (CCID.sub.50). For example, the compositions
according to the invention can contain from 10 to 10.sup.6
CCID.sub.50, in particular from 10.sup.3 to 10.sup.5 CCID.sub.50 of
vaccinal dengue virus serotype 1, 2, 3 or 4 for a monovalent or
bivalent composition. Thus, in the compositions or use according to
the invention, the doses of vaccinal dengue viruses serotypes 1, 2,
3 and 4 are preferably each within a range of from 10 to 10.sup.6
CCID.sub.50, such as 10, 10.sup.1, 10.sup.2, 10.sup.3, 10.sup.4,
10.sup.5 or 10.sup.6 CCID.sub.50, in particular in a range from
10.sup.3 to 10.sup.5 CCID.sub.50. The vaccinal viruses can be used
at identical or different doses, which can be adjusted according to
the nature of the vaccinal virus used and to the strength of the
immune response obtained.
[0149] Preferably, the homologous neutralizing antibody response is
long-lasting, i.e. it can be detected in the serum at least 6
months, after administration of the dengue serotypes (ii).
[0150] In the sequential administration according to the invention,
the vaccinal dengue viruses of the third and fourth serotypes are
administered at least 30 days and at most 12 months after the
administration of the vaccinal dengue viruses of the first and
second serotypes.
[0151] In the context of the present invention, the vaccinal dengue
viruses of the third and fourth serotypes can, for example, be
administered 30 days to 1 year, for example 30 days, 45 days, 60
days, 3 months, 6 months, 9 months or 1 year, advantageously 30
days to 3 months, in particular 1 to 2 months, after the
administration of the vaccinal dengue viruses of the first and
second serotypes.
[0152] The dose of a vaccinal dengue virus of a first serotype and
the dose of a vaccinal dengue virus of a second serotype are
administered simultaneously in the form of two monovalent
compositions, or in the form of a single bivalent composition.
[0153] Similarly, the dose of a vaccinal dengue virus of a third
serotype and the dose of a vaccinal dengue virus of a fourth
serotype are administered simultaneously. For example, the third
and fourth serotypes can be administered simultaneously in the form
of two monovalent vaccinal compositions, or in the form of a single
bivalent vaccinal composition.
[0154] The vaccinal viruses are administered in the form of
vaccinal compositions which can be prepared according to any method
known to those skilled in the art. Usually, the viruses, generally
in lyophilized form, are mixed with a pharmaceutically acceptable
excipient, such as water or a phosphate buffered saline solution,
wetting agents or stabilizers. The term "pharmaceutically
acceptable excipient" is intended to mean any solvent, dispersing
medium, filler, etc., which does not produce a side reaction, for
example an allergic reaction, in humans or animals. The excipient
is selected according to the pharmaceutical form chosen, and to the
method and route of administration. Appropriate excipients and also
the requirements in terms of pharmaceutical formulation are
described in "Remington: The Science & Practice of Pharmacy",
which represents a reference work in the field.
[0155] Preferably, the vaccinal compositions are prepared in an
injectable form, and can correspond to liquid solutions,
suspensions or emulsions. The compositions can in particular
include an aqueous solution buffered so as to maintain a pH of
between approximately 6 and 9 (as determined with a pH meter at
ambient temperature).
[0156] Although it is not necessary to add an adjuvant, the
compositions can nevertheless include such a compound, i.e. a
substance which increases, stimulates or strengthens the cellular
or humoral immune response induced by the vaccinal strain
administered simultaneously. Those skilled in the art are in a
position to select, from the adjuvants conventionally used in the
field of vaccines, an adjuvant which may be suitable in the context
of the present invention.
[0157] The vaccinal compositions according to the invention can be
administered according to any route normally used in immunization,
for example parenterally (in particular intradermally,
subcutaneously or intramuscularly). Preferably, the vaccinal
compositions are injectable compositions administered
subcutaneously in the deltoid region.
[0158] The volume of composition administered depends on the route
of administration. For subcutaneous injections, the volume is
generally between 0.1 and 1.0 ml, preferably approximately 0.5
ml.
[0159] The optimal period for the administration of the first and
second serotypes, or preferably of all the serotypes 1 to 4, is
approximately 1 to 3 months before exposure to the dengue virus.
The vaccines can be administered as a prophylactic treatment for
infection with a dengue virus in adults and children. Target
populations therefore include individuals who may be naive (i.e.
not previously immunized) or non-naive with respect to the dengue
virus.
[0160] Vaccinal dengue virus serotypes 1 to 4 booster
administrations can also be carried out, for example, between 6
months and 10 years, for example 6 months, 1 year, 3 years, 5 years
or 10 years, after administration of the third and fourth
serotypes.
[0161] The invention is illustrated by means of the following
examples. All publications referred to herein are hereby
incorporated by reference in their entirety.
EXAMPLES
Example 1
Sequential Immunization in Monkeys
[0162] The viremia and the immunogenicity were therefore tested in
a monkey model. The viremia, in particular, was identified as one
of the factors associated with the virulence and the severity of
the disease in man and therefore constitutes an important parameter
to be taken into consideration. The immunogenicity is, for its
part, a key parameter in the context of the evaluation of the
protection conferred.
[0163] 1.1 Materials and Methods:
[0164] The experiments in monkeys were carried out according to the
European Directives relating to animal experimentation. The
immunizations were carried out in cynomolgus monkeys (Macaca
fascicularis) originating from Mauritania. The monkeys were placed
in quarantine for six weeks before immunization.
[0165] The monkeys were immunized subcutaneously in the arm(s) with
0.5 ml of vaccinal composition. After a light anesthesia with
ketamine (Imalgene, Merial), blood was collected by puncture from
the inguinal or saphenous veins. At day 0 and 28, 5 ml of blood
were sampled in order to evaluate the antibody responses, while,
between days 2 and 10, 1 ml of blood was sampled in order to
evaluate the viremia. The blood was collected on ice and stored on
ice until serum separation. To do this, the blood was centrifuged
for 20 minutes at 4.degree. C. and the serum collected was stored
at -80.degree. C. until the time of the tests.
Measurement of Viremia
[0166] The post-vaccinal viremias were monitored by quantitative
real-time RP-PCR (qRT-PCR). Two sets of primers and of probes
located in the NS5 gene of the DENT and DEN2 strains were used to
quantify the VDV-1 RNA and VDV-2 RNA, respectively. A third set of
primers and of probes located in the NS5 gene of the YF virus was
used to quantify the CYD RNA. Finally, 4 sets of primers and of
probes specific for the various serotypes, located at the junction
of the E (DEN)/NS1 (YF) genes were used to identify the serotype in
the samples positive for the YF NS5 RNA (see also table I). 7
plasmids containing, under the control of the T7 promoter, the
region targeted by each PCR were transcribed in vitro so as to
generate a series of synthetic RNAs which were included as an
internal reference in each RT-PCR assay. These synthetic RNAs were
assayed by spectrophotometry, and the amount of RNA obtained was
converted to number of RNA copies and expressed as GEQ (genomic
equivalents).
[0167] 0.140 ml of monkey serum was extracted using the Macherey
Nagel "Nucleospin 96 Virus.TM." RNA extraction kit, according to
the manufacturer's instructions, and then the purified RNA was
eluted with 0.140 ml (0.090 ml, then 0.05 ml) of RNase-free water.
In order to avoid repeated freezing/thawing cycles, a first
quantification was carried out immediately after the extraction, on
5 .mu.l of said RNA preparation. The remaining volume was frozen at
70.degree. C.
[0168] The reaction mixtures contained, in addition to the
components of the "Qiagen Qauntitect.TM. probes" RT-PCR
quantification kit (Qiagen), 10 picomol of each primers, 4 picomol
of each probe and 5 .mu.l of RNA, in the total volume of 25 .mu.l.
In the case of the RNAs to be tested, 5 .mu.l of the purified
preparation were directly introduced into the reaction mixture,
without any prior dilution step. The synthetic RNAs were diluted to
1/10 in RNAse-free water, and 7 dilutions containing approximately
10 to 10.sup.6 GEQ in 5 .mu.l were quantified in parallel in order
to generate the standard curve.
[0169] The quantification reactions were carried out on the Applied
Biosystem ABIPrism 700.TM. device, using the following program:
50.degree. C./30 min, 95.degree. C./15 min, then 40 cycles of
95.degree. C./15 sec-60.degree. C./60 sec.
[0170] The limit of quantification of the viral RNA in this test is
from 2.9 to 3.3 log.sub.10GEQ/ml (800 to 2000 GEQ/ml; 4 to 10
GEQ/reaction), according to the PCR targets (standard deviation:
+/-0.3 log.sub.10).
[0171] The correlation between the infectious titer and the viral
RNA quantification was established in parallel to the assays, by
analysis of 0.140 ml of negative monkey serum samples (DO) to which
a known amount of infectious particles of the viruses which were
used for the immunization (CYD or VDV) were added. Said control
sera were prepared at two dilutions containing approximately 1 PFU
and approximately 100 PFU in 5 .mu.l (2.3 and 4.3 log.sub.10PFU/ml,
respectively).
[0172] The primers and probes used are given in table 1 below, in
which are listed, in order, for each assay, the sense and antisense
primers and the probe.
TABLE-US-00001 TABLE 1 sequence Y YF-NS5 sense 5'
GCACGGATGTAACAGACTGAAGA (23 bases) F YF NS5 anti 5'
CCAGGCCGAACCTGTCAT (18 bases) YF-NS5 5' Fam-
CGACTGTGTGGTCCGGCCCATC-Tamra (22 bases) CYD1 CYD1- sense 5' CAT TGC
AGT TGG CCT GGT AA (20 b) spe CYD1- anti 5' CTT TGG CAA GAG AGA GCT
CAA GT (23 b) CYD1- 5' Fam-CCG ATC AAG GAT GCG CCA TCA-Tamra (21 b)
CYD2 CYD2- sense 5' GTG GGA GTC GTG ACG CTG TA (20 b) spe CYD2-
anti 5' GTT GAT GGC GCA TCC TTG ATC (21 b) CYD2 5' Fam-TGG GAG TTA
TGG TGG GCG CCG-Tamra (21 b) CYD3 CYD3- sense 5' AAA ACA CTT CCA
TGT CAT TTT CAT G (25b) spe CYD3- anti 5' GTT GAT GGC GCA TCC TTG
ATC (21 b) CYD3- 5'Fam-TGCGATAGGAATTATCACACTCTATCTGGGAGC-Tamra
(33b) CYD4 CYD4- sense 5' CTT AGT ATT GTG GAT TGG CAC GAA (24 b)
spe CYD4- anti 5' GCG CCA ACT GTG AAA CCT AGA (21 b) CYD4-
5'-Fam-AGAAACACTTCAATGGCAATGACGTGCAT-Tamra (29 b) VDV1 VDV1-NS5
sense 5' TCG CAA CAG CCT TAA CAG C (19 b) spe VDV1-NS5 anti 5' ACT
ATC TCC CTC CCA TCC TTC (21 b) VDV1-NS5 5' Fam-TTC ACA CCA CTT CCA
C-M GB/NFQ (16 b) VDV2 VDV2-NS5 sense 5' AAT GAC AGA CAC GAC TCC
(18 b) spec VDV2-NS5 anti 5' CCC AAA ACC TAC TAT CTT CAA C (22 b)
VDV2-NS5 5' Fam-TGG AAG TCG GCA CGT GA-MGB/NFQ (17 b)
Measurement of Neutralizing Antibodies (Seroneutralization Test)
(SN50)
[0173] Conventionally, the dengue antibody measurement is
established using the PRNT50 (50% PFU number reduction
neutralization test). Since this test is laborious and uses up a
lot of material, we developed the SN50 test, based on 50% reduction
in the number of units measured in a CCID50 test.
[0174] In a 96-well plate, 0.120 ml of each decomplemented serum is
added to 0.480 ml of diluent (ISCOVE 4% FCS) per well. 6-fold
serial dilutions are prepared by transfer of 0.150 ml of serum into
0.450 ml of diluent. 450 .mu.l of virual dilution at 2.7 log.sub.10
CCID50/ml are added to each well so as to obtain 25 CCID50/well.
The plate is incubated at 37.degree. C. for 1 hour. 100 .mu.l of
each dilution are then distributed into 6 wells of a 96-well plate
into which VERO cells had been seeded 3 days before the beginning
of the experiment at a density of 8000 cells/well, in 100 .mu.l of
ISCOVE medium containing 4% FCS. After incubation at 37.degree. C.
for 6 days, in the presence of 5% CO.sub.2, the cells are fixed
with an ethanol/acetone (70/30) mixture at 4.degree. C. for 15
minutes, and then washed 3 times in PBS and incubated for 1 h at
37.degree. C. in the presence of 50 .mu.l of a 1/2000 dilution of
an anti-flavivirus monoclonal antibody (mAb 4G2). The plates are
then washed twice and incubated for 1 h at 37.degree. C. in the
presence of 50 .mu.l of a 1/1000 dilution of an alkaline
phosphatase-conjugated anti-mouse IgG. The lysis plaques are
visualized by adding 50 .mu.l of a colored substrate: BCIP/NBT. The
neutralizing antibody titers are calculated using the Karber
formula as defined below:
log.sub.10SN50=d+f/N(X+N/2),
[0175] in which: [0176] d represents the dilution resulting in 100%
neutralization (i.e. 6 negative replicates, i.e. replicates
exhibiting no sign of infection) [0177] f: represents the dilution
factor in log 10 (e.g. dilution factor of 1:4, f=0.6) [0178] N:
represents the number of replicates/dilution (N=6) [0179] X: total
number of wells exhibiting no sign of infection, with the exception
of the dilution d.
[0180] The limit of viral detection is 10 SN50 (i.e. 1.0
log.sub.10SN50).
[0181] The viral strains which were used for the neutralization are
the DEN1 16007, DEN2 16681, DEN3 16562 or DEN4 1036 strains.
[0182] For the controls, the initial viral dilutions were
re-titrated.
[0183] The correlation between the neutralizing titer measured in
the SN50 test and the neutralizing titer measured conventionally in
the PRNT50 test is: log.sub.10PRNT50=log.sub.10SN50+0.2
[0184] The mean titer (GMT) is established by calculating the
geometric mean of the titers expressed as linear value; samples for
which the titer is below the detection threshold are, by
convention, given a value equal to half this threshold.
[0185] 1.2 Evaluation of the sequential immunizations
[0186] 3 groups of 4 monkeys of equivalent age and weight were
immunized (see table 2).
[0187] The immunization was carried out subcutaneously in the arm,
with a 23G1 needle, at a dose of 10.sup.5 CCID.sub.50 for each
serotype for the CYD DEN 1 to 4 vaccines. VDV-1 and VDV-2 were
injected at a dose of 3.96 log.sub.10 and 4.84 log.sub.10,
respectively.
TABLE-US-00002 TABLE 2 Composition of the groups and immunization
protocol No of the Immunizations Group monkeys D0 D56 1 AM633
VDV-1,2 CYD-3,4 AM634 (bivalent (bivalent AM941 composition)
composition) AN045 2 AM637 CYD-1,2 CYD-3,4 AN002 (bivalent
(bivalent AN013 composition) composition) AN073 3 AM496 CYD-1,2,3,4
CYD-1,2,3,4 AM645 (tetravalent (tetravalent composition) AM766
composition) AM813
[0188] The immunogenicity results obtained after one immunization
(D28) and two immunizations (D84) are given in table 3.
[0189] The viremia results are given in table 4.
TABLE-US-00003 TABLE 3 SN50 neutralizing titer Monkeys
Immunizations D + 28 D + 84 Group ID D0 D56 DEN-1 DEN-2 DEN-3 DEN-4
DEN-1 DEN-2 DEN-3 DEN-4 1 AM633 VDV 12 CYD 34 16 10 -- -- 20 126 20
126 AM634 126 200 -- -- 319 802 100 637 AM941 32 200 -- -- 252 802
40 252 AN045 25 200 -- -- 63 400 50 252 geometric 35 94 -- -- 100
425 45 268 mean 2 AM637 CYD 12 CYD 34 32 10 -- -- 637 31 40 159
AN002 40 31 -- -- 1277 634 100 159 AN013 20 316 -- -- 20 400 20 16
AN073 -- -- -- -- 63 126 40 504 geometric 19 27 -- -- 179 178 42
119 mean 3 AM496 CYD CYD 50 -- 16 32 100 40 80 252 AM645 1234 1234
-- -- 13 31 16 -- -- 63 AM766 -- -- -- 32 20 -- -- 80 AM813 25 --
-- 13 63 13 20 63 geometric 13 -- 8 25 38 11 14 95 mean --= <10
SN.sub.50 corresponding to the limit of sensitivity of the test
(titer = 5 for the calculation of the geometric mean)*
TABLE-US-00004 TABLE 4 Viremia titers Monitoring of post-vaccinal
viremias of the F IM DENO11 Mk monkey study 1st immunization (D0)
Group Monkey type D2 D3 D4 D5 D6 D7 D8 D9 D10 1 AM633 VDV1 -- -- --
-- -- -- -- -- -- VDV2 -- -- -- -- 3.928 -- 3.54 -- -- (i)VDV 1.2
AM634 VDV1 -- -- -- -- -- -- -- -- -- (ii)CYD3.4 VDV2 -- 4.08 4.75
5.14 5.38 2.93 4.42 3.42 -- AM941 VDV1 -- -- -- -- -- -- -- -- --
VDV2 4.191 -- 4.015 4.341 4.897 4.894 4.276 -- 2.754 AN045 VDV1 --
-- -- -- -- -- -- -- -- VDV2 3.446 -- 4.108 4.905 4.968 4.749 3.175
2.908 -- 2 AM637 CYD1 3.32 -- -- -- -- -- -- -- -- CYD2 -- -- -- --
-- -- -- -- -- (i)CYD1.2 AN002 CYD1 -- -- -- -- -- -- -- -- --
(ii)CYD3.4 CYD2 -- -- -- -- -- -- -- -- -- AN013 CYD1 -- -- -- --
-- -- -- -- -- CYD2 -- -- -- -- -- -- -- -- -- AN073 CYD1 -- -- --
-- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- -- -- 6 AM496 CYD1 --
-- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- -- -- (i)CYD1-4
CYD3 -- -- -- -- -- -- -- -- -- (ii)CYD1-4 CYD4 4.221 3.363 3.711
4.154 3.145 -- 3.579 -- -- AM645 CYD1 3.27 -- -- -- -- -- -- -- --
CYD2 -- -- -- -- -- -- -- -- -- CYD3 3.55 -- -- -- -- -- -- -- --
CYD4 3.66 3.607 2.82 3.514 3.654 3.238 -- 3.475 3.443 AM766 CYD1 --
-- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- -- -- CYD3 -- --
-- -- -- -- -- -- -- CYD4 3.966 3.06 3.378 4.193 3.80 3.729 -- --
-- AM813 CYD1 -- -- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- --
-- -- CYD3 -- -- -- -- -- -- -- -- -- CYD4 4.813 4.603 3.173 2.85
-- -- -- -- -- 2nd immunization (D56) Group Monkey type D58 D59 D60
D61 D62 D63 D64 D65 D66 1 AM633 CYD3 -- -- -- -- -- -- -- -- --
CYD4 3.613 -- -- -- -- 3.075 -- -- -- (i)VDV 1.2 AM634 CYD3 -- --
-- -- -- -- -- -- -- (ii)CYD3.4 CYD4 -- -- -- -- -- 2.986 -- -- --
AM941 CYD3 -- -- -- -- -- -- -- -- -- CYD4 -- -- -- -- -- 3.444 --
-- -- AN045 CYD3 -- -- -- -- -- -- -- -- -- CYD4 2.97 -- -- 2.95 --
3.344 3.509 3.40 -- 2 AM637 CYD3 -- -- -- -- -- -- -- -- -- CYD4
5.209 4.629 3.664 2.985 -- -- -- -- -- (i)CYD1.2 AN002 CYD3 -- --
-- -- -- -- -- -- -- (ii)CYD3.4 CYD4 3.559 -- -- -- 3.674 3.835
3.573 3.587 3.30 AN013 CYD3 -- -- -- -- -- -- -- -- -- CYD4 -- --
-- -- -- -- -- -- -- AN073 CYD3 -- -- -- -- -- -- -- -- -- CYD4
3.73 3.50 3.111 2.8 3.337 -- 3.068 3.284 -- 6 AM496 CYD1 -- -- --
-- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- -- -- (i)CYD1-4 CYD3 --
-- -- -- -- -- -- -- -- (ii)CYD1-4 CYD4 -- -- -- -- -- -- -- -- --
AM645 CYD1 -- -- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- --
-- CYD3 -- -- -- -- -- -- -- -- -- CYD4 -- -- -- -- -- -- -- -- --
AM766 CYD1 -- -- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- --
-- CYD3 -- -- -- -- -- -- -- -- -- CYD4 -- -- -- -- -- -- -- -- --
AM813 CYD1 -- -- -- -- -- -- -- -- -- CYD2 -- -- -- -- -- -- -- --
-- CYD3 -- -- -- -- -- -- -- -- -- CYD4 -- -- -- -- -- -- -- --
--
Correlation Between GEQ and PFU
[0190] GEQ/PFU ratio of 2.7 log.sub.10 (i.e.: 1 PFU=500 GEQ) for
the sera positive with respect to YF or CYDs
[0191] GEQ/PFU ratio of 2.5 log.sub.10 (i.e.: 1 PFU=320 GEQ) for
the sera positive with respect to VDV1 or VDV2
[0192] Quantification Limits:
[0193] <3.3 log.sub.10 GEQ/ml (i.e.: <4 PFU/ml) for the
qRT-PCRs with respect to YF and CYDs
[0194] <2.9 log.sub.10 GEQ/ml (i.e.: <2.5 PFU/ml) for the
qRT-PCRs with respect to VDV1 and VDV2
[0195] Briefly, the results can be summarized as follows: [0196]
The administration scheme according to the present invention makes
it possible to qualitatively and quantitatively increase the
homologous neutralizing antibody response which is obtained with
the tetravalent immunization. [0197] The bivalent immunization
CYD-1,2 followed two months later by an immunization CYD-3,4
induces high homologous responses against the four serotypes in all
the monkeys. Similarly, the same good responses are observed after
an administration of VDV-1,2 followed by CYD-3,4. [0198] A notable
result is the strong stimulatory effect of the CYD-3,4 serotypes on
the responses induced by CYD-1,2 after primary immunization. An
increase in the homologous, but also heterologous, neutralizing
antibody responses can be noted. This phenomenon could be explained
by a positive helper effect of the anti-NS-yellow fever response on
the anti-E responses, without immunodominance. E epitopes with
cross reactivity may also play a role. Paradoxically, this
stimulating effect is not observed after a tetravalent booster,
insofar as only the dominant E responses induced after primary
immunization (here, 3) are boosted. [0199] The viremia (table 4) is
predominantly caused by CYD-4 in the case of the CYD vaccines and
no difference is observed between two sequential bivalent
administrations and one tetravalent administration (group 2 versus
group 3). Thus, no difference in terms of safety after two bivalent
immunizations or one tetravalent immunization is expected. A
tendency toward a lower viremia is even rather observed with the
vaccinal scheme according to the invention; see, for example, group
2 compared with group 3.
Example 2
Sequential Immunization in Monkeys Carried Out with a 1 Month
Interval. Comparison of Schemes CYD-1,2 Followed by CYD-3,4 Versus
CYD-2,3 Followed by CYD-1,4
[0200] The viremia and the immunogenicity were tested in a monkey
model as in the previous example. In the present example, a
one-month interval was used between the two immunizations, against
two months in the previous example. The primary immunization
carried out with the two vaccinal viruses that are the least
immunogenic in monkeys (CYD-2,3) is followed by an administration
with the two immunodominant vaccinal viruses (CYD-1,4).
[0201] 2.1 Materials and Methods: Identical to Example 1
[0202] 2.2 Evaluation of Sequential Immunizations with a One-Month
Interval
[0203] 3 groups of 4 monkeys of equivalent age and weight were
immunized. (see table 5).
[0204] The immunization was carried out subcutaneously in the arm
with a 23G1 needle, at a dose of 10.sup.5 CCID.sub.50 for each
serotype for the vaccinal viruses CYD DEN1 to 4 as previously.
TABLE-US-00005 TABLE 5 Group composition and immunization protocol
Immunizations Group D0 D28 1 CYD CYD Tetrav Tetrav (5555) (5555) 2
CYD CYD Biv 1-2 Biv 3-4 (55) (55) 3 CYD CYD Biv 2-3 Biv 1-4 (55)
(55)
[0205] The immunogenicity results obtained after one immunization
(D28) and two immunizations (D56) are given in table 6.
[0206] The viremia results are similar to those given in example 1,
showing a weak viremia induced by CYD4 and no significant
difference between the various groups.
TABLE-US-00006 TABLE 6 SN 50 Monkeys Immunizations D0 + 24 D0 + 56
Group ID D0 D28 DEN-1 DEN-2 DEN-3 DEN-4 DEN-1 DEN-2 DEN-3 DEN-4 1
AR193 CYD CYD 160 80 32 638 638 63 40 401 AR197 Tetrav Tetrav 50 --
-- 318 32 16 10 401 AR209 (5555) (5555) 100 -- -- 159 160 16 32 317
AR335 40 -- -- 505 126 25 -- 100 Geometric 75 -- -- 357 142 25 23
267 mean 2 AR162 CYD Biv CYD Biv 1604 63 ND ND 1274 50 63 318 AR230
1-2 3-4 32 -- ND ND 100 63 12 160 AR264 (55) (55) 1274 63 ND ND 635
25 40 401 AR336 4048 -- ND ND 2019 13 126 401 Geometric 715 21 ND
ND 636 32 44 301 mean 3 AR156 CYD Biv CYD Biv ND -- 318 ND 32 25
126 126 AR173 2-3 1-4 ND 25 80 ND 63 50 80 253 AR337 (55) (55) ND
32 -- ND 40 63 160 401 AR367 ND 50 100 ND 32 80 126 126 Geometric
ND 18 50 ND 40 50 119 200 mean ND: not determined --: =<10
SN.sub.50 corresponding to the limit of sensitivity of the test
[0207] Briefly, the results complete those obtained in example 1
and can be summarized as follows: [0208] The administration scheme
according to the present invention makes it possible to
qualitatively and quantitatively increase the homologous
neutralizing antibody response that is obtained with the
tetravalent vaccination when the two immunizations are carried out
with a 1 month interval. [0209] The CYD-1,2 bivalent immunization
followed, one month later, by a CYD-3,4 immunization (group 2)
induces high homologous responses against the four serotypes in all
the monkeys, with serotypes 1 and 4 being dominant. [0210] In this
group, the booster effect on serotypes 1 and 2 is less marked when
the second administration is carried out after one month, than when
it is carried out after 2 months as in example 1. [0211] When the
immunizations begin with the less immunogenic serotypes (CYD-2,3)
and the booster is carried out with the strongest serotypes
(CYD-1,4), the response obtained is better balanced, with less
dominance of serotypes 1 and 4 (group 3). [0212] These results
confirm those obtained in example 1, which show that an
immunization carried out sequentially with two bivalents is
effective in inducing a response against all the serotypes in all
the animals, even when the booster is carried out only 1 month
after the primary immunization.
Sequence CWU 1
1
2110735DNADengue virus 1agttgttagt ctacgtggac cgacaagaac agtttcgaat
cggaagcttg cttaacgtag 60ttctaacagt tttttattag agagcagatc tctgatgatc
aaccaacgaa aaaagacggg 120tcgaccgtct ttcaatatgc tgaaacgcgc
gagaaaccgc gtgtcaactg tttcacagtt 180ggcgaagaga ttctcaaaag
gattgctctc aggccaagga cccatgaaat tggtgatggc 240tttcatagca
ttcttaagat ttctagccat acccccaaca gcaggaattt tggctagatg
300gggctcattc aagaagaatg gagcgattaa agtgttacgg ggtttcaaga
gagaaatctc 360aaacatgcta aacataatga acaggaggaa aagatccgtg
accatgctcc ttatgctgct 420gcccacagcc ctggcgttcc atctgacgac
acgaggggga gagccgcata tgatagttag 480caagcaggaa agaggaaagt
cacttttgtt caagacctct gcaggtgtca acatgtgcac 540cctcattgcg
atggatttgg gagagttgtg tgaggacacg atgacctaca aatgcccccg
600gatcactgag gcggaaccag atgacgttga ctgttggtgc aatgccacgg
acacatgggt 660gacctatgga acgtgctctc aaactggcga acaccgacga
gacaaacgtt ccgtcgcatt 720ggccccacac gtggggcttg gcctagaaac
aagagccgaa acgtggatgt cctctgaagg 780tgcttggaaa cagatacaaa
aagtagagac ttgggctctg agacatccag gattcacggt 840gatagccctt
tttctagcac atgccatagg aacatccatc acccagaaag ggatcatttt
900cattttgctg atgctggtaa caccatctat ggccatgcga tgcgtgggaa
taggcaacag 960agacttcgtg gaaggactgt caggagcaac atgggtggat
gtggtactgg agcatggaag 1020ttgcgtcacc accatggcaa aaaacaaacc
aacactggac attgaactct tgaagacgga 1080ggtcacaaac cctgcagttc
tgcgtaaatt gtgcattgaa gctaaaatat caaacaccac 1140caccgattcg
agatgtccaa cacaaggaga agccacactg gtggaagaac aagacgcgaa
1200ctttgtgtgc cgacgaacgt tcgtggacag aggctggggc aatggctgtg
ggctattcgg 1260aaaaggtagt ctaataacgt gtgccaagtt taagtgtgtg
acaaaactag aaggaaagat 1320agctcaatat gaaaacctaa aatattcagt
gatagtcacc gtccacactg gagatcagca 1380ccaggtggga aatgagacta
cagaacatgg aacaactgca accataacac ctcaagctcc 1440tacgtcggaa
atacagctga ccgactacgg aacccttaca ttagattgtt cacctaggac
1500agggctagat tttaacgaga tggtgttgct gacaatgaaa aagaaatcat
ggcttgtcca 1560caaacagtgg tttctagact taccactgcc ttggacctct
ggggctttaa catcccaaga 1620gacttggaac agacaagatt tactggtcac
atttaagaca gctcatgcaa agaagcagga 1680agtagtcgta ctaggatcac
aagaaggagc aatgcacact gcgctgactg gagcgacaga 1740aatccaaacg
tcaggaacga caacaatttt cgcaggacac ctaaaatgca gactaaaaat
1800ggacaaacta actttaaaag ggatgtcata tgtgatgtgc acaggctcat
tcaagttaga 1860gaaagaagtg gctgagaccc agcatggaac tgttctggtg
caggttaaat atgaaggaac 1920agacgcacca tgcaagattc ccttttcgac
ccaagatgag aaaggagcaa cccagaatgg 1980gagattaata acagccaacc
ccatagtcac tgacaaagaa aaaccagtca atattgaggc 2040agaaccaccc
tttggtgaga gctacatcgt ggtaggagca ggtgaaaaag ctttgaaact
2100aagctggttc aagaaaggaa gcagcatagg gaaaatgttt gaagcaactg
cccgaggagc 2160acgaaggatg gccattctgg gagacaccgc atgggacttc
ggttctatag gaggagtgtt 2220cacgtctatg ggaaaactgg tacaccaggt
ttttggaact gcatatggag ttttgtttag 2280cggagtttct tggaccatga
aaataggaat agggattctg ctgacatggc taggattaaa 2340ttcaaggaac
acgtcccttt cggtgatgtg catcgcagtt ggcatggtca cactgtacct
2400aggagtcatg gttcaggcag attcgggatg tgtaatcaac tggaaaggca
gagaacttaa 2460atgtggaagc ggcatttttg tcactaatga agttcacact
tggacagagc aatacaaatt 2520ccaggctgac tcccccaaga gactatcagc
agccattggg aaggcatggg aggagggtgt 2580gtgtggaatc cgatcagcca
ctcgtctcga gaacatcatg tggaaacaaa tatcaaatga 2640attgaaccac
atcctacttg aaaatgacat gaaatttaca gtggtcgtgg gagacgttag
2700tggaatcttg gcccaaggaa aaaaaatgat taggccacaa cccatggaac
acaaatactc 2760gtggaaaagc tggggaaaag ctaaaatcat aggagcggat
gtacagaaca ccaccttcat 2820catcgacggc ccaaacaccc cagaatgccc
tgacaatcaa agagcatgga atatttggga 2880agtagaggac tatggatttg
ggattttcac gacaaacata tggttgaaat tgcgtgactc 2940ctacacccaa
gtatgtgacc accggctgat gtcagctgcc attaaggaca gcaaggcagt
3000ccatgctgac atggggtact ggatagaaag tgaaaagaac gagacatgga
agttggcgag 3060agcctccttt atagaagtta agacatgcat ctggccaaaa
tcccacactc tatggagcaa 3120tggagttctg gaaagtgaaa tgataattcc
aaagatatat ggaggaccaa tatctcagca 3180caactacaga ccaggatatt
tcacacaaac agcagggccg tggcacctag gcaagttgga 3240actagatttc
gatttttgtg aaggtaccac agttgttgtg gatgaacatt gtggaaatcg
3300aggaccatct ctcagaacca caacagtcac aggaaagata atccatgaat
ggtgctgcag 3360atcttgtacg ctaccccccc tacgtttcaa aggggaagac
gggtgttggt acggcatgga 3420aatcagacca gtgaaggaca aggaagagaa
cctggtcaag tcaatggtct ctgcagggtc 3480aggagaagtg gacagctttt
cactaggact gctatgcata tcaataatga ttgaagaagt 3540gatgagatcc
agatggagca aaaaaatgct gatgactgga acactggctg tgttcctcct
3600tcttataatg ggacaattga catggagtga tctgatcagg ttatgtatta
tggttggagc 3660caacgcttca gacaagatgg ggatgggaac aacgtaccta
gctttaatgg ccactttcaa 3720aatgagacca atgttcgccg tcgggctatt
atttcgcaga ctaacatcta gagaagttct 3780tcttcttaca attggcttga
gcctggtggc atccgtggag ctaccaagtt ccctagagga 3840gctgggggat
ggacttgcaa taggcatcat gatgttgaaa ttattgactg attttcagtc
3900acaccagcta tgggctactc tgctatcctt gacatttatt aaaacaactt
tttcattgca 3960ctatgcatgg aagacaatgg ctatggtact gtcaattgta
tctctcttcc ctttatgcct 4020gtccacgacc tctcaaaaaa caacatggct
tccggtgctg ttgggatctc ttggatgcaa 4080accactaccc atgtttctta
taacagaaaa caaaatctgg ggaaggaaga gttggcccct 4140caatgaagga
attatggctg ttggaatagt tagtattcta ctaagttcac ttttaaaaaa
4200tgatgtgccg ctagccggcc cattaatagc tggaggcatg ctaatagcat
gttatgtcat 4260atccggaagc tcagctgatt tatcactgga gaaagcggct
gaggtctcct gggaggaaga 4320agcagaacac tcaggcgcct cacacaacat
actagtagag gttcaagatg atggaaccat 4380gaagataaaa gatgaagaga
gagatgacac gctcaccatt ctccttaaag caactctgct 4440ggcagtctca
ggggtgtacc caatgtcaat accagcgacc ctttttgtgt ggtatttttg
4500gcagaaaaag aaacagagat caggagtgct atgggacaca cccagccccc
cagaagtgga 4560aagagcagtt cttgatgatg gcatctatag aattttgcaa
agaggactgt tgggcaggtc 4620ccaagtagga gtaggagttt tccaagaagg
cgtgttccac acaatgtggc acgtcactag 4680gggagctgtc ctcatgtatc
aaggaaaaag gctggaacca agctgggcca gtgtcaaaaa 4740agacttgatc
tcatatggag gaggttggag gtttcaagga tcctggaaca cgggagaaga
4800agtacaggtg attgctgttg aaccgggaaa aaaccccaaa aatgtacaaa
caacgccggg 4860taccttcaag acccctgaag gcgaagttgg agccatagcc
ttagacttta aacctggcac 4920atctggatct cccatcgtaa acagagaggg
aaaaatagta ggtctttatg gaaatggagt 4980ggtgacaaca agcggaactt
acgttagtgc catagctcaa gctaaggcat cacaagaagg 5040gcctctacca
gagattgagg acaaggtgtt taggaaaaga aacttaacaa taatggacct
5100acatccagga tcgggaaaaa caagaagata ccttccagcc atagtccgtg
aggccataaa 5160aaggaagctg cgcacgctaa tcctagctcc cacaagagtt
gtcgcttctg aaatggcaga 5220ggcactcaag ggagtgccaa taaggtatca
gacaacagca gtgaagagtg aacacacagg 5280aaaggagata gttgacctta
tgtgccacgc cactttcacc atgcgcctcc tgtctcccgt 5340gagagttccc
aattataaca tgattatcat ggatgaagca cacttcaccg atccagccag
5400catagcagcc agagggtaca tctcaacccg agtgggtatg ggtgaagcag
ctgcgatctt 5460tatgacagcc actcccccag gatcggtgga ggcctttcca
cagagcaatg caattatcca 5520agatgaggaa agagacattc ctgagagatc
atggaactca ggctatgact ggatcactga 5580ttttccaggt aaaacagtct
ggtttgttcc aagcatcaaa tcaggaaatg acattgccaa 5640ctgtttaaga
aaaaacggga aacgggtgat ccaattgagc agaaaaacct ttgacactga
5700gtaccagaaa acaaaaaaca acgactggga ctatgtcgtc acaacagaca
tttccgaaat 5760gggagcaaat ttccgggccg acagggtaat agacccaagg
cggtgtctga aaccggtaat 5820actaaaagat ggtccagagc gcgtcattct
agccggaccg atgccagtga ctgtggccag 5880tgccgcccag aggagaggaa
gaattggaag gaaccaaaac aaggaaggtg atcagtatat 5940ttacatggga
cagcctttaa aaaatgatga ggaccacgct cattggacag aagcaaagat
6000gctccttgac aatataaaca caccagaagg gattatccca gccctctttg
agccggagag 6060agaaaagagt gcagctatag acggggaata cagactgcgg
ggtgaagcaa ggaaaacgtt 6120cgtggagctc atgagaagag gggatctacc
agtctggcta tcctacaaag ttgcctcaga 6180aggcttccag tactccgaca
gaaggtggtg cttcgatggg gaaaggaaca accaggtgtt 6240ggaggagaac
atggacgtgg agatctggac aaaagaagga gaaagaaaga aactacgacc
6300tcgctggttg gacgccagaa catactctga cccactggct ctgcgcgagt
ttaaagagtt 6360tgcagcagga agaagaagcg tctcaggtga cctaatatta
gaaataggga aacttccaca 6420acatttgacg caaagggccc agaatgcttt
ggacaacttg gtcatgttgc acaattccga 6480acaaggagga aaagcctata
gacatgctat ggaagaactg ccagacacaa tagaaacgtt 6540gatgctccta
gccttgatag ctgtgttgac tggtggagtg acgctgttct tcctatcagg
6600aagaggtcta ggaaaaacat ctatcggctt actctgcgtg atggcctcaa
gcgcactgtt 6660atggatggcc agtgtggagc cccattggat agcggcctcc
atcatactgg agttctttct 6720gatggtactg cttattccag agccagacag
acagcgcact ccacaggaca accagctagc 6780atatgtggtg ataggtctgt
tattcgtgat attgacagtg gcagccaatg agatgggatt 6840attggaaacc
acaaagaaag acctggggat tggccatgta gctgctgaaa accaccacca
6900tgctacaatg ctggacgtag acctacatcc agcttcagcc tggaccctct
atgcagtggc 6960cacaacaatc atcactccta tgatgagaca cacaattgaa
aacacaacgg caaatatttc 7020cctgacagcc atcgcaaacc aagcagctat
attgatggga cttgacaagg gatggccaat 7080atcgaagatg gacataggag
ttccacttct cgccttgggg tgctattccc aagtgaatcc 7140gctgacactg
atagcggcag tattgatgct agtagctcat tacgccataa ttggacctgg
7200actgcaagca aaagctacta gagaagctca aaaaagaaca gcggctggaa
taatgaaaaa 7260tccaactgtc gacgggattg ttgcaataga cttagatccc
gtggtttacg atgcaaaatt 7320tgaaaaacag ctaggccaaa taatgttgtt
gatactttgc acatcacaga ttcttttgat 7380gcggactaca tgggccttgt
gtgaatccat cacattggct actggacctc tgaccactct 7440ttgggaggga
tctccaggaa aattctggaa caccacaata gcggtatcca tggcaaacat
7500tttcaggggg agttatctag caggagcagg tctggccttc tcattaatga
aatctctagg 7560aggaggtagg agaggcacgg gagcccaagg ggaaacactg
ggagaaaaat ggaaaagaca 7620actaaaccaa ctgagcaagt cagaattcaa
tacttacaag aggagtggga ttatggaggt 7680ggatagatcc gaagccaaag
agggactgaa aagaggagaa acaaccaaac acgcagtatc 7740gagaggaacg
gccaaactga ggtggttcgt ggagaggaac cttgtgaaac cagaagggaa
7800agtcatagac ctcggttgtg gaagaggtgg ctggtcatat tattgcgctg
ggctgaagaa 7860agtcacagaa gtgaaaggat acacaaaagg aggacctgga
catgaggaac caatcccaat 7920ggcgacctat ggatggaacc tagtaaggct
gcactccgga aaagatgtat tttttatacc 7980acctgagaaa tgtgacaccc
ttttgtgtga tattggtgag tcctctccga acccaactat 8040agaggaagga
agaacgttac gtgttctgaa aatggtggaa ccatggctca gaggaaacca
8100attttgcata aaaattctaa atccctatat gccgagcgtg gtagaaactc
tggaacaaat 8160gcaaagaaaa catggaggaa tgctagtgcg aaacccactc
tcaagaaatt ccacccatga 8220aatgtactgg gtttcatgtg gaacaggaaa
cattgtgtca gcagtaaaca tgacatctag 8280aatgttgcta aatcggttca
caatggctca caggaagcca acatatgaaa gagacgtgga 8340cttaggcgct
ggaacaagac atgtggcagt agaaccagag gtagccaacc tagatatcat
8400tggccagagg atagagaata taaaaaatga acataagtca acatggcatt
atgatgagga 8460caatccatac aaaacatggg cctatcatgg atcatatgag
gttaagccat caggatcggc 8520ctcatccatg gtcaatggcg tggtgagatt
gctcaccaaa ccatgggatg ttatccccat 8580ggtcacacaa atagccatga
ctgataccac accctttgga caacagaggg tgtttaaaga 8640gaaagttgac
acgcgcacac caaaagcaaa acgtggcaca gcacaaatta tggaagtgac
8700agccaggtgg ttatggggtt tcctttctag aaacaaaaaa cccagaattt
gcacaagaga 8760ggagtttaca agaaaagtta ggtcaaacgc agctattgga
gcagtgttcg ttgatgaaaa 8820tcaatggaac tcggcaaaag aagcagtgga
agacgaacgg ttctgggaac ttgtccacag 8880agagagggag cttcataaac
aggggaaatg tgccacgtgt gtctacaata tgatggggaa 8940gagagagaaa
aaattaggag agttcggaaa ggcaaaagga agtcgtgcaa tatggtacat
9000gtggttggga gcacgcttcc tagagtttga agcccttggt ttcatgaatg
aagatcactg 9060gttcagtaga gagaattcac tcagtggagt ggaaggagaa
ggactccaca aacttggata 9120catactcaga gacatatcaa ggattccagg
ggggaacatg tatgcagatg acacagccgg 9180atgggacaca agaataacag
aggatgatct ccagaatgag gctaaaatca ctgacatcat 9240ggagcccgaa
catgccctgc tggctacgtc aatctttaag ctgacctacc aaaataaggt
9300ggtaagggtg cagagaccag caaaaaatgg aaccgtgatg gatgttatat
ccagacgtga 9360ccagagaggc agtggacagg ttggaactta tggcttaaac
actttcacca acatggaggc 9420ccaactgata agacaaatgg agtctgaggg
aatcttttta cccagcgaat tggaaacccc 9480aaatctagcc ggaagagttc
tcgactggtt ggaaaaatat ggtgtcgaaa ggctgaaaag 9540aatggcaatc
agcggagatg actgtgtggt gaaaccaatt gatgacaggt tcgcaacagc
9600cttaacagct ttgaatgaca tgggaaaagt aagaaaagac ataccacaat
gggaaccttc 9660aaaaggatgg aatgattggc aacaagtgcc tttctgttca
caccacttcc accagctaat 9720tatgaaggat gggagggaga tagtggtgcc
atgccgcaac caagatgaac ttgtggggag 9780ggccagagta tcacaaggcg
ccggatggag cctgagagaa accgcatgcc taggcaagtc 9840atatgcacaa
atgtggcagc tgatgtattt ccacaggaga gacctgagac tggcggctaa
9900cgctatttgt tcagccgttc cagttgattg ggtcccaacc agccgcacca
cctggtcgat 9960ccatgcccat caccaatgga tgacaacaga agacatgtta
tcagtatgga atagggtctg 10020gatagaggaa aacccatgga tggaggataa
gactcatgtg tccagttggg aagaagttcc 10080atacctagga aagagggaag
atcagtggtg tggatccctg ataggcttaa cagcaagggc 10140cacctgggcc
actaatatac aagtggccat aaaccaagtg agaaggctca ttgggaatga
10200gaattatcta gattacatga catcaatgaa gagattcaag aatgagagtg
atcccgaagg 10260ggcactctgg taagtcaaca cattcacaaa ataaaggaaa
ataaaaaatc aaatgaggca 10320agaagtcagg ccagattaag ccatagtacg
gtaagagcta tgctgcctgt gagccccgtc 10380caaggacgta aaatgaagtc
aggccgaaag ccacggtttg agcaagccgt gctgcctgtg 10440gctccatcgt
ggggatgtaa aaacccggga ggctgcaacc catggaagct gtacgcatgg
10500ggtagcagac tagtggttag aggagacccc tcccaagaca caacgcagca
gcggggccca 10560acaccagggg aagctgtacc ctggtggtaa ggactagagg
ttagaggaga ccccccgcgt 10620aacaataaac agcatattga cgctgggaga
gaccagagat cctgctgtct ctacagcatc 10680attccaggca cagaacgcca
gaaaatggaa tggtgctgtt gaatcaacag gttct 10735210723DNADengue virus
2agttgttagt ctacgtggac cgacaaagac agattctttg agggagctaa gctcaatgta
60gttctaacag ttttttaatt agagagcaga tctctgatga ataaccaacg gaaaaaggcg
120aaaaacacgc ctttcaatat gctgaaacgc gagagaaacc gcgtgtcgac
tgtgcaacag 180ctgacaaaga gattctcact tggaatgctg cagggacgag
gaccattaaa actgttcatg 240gccctggtgg cgttccttcg tttcctaaca
atcccaccaa cagcagggat attgaagaga 300tggggaacaa ttaaaaaatc
aaaagctatt aatgttttga gagggttcag gaaagagatt 360ggaaggatgc
tgaacatctt gaataggaga cgcagatctg caggcatgat cattatgctg
420attccaacag tgatggcgtt ccatttaacc acacgtaacg gagaaccaca
catgatcgtc 480agcagacaag agaaagggaa aagtcttctg tttaaaacag
aggttggcgt gaacatgtgt 540accctcatgg ccatggacct tggtgaattg
tgtgaagaca caatcacgta caagtgtccc 600cttctcaggc agaatgagcc
agaagacata gactgttggt gcaactctac gtccacgtgg 660gtaacttatg
ggacgtgtac caccatggga gaacatagaa gagaaaaaag atcagtggca
720ctcgttccac atgtgcgaat gggactggag acacgaactg aaacatggat
gtcatcagaa 780ggggcctgga aacatgtcca gagaattgaa acttggatct
tgagacatcc aggcttcacc 840atgatggcag caatcctggc atacaccata
ggaacgacac atttccaaag agccctgatt 900ttcatcttac tgacagctgt
cactccttca atgacaatgc gttgcatagg aatgtcaaat 960agagactttg
tggaaggggt ttcaggagga agctgggttg acatagtctt agaacatgga
1020agctgtgtga cgacgatggc aaaaaacaaa ccaacattgg attttgaact
gataaaaaca 1080gaagccaaac agcctgccac cctaaggaag tactgtatag
aggcaaagct aaccaacaca 1140acaacagaat ctcgctgccc aacacaaggg
gaacccagcc taaatgaaga gcaggacaaa 1200aggttcgtct gcaaacactc
catggtagac agaggatggg gaaatggatg tggactattt 1260ggaaagggag
gcattgtgac ctgtgctatg ttcagatgca aaaagaacat ggaaggaaaa
1320gttgtgcaac cagaaaactt ggaatacacc attgtgataa cacctcactc
aggggaagag 1380catgcagtcg gaaatgacac aggaaaacat ggcaaggaaa
tcaaaataac accacagagt 1440tccatcacag aagcagaatt gacaggttat
ggcactgtca caatggagtg ctctccaaga 1500acgggcctcg acttcaatga
gatggtgttg ctgcagatgg aaaataaagc ttggctggtg 1560cacaggcaat
ggttcctaga cctgccgtta ccatggttgc ccggagcgga cacacaagag
1620tcaaattgga tacagaagga gacattggtc actttcaaaa atccccatgc
gaagaaacag 1680gatgttgttg ttttaggatc ccaagaaggg gccatgcaca
cagcacttac aggggccaca 1740gaaatccaaa tgtcatcagg aaacttactc
ttcacaggac atctcaagtg caggctgaga 1800atggacaagc tacagctcaa
aggaatgtca tactctatgt gcacaggaaa gtttaaagtt 1860gtgaaggaaa
tagcagaaac acaacatgga acaatagtta tcagagtgca atatgaaggg
1920gacggctctc catgcaagat cccttttgag ataatggatt tggaaaaaag
acatgtctta 1980ggtcgcctga ttacagtcaa cccaattgtg acagaaaaag
atagcccagt caacatagaa 2040gcagaacctc catttggaga cagctacatc
atcataggag tagagccggg acaactgaag 2100ctcaactggt ttaagaaagg
aagttctatc ggccaaatgt ttgagacaac aatgaggggg 2160gcgaagagaa
tggccatttt aggtgacaca gcctgggatt ttggatcctt gggaggagtg
2220tttacatcta taggaaaggc tctccaccaa gtctttggag caatctatgg
agctgccttc 2280agtggggttt catggactat gaaaatcctc ataggagtca
ttatcacatg gataggaatg 2340aattcacgca gcacctcact gtctgtgaca
ctagtattgg tgggaattgt gacactgtat 2400ttgggagtca tggtgcaggc
cgatagtggt tgcgttgtga gctggaaaaa caaagaactg 2460aaatgtggca
gtgggatttt catcacagac aacgtgcaca catggacaga acaatacaaa
2520ttccaaccag aatccccttc aaaactagct tcagctatcc agaaagccca
tgaagaggac 2580atttgtggaa tccgctcagt aacaagactg gagaatctga
tgtggaaaca aataacacca 2640gaattgaatc acattctatc agaaaatgag
gtgaagttaa ctattatgac aggagacatc 2700aaaggaatca tgcaggcagg
aaaacgatct ctgcggcctc agcccactga gctgaagtat 2760tcatggaaaa
catggggcaa agcaaaaatg ctctctacag agtctcataa ccagaccttt
2820ctcattgatg gccccgaaac agcagaatgc cccaacacaa atagagcttg
gaattcgttg 2880gaagttgaag actatggctt tggagtattc accaccaata
tatggctaaa attgaaagaa 2940aaacaggatg tattctgcga ctcaaaactc
atgtcagcgg ccataaaaga caacagagcc 3000gtccatgccg atatgggtta
ttggatagaa agtgcactca atgacacatg gaagatagag 3060aaagcctctt
tcattgaagt taaaaactgc cactggccaa aatcacacac cctctggagc
3120aatggagtgc tagaaagtga gatgataatt ccaaagaatc tcgctggacc
agtgtctcaa 3180cacaactata gaccaggcta ccatacacaa ataacaggac
catggcatct aggtaagctt 3240gagatggact ttgatttctg tgatggaaca
acagtggtag tgactgagga ctgcggaaat 3300agaggaccct ctttgagaac
aaccactgcc tctggaaaac tcataacaga atggtgctgc 3360cgatcttgca
cattaccacc gctaagatac agaggtgagg atgggtgctg gtacgggatg
3420gaaatcagac cattgaagga gaaagaagag aatttggtca actccttggt
cacagctgga 3480catgggcagg tcgacaactt ttcactagga gtcttgggaa
tggcattgtt cctggaggaa 3540atgcttagga cccgagtagg aacgaaacat
gcaatactac tagttgcagt ttcttttgtg 3600acattgatca cagggaacat
gtcctttaga gacctgggaa gagtgatggt tatggtaggc 3660gccactatga
cggatgacat aggtatgggc gtgacttatc ttgccctact agcagccttc
3720aaagtcagac caacttttgc agctggacta ctcttgagaa agctgacctc
caaggaattg 3780atgatgacta ctataggaat tgtactcctc tcccagagca
ccataccaga gaccattctt 3840gagttgactg atgcgttagc cttaggcatg
atggtcctca aaatggtgag aaatatggaa 3900aagtatcaat tggcagtgac
tatcatggct atcttgtgcg tcccaaacgc agtgatatta 3960caaaacgcat
ggaaagtgag ttgcacaata ttggcagtgg tgtccgtttc cccactgttc
4020ttaacatcct cacagcaaaa aacagattgg ataccattag cattgacgat
caaaggtctc 4080aatccaacag ctatttttct aacaaccctc tcaagaacca
gcaagaaaag gagctggcca 4140ttaaatgagg ctatcatggc agtcgggatg
gtgagcattt tagccagttc tctcctaaaa 4200aatgatattc ccatgacagg
accattagtg gctggagggc tcctcactgt gtgctacgtg 4260ctcactggac
gatcggccga
tttggaactg gagagagcag ccgatgtcaa atgggaagac 4320caggcagaga
tatcaggaag cagtccaatc ctgtcaataa caatatcaga agatggtagc
4380atgtcgataa aaaatgaaga ggaagaacaa acactgacca tactcattag
aacaggattg 4440ctggtgatct caggactttt tcctgtatca ataccaatca
cggcagcagc atggtacctg 4500tgggaagtga agaaacaacg ggccggagta
ttgtgggatg ttccttcacc cccacccatg 4560ggaaaggctg aactggaaga
tggagcctat agaattaagc aaaaagggat tcttggatat 4620tcccagatcg
gagccggagt ttacaaagaa ggaacattcc atacaatgtg gcatgtcaca
4680cgtggcgctg ttctaatgca taaaggaaag aggattgaac caacatgggc
ggacgtcaag 4740aaagacctaa tatcatatgg aggaggctgg aagttagaag
gagaatggaa ggaaggagaa 4800gaagtccagg tattggcact ggagcctgga
aaaaatccaa gagccgtcca aacgaaacct 4860ggtcttttca aaaccaacgc
cggaacaata ggtgctgtat ctctggactt ttctcctgga 4920acgtcaggat
ctccaattat cgacaaaaaa ggaaaagttg tgggtcttta tggtaatggt
4980gttgttacaa ggagtggagc atatgtgagt gctatagccc agactgaaaa
aagcattgaa 5040gacaacccag agatcgaaga tcacattttc cgaaagagaa
gactgaccat catggacctc 5100cacccaggag cgggaaagac gaagagatac
cttccggcca tagtcagaga agctataaaa 5160cggggtttga gaacattaat
cttggccccc actagagttg tggcagctga aatggaggaa 5220gcccttagag
gacttccaat aagataccag accccagcca tcagagctga gcacaccggg
5280cgggagattg tggacctaat gtgtcatgcc acatttacca tgaggctgct
atcaccagtt 5340agagtgccaa actacaacct gattatcatg gacgaagccc
atttcacaga cccagcaagt 5400atagcagcta gaggatacat ctcaactcga
gtggagatgg gtgaggcagc tgggattttt 5460atgacagcca ctcccccggg
aagcagagac ccatttcctc agagcaatgc accaatcata 5520gatgaagaaa
gagaaatccc tgaacgctcg tggaattccg gacatgaatg ggtcacggat
5580tttaaaggga agactgtttg gttcgttcca agtataaaag caggaaatga
tatagcagct 5640tgcctgagga aaaatggaaa gaaagtgata caactcagta
ggaagacctt tgattctgag 5700tatgtcaaga ctagaaccaa tgattgggac
ttcgtggtta caactgacat ttcagaaatg 5760ggtgccaatt tcaaggctga
gagggttata gaccccagac gctgcatgaa accagtcata 5820ctaacagatg
gtgaagagcg ggtgattctg gcaggaccta tgccagtgac ccactctagt
5880gcagcacaaa gaagagggag aataggaaga aatccaaaaa atgagaatga
ccagtacata 5940tacatggggg aacctctgga aaatgatgaa gactgtgcac
actggaaaga agctaaaatg 6000ctcctagata acatcaacac gccagaagga
atcattccta gcatgttcga accagagcgt 6060gaaaaggtgg atgccattga
tggcgaatac cgcttgagag gagaagcaag gaaaaccttt 6120gtagacttaa
tgagaagagg agacctacca gtctggttgg cctacagagt ggcagctgaa
6180ggcatcaact acgcagacag aaggtggtgt tttgatggag tcaagaacaa
ccaaatccta 6240gaagaaaacg tggaagttga aatctggaca aaagaagggg
aaaggaagaa attgaaaccc 6300agatggttgg atgctaggat ctattctgac
ccactggcgc taaaagaatt taaggaattt 6360gcagccggaa gaaagtctct
gaccctgaac ctaatcacag aaatgggtag gctcccaacc 6420ttcatgactc
agaaggcaag agacgcactg gacaacttag cagtgctgca cacggctgag
6480gcaggtggaa gggcgtacaa ccatgctctc agtgaactgc cggagaccct
ggagacattg 6540cttttactga cacttctggc tacagtcacg ggagggatct
ttttattctt gatgagcgca 6600aggggcatag ggaagatgac cctgggaatg
tgctgcataa tcacggctag catcctccta 6660tggtacgcac aaatacagcc
acactggata gcagcttcaa taatactgga gttttttctc 6720atagttttgc
ttattccaga acctgaaaaa cagagaacac cccaagacaa ccaactgacc
6780tacgttgtca tagccatcct cacagtggtg gccgcaacca tggcaaacga
gatgggtttc 6840ctagaaaaaa cgaagaaaga tctcggattg ggaagcattg
caacccagca acccgagagc 6900aacatcctgg acatagatct acgtcctgca
tcagcatgga cgctgtatgc cgtggccaca 6960acatttgtta caccaatgtt
gagacatagc attgaaaatt cctcagtgaa tgtgtcccta 7020acagctatag
ccaaccaagc cacagtgtta atgggtctcg ggaaaggatg gccattgtca
7080aagatggaca tcggagttcc ccttctcgcc attggatgct actcacaagt
caaccccata 7140actctcacag cagctctttt cttattggta gcacattatg
ccatcatagg gccaggactc 7200caagcaaaag caaccagaga agctcagaaa
agagcagcgg cgggcatcat gaaaaaccca 7260actgtcgatg gaataacagt
gattgaccta gatccaatac cttatgatcc aaagtttgaa 7320aagcagttgg
gacaagtaat gctcctagtc ctctgcgtga ctcaagtatt gatgatgagg
7380actacatggg ctctgtgtga ggctttaacc ttagctaccg ggcccatctc
cacattgtgg 7440gaaggaaatc cagggaggtt ttggaacact accattgcgg
tgtcaatggc taacattttt 7500agagggagtt acttggccgg agctggactt
ctcttttcta ttatgaagaa cacaaccaac 7560acaagaaggg gaactggcaa
cataggagag acgcttggag agaaatggaa aagccgattg 7620aacgcattgg
gaaaaagtga attccagatc tacaagaaaa gtggaatcca ggaagtggat
7680agaaccttag caaaagaagg cattaaaaga ggagaaacgg accatcacgc
tgtgtcgcga 7740ggctcagcaa aactgagatg gttcgttgag agaaacatgg
tcacaccaga agggaaagta 7800gtggacctcg gttgtggcag aggaggctgg
tcatactatt gtggaggact aaagaatgta 7860agagaagtca aaggcctaac
aaaaggagga ccaggacacg aagaacccat ccccatgtca 7920acatatgggt
ggaatctagt gcgtcttcaa agtggagttg acgttttctt catcccgcca
7980gaaaagtgtg acacattatt gtgtgacata ggggagtcat caccaaatcc
cacagtggaa 8040gcaggacgaa cactcagagt ccttaactta gtagaaaatt
ggttgaacaa caacactcaa 8100ttttgcataa aggttctcaa cccatatatg
ccctcagtca tagaaaaaat ggaagcacta 8160caaaggaaat atggaggagc
cttagtgagg aatccactct cacgaaactc cacacatgag 8220atgtactggg
tatccaatgc ttccgggaac atagtgtcat cagtgaacat gatttcaagg
8280atgttgatca acagatttac aatgagatac aagaaagcca cttacgagcc
ggatgttgac 8340ctcggaagcg gaacccgtaa catcgggatt gaaagtgaga
taccaaacct agatataatt 8400gggaaaagaa tagaaaaaat aaagcaagag
catgaaacat catggcacta tgaccaagac 8460cacccataca aaacgtgggc
ataccatggt agctatgaaa caaaacagac tggatcagca 8520tcatccatgg
tcaacggagt ggtcaggctg ctgacaaaac cttgggacgt tgtccccatg
8580gtgacacaga tggcaatgac agacacgact ccatttggac aacagcgcgt
ttttaaagag 8640aaagtggaca cgagaaccca agaaccgaaa gaaggcacga
agaaactaat gaaaataaca 8700gcagagtggc tttggaaaga attagggaag
aaaaagacac ccaggatgtg caccagagaa 8760gaattcacaa gaaaggtgag
aagcaatgca gccttggggg ccatattcac tgatgagaac 8820aagtggaagt
cggcacgtga ggctgttgaa gatagtaggt tttgggagct ggttgacaag
8880gaaaggaatc tccatcttga aggaaagtgt gaaacatgtg tgtacaacat
gatgggaaaa 8940agagagaaga agctagggga attcggcaag gcaaaaggca
gcagagccat atggtacatg 9000tggcttggag cacgcttctt agagtttgaa
gccctaggat tcttaaatga agatcactgg 9060ttctccagag agaactccct
gagtggagtg gaaggagaag ggctgcacaa gctaggttac 9120attctaagag
acgtgagcaa gaaagaggga ggagcaatgt atgccgatga caccgcagga
9180tgggatacaa aaatcacact agaagaccta aaaaatgaag agatggtaac
aaaccacatg 9240gaaggagaac acaagaaact agccgaggcc attttcaaac
taacgtacca aaacaaggtg 9300gtgcgtgtgc aaagaccaac accaagaggc
acagtaatgg acatcatatc gagaagagac 9360caaagaggta gtggacaagt
tggcacctat ggactcaata ctttcaccaa tatggaagcc 9420caactaatca
gacagatgga gggagaagga gtctttaaaa gcattcagca cctaacaatc
9480acagaagaaa tcgctgtgca aaactggtta gcaagagtgg ggcgcgaaag
gttatcaaga 9540atggccatca gtggagatga ttgtgttgtg aaacctttag
atgacaggtt cgcaagcgct 9600ttaacagctc taaatgacat gggaaagatt
aggaaagaca tacaacaatg ggaaccttca 9660agaggatgga atgattggac
acaagtgccc ttctgttcac accatttcca tgagttaatc 9720atgaaagacg
gtcgcgtact cgttgttcca tgtagaaacc aagatgaact gattggcaga
9780gcccgaatct cccaaggagc agggtggtct ttgcgggaga cggcctgttt
ggggaagtct 9840tacgcccaaa tgtggagctt gatgtacttc cacagacgcg
acctcaggct ggcggcaaat 9900gctatttgct cggcagtacc atcacattgg
gttccaacaa gtcgaacaac ctggtccata 9960catgctaaac atgaatggat
gacaacggaa gacatgctga cagtctggaa cagggtgtgg 10020attcaagaaa
acccatggat ggaagacaaa actccagtgg aaacatggga ggaaatccca
10080tacttgggga aaagagaaga ccaatggtgc ggctcattga ttgggttaac
aagcagggcc 10140acctgggcaa agaacatcca agcagcaata aatcaagtta
gatcccttat aggcaatgaa 10200gaatacacag attacatgcc atccatgaaa
agattcagaa gagaagagga agaagcagga 10260gttctgtggt agaaagcaaa
actaacatga aacaaggcta gaagtcaggt cggattaagc 10320catagtacgg
aaaaaactat gctacctgtg agccccgtcc aaggacgtta aaagaagtca
10380ggccatcata aatgccatag cttgagtaaa ctatgcagcc tgtagctcca
cctgagaagg 10440tgtaaaaaat ccgggaggcc acaaaccatg gaagctgtac
gcatggcgta gtggactagc 10500ggttagggga gacccctccc ttacaaatcg
cagcaacaat gggggcccaa ggcgagatga 10560agctgtagtc tcgctggaag
gactagaggt tagaggagac ccccccgaaa caaaaaacag 10620catattgacg
ctgggaaaga ccagagatcc tgctgtctcc tcagcatcat tccaggcaca
10680gaacgccaga aaatggaatg gtgctgttga atcaacaggt tct 10723
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