Dr Richard Antrobus has been conducting a Phase I study of a Universal Vaccine for Influenza. Progress so far indicates that this approach induces a potent T cell response, and Dr Antrobus is currently assessing whether this response is equally potent in the elderly – one of the 'at risk' groups of the Influenza virus.
A Universal Flu Vaccine would protect against a wide range of strains of the virus. Universal vaccines target the parts of the virus that stay relatively stable and are the same between different strains of flu. The ultimate goal is to produce a vaccine that will eventually replace the normal seasonal flu jab.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: Why do some people need a flu jab every autumn?
RA: The reason that some people need a flu jab every autumn is that influenza has seasonal peaks and troughs. Flu doesn’t really circulate very much in the summer and having the flu jab in September or October allows you to develop some immunity for when flu’s really circulating in the winter. The reason why that needs to be repeated every year is that the flu virus changes very rapidly so the immunity you develop one year won’t necessarily help to protect you the following year. Then why do only some people get the flu jab? Well we know that it’s more serious to get flu if you’re elderly or if you have a certain medical condition like heart failure. The vaccination programme is specifically targeted at those ‘at risk’ groups.
Q: How does the universal flu vaccine actually work?
RA: A universal flu vaccine is one that can provide protection against a broad range of influenza strains. There are many different ways to try and achieve that and ours is just one vaccine candidate in development. What all universal flu vaccine candidates have in common is that, although some of the parts of the flu virus change rapidly, there are actually other parts of the virus that are relatively stable year on year. They are also relatively the same between different strains of flu. Universal vaccines target the immune system at these relatively stable parts of the virus. Our vaccine specifically works by stimulating a type of cell called T cells, and these T cells recognise a couple of key internal proteins from within the flu virus. That has some issues; T cells to some extent will decrease more rapidly over time as opposed to things like antibodies which more conventional vaccines utilise. Another question is: will universal vaccines be able to replace the normal seasonal flu jab? That is certainly the ultimate goal, but that is going to be particularly challenging. Our vaccine candidate is designed to protect against different strains within Influenza A, but there is also an Influenza B. So a truly universal vaccine will need to cross both of those strains, which will be quite difficult.
Q: When will it be available for everybody?
RA: It is difficult to say with any certainty; roughly it takes about ten years to take a vaccine from the early stages of clinical development through to being licensed for generalised use. Rather than a truly universal vaccine springing onto the market, I think it is more likely that we will see a series of vaccines being released, each of which will provide more and more protection against a broader and broader range of Influenza strains.
Q: What are the most important lines of research that have developed over the last five or ten years?
RA: H5N1 Avian Influenza has been very important over the last ten years. Initially cases were reported in Hong Kong and main land China, but it is not a disease that has gone away. In fact it has spread progressively further and further West. Even last year Egypt reported some cases where people had died from H5N1 Influenza. And so a lot of the work has been looking at how the immune responses that we get to that strain, how those interact and relate to immune responses that we get to more conventional strains of flu. For us developing universal vaccines, another important line of research in the last few years has been trying to identify the particular parts of the flu virus are going to be the important targets for our universal vaccines.
Q: Why does your line of research matter and why should we put money into it?
RA: Vaccine research matters a lot; if you think about where we would be without vaccines we would still be faced with polio epidemics and smallpox and measles. Sometimes progress with one vaccine can help develop other vaccines, for example if people discover an adjuvant that works with a vaccine, or discover a new manufacturing process with a vaccine, that can help the field in general. Flu itself is a very important disease – the World Health Organisation estimates that between a quarter of a million and half a million people worldwide die of flu each year, and there is good evidence that flu vaccines can prevent disease. So our line of research is very important because it might help to save lives in the future. Finding a universal vaccine is particularly important because of the inevitability of the next pandemic. In the 20th century we had three pandemic s, with Spanish Flu being the most severe. The 2009 Swine Flu epidemic was relatively less severe, but it is only a matter of time before the next severe pandemic comes along.
Q: How does your research fit into translational medicine within the department?
RA: Translational medicine is about taking findings from the laboratory and using them to help develop better treatments for patients. In the flu group we have got both scientists and clinicians working along side each other, and it is with that integrated multi disciplinary approach that the best ideas can get fast tracked through. So even in the short time that I have been working in the group I have been able to use data from the laboratory to help me design a new clinical trial where we have tested a novel combination of vaccines for the first time in people. So I think vaccine research is very much a part of translational medicine.