Safety and Immunogenicity of a Candidate Bioconjugate Vaccine against Shigella flexneri 2a Administered to Healthy Adults: a Single-Blind, Randomized Phase I Study.
Identifieur interne : 000629 ( Main/Corpus ); précédent : 000628; suivant : 000630Safety and Immunogenicity of a Candidate Bioconjugate Vaccine against Shigella flexneri 2a Administered to Healthy Adults: a Single-Blind, Randomized Phase I Study.
Auteurs : Mark S. Riddle ; Robert W. Kaminski ; Claudio Di Paolo ; Chad K. Porter ; Ramiro L. Gutierrez ; Kristen A. Clarkson ; Hailey E. Weerts ; Christopher Duplessis ; Amy Castellano ; Cristina Alaimo ; Kristopher Paolino ; Robert Gormley ; Veronica Gambillara FonckSource :
- Clinical and vaccine immunology : CVI [ 1556-679X ] ; 2016.
English descriptors
- KwdEn :
- ADP Ribose Transferases (genetics), ADP Ribose Transferases (immunology), Adolescent (MeSH), Adult (MeSH), Antibodies, Bacterial (blood), Antibodies, Bacterial (immunology), Bacterial Proteins (immunology), Bacterial Toxins (genetics), Bacterial Toxins (immunology), Dysentery, Bacillary (immunology), Dysentery, Bacillary (prevention & control), Exotoxins (genetics), Exotoxins (immunology), Female (MeSH), Healthy Volunteers (MeSH), Humans (MeSH), Immunogenicity, Vaccine (MeSH), Immunoglobulin A (immunology), Lipopolysaccharides (immunology), Male (MeSH), Middle Aged (MeSH), O Antigens (immunology), Shigella Vaccines (administration & dosage), Shigella Vaccines (adverse effects), Shigella Vaccines (immunology), Shigella flexneri (immunology), Shigella sonnei (immunology), Single-Blind Method (MeSH), Vaccines, Conjugate (administration & dosage), Vaccines, Conjugate (adverse effects), Vaccines, Conjugate (immunology), Virulence Factors (genetics), Virulence Factors (immunology), Young Adult (MeSH).
- MESH :
- chemical , administration & dosage : Shigella Vaccines, Vaccines, Conjugate.
- chemical , adverse effects : Shigella Vaccines, Vaccines, Conjugate.
- chemical , blood : Antibodies, Bacterial.
- chemical , genetics : ADP Ribose Transferases, Bacterial Toxins, Exotoxins, Virulence Factors.
- chemical , immunology : ADP Ribose Transferases, Antibodies, Bacterial, Bacterial Proteins, Bacterial Toxins, Exotoxins, Immunoglobulin A, Lipopolysaccharides, O Antigens, Shigella Vaccines, Vaccines, Conjugate, Virulence Factors.
- immunology : Dysentery, Bacillary, Shigella flexneri, Shigella sonnei.
- prevention & control : Dysentery, Bacillary.
- Adolescent, Adult, Female, Healthy Volunteers, Humans, Immunogenicity, Vaccine, Male, Middle Aged, Single-Blind Method, Young Adult.
Abstract
Several candidate vaccines against Shigella spp. are in development, but the lack of a clear correlate of protection from challenge with the induction of adequate immune responses among the youngest age groups in the developing world has hampered Shigella vaccine development over the past several decades. Bioconjugation technology, exploited here for an Shigella flexneri 2a candidate vaccine, offers a novel and potentially cost-effective way to develop and produce vaccines against a major pathogen of global health importance. Flexyn2a, a novel S. flexneri 2a bioconjugate vaccine made of the polysaccharide component of the S. flexneri 2a O-antigen, conjugated to the exotoxin protein A of Pseudomonas aeruginosa (EPA), was evaluated for safety and immunogenicity among healthy adults in a single-blind, phase I study with a staggered randomization approach. Thirty subjects (12 receiving 10 μg Flexyn2a, 12 receiving Flexyn2a with aluminum adjuvant, and 6 receiving placebo) were administered two injections 4 weeks apart and were followed for 168 days. Flexyn2a was well-tolerated, independently of the adjuvant and number of injections. The Flexyn2a vaccine elicited statistically significant S. flexneri 2a lipopolysaccharide (LPS)-specific humoral responses at all time points postimmunization in all groups that received the vaccine. Elicited serum antibodies were functional, as evidenced by bactericidal activity against S. flexneri 2a. The bioconjugate candidate vaccine Flexyn2a has a satisfactory safety profile and elicited a robust humoral response to S. flexneri 2a LPS with or without inclusion of an adjuvant. Moreover, the bioconjugate also induced functional antibodies, showing the technology's features in producing a promising candidate vaccine. (This study has been registered at ClinicalTrials.gov under registration no. NCT02388009.).
DOI: 10.1128/CVI.00224-16
PubMed: 27581434
PubMed Central: PMC5139601
Links to Exploration step
pubmed:27581434Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Safety and Immunogenicity of a Candidate Bioconjugate Vaccine against Shigella flexneri 2a Administered to Healthy Adults: a Single-Blind, Randomized Phase I Study.</title><author><name sortKey="Riddle, Mark S" sort="Riddle, Mark S" uniqKey="Riddle M" first="Mark S" last="Riddle">Mark S. Riddle</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA mark.s.riddle10.mil@mail.mil veronica.gambillara@lmtbio.com.</nlm:affiliation></affiliation></author><author><name sortKey="Kaminski, Robert W" sort="Kaminski, Robert W" uniqKey="Kaminski R" first="Robert W" last="Kaminski">Robert W. Kaminski</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Di Paolo, Claudio" sort="Di Paolo, Claudio" uniqKey="Di Paolo C" first="Claudio" last="Di Paolo">Claudio Di Paolo</name><affiliation><nlm:affiliation>LimmaTech Biologics, Schlieren, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Porter, Chad K" sort="Porter, Chad K" uniqKey="Porter C" first="Chad K" last="Porter">Chad K. Porter</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gutierrez, Ramiro L" sort="Gutierrez, Ramiro L" uniqKey="Gutierrez R" first="Ramiro L" last="Gutierrez">Ramiro L. 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Riddle</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA mark.s.riddle10.mil@mail.mil veronica.gambillara@lmtbio.com.</nlm:affiliation></affiliation></author><author><name sortKey="Kaminski, Robert W" sort="Kaminski, Robert W" uniqKey="Kaminski R" first="Robert W" last="Kaminski">Robert W. Kaminski</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Di Paolo, Claudio" sort="Di Paolo, Claudio" uniqKey="Di Paolo C" first="Claudio" last="Di Paolo">Claudio Di Paolo</name><affiliation><nlm:affiliation>LimmaTech Biologics, Schlieren, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Porter, Chad K" sort="Porter, Chad K" uniqKey="Porter C" first="Chad K" last="Porter">Chad K. Porter</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gutierrez, Ramiro L" sort="Gutierrez, Ramiro L" uniqKey="Gutierrez R" first="Ramiro L" last="Gutierrez">Ramiro L. Gutierrez</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Clarkson, Kristen A" sort="Clarkson, Kristen A" uniqKey="Clarkson K" first="Kristen A" last="Clarkson">Kristen A. Clarkson</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Weerts, Hailey E" sort="Weerts, Hailey E" uniqKey="Weerts H" first="Hailey E" last="Weerts">Hailey E. Weerts</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Duplessis, Christopher" sort="Duplessis, Christopher" uniqKey="Duplessis C" first="Christopher" last="Duplessis">Christopher Duplessis</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Castellano, Amy" sort="Castellano, Amy" uniqKey="Castellano A" first="Amy" last="Castellano">Amy Castellano</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Alaimo, Cristina" sort="Alaimo, Cristina" uniqKey="Alaimo C" first="Cristina" last="Alaimo">Cristina Alaimo</name><affiliation><nlm:affiliation>LimmaTech Biologics, Schlieren, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Paolino, Kristopher" sort="Paolino, Kristopher" uniqKey="Paolino K" first="Kristopher" last="Paolino">Kristopher Paolino</name><affiliation><nlm:affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gormley, Robert" sort="Gormley, Robert" uniqKey="Gormley R" first="Robert" last="Gormley">Robert Gormley</name><affiliation><nlm:affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Gambillara Fonck, Veronica" sort="Gambillara Fonck, Veronica" uniqKey="Gambillara Fonck V" first="Veronica" last="Gambillara Fonck">Veronica Gambillara Fonck</name><affiliation><nlm:affiliation>LimmaTech Biologics, Schlieren, Switzerland mark.s.riddle10.mil@mail.mil veronica.gambillara@lmtbio.com.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Clinical and vaccine immunology : CVI</title><idno type="eISSN">1556-679X</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADP Ribose Transferases (genetics)</term><term>ADP Ribose Transferases (immunology)</term><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Antibodies, Bacterial (blood)</term><term>Antibodies, Bacterial (immunology)</term><term>Bacterial Proteins (immunology)</term><term>Bacterial Toxins (genetics)</term><term>Bacterial Toxins (immunology)</term><term>Dysentery, Bacillary (immunology)</term><term>Dysentery, Bacillary (prevention & control)</term><term>Exotoxins (genetics)</term><term>Exotoxins (immunology)</term><term>Female (MeSH)</term><term>Healthy Volunteers (MeSH)</term><term>Humans (MeSH)</term><term>Immunogenicity, Vaccine (MeSH)</term><term>Immunoglobulin A (immunology)</term><term>Lipopolysaccharides (immunology)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>O Antigens (immunology)</term><term>Shigella Vaccines (administration & dosage)</term><term>Shigella Vaccines (adverse effects)</term><term>Shigella Vaccines (immunology)</term><term>Shigella flexneri (immunology)</term><term>Shigella sonnei (immunology)</term><term>Single-Blind Method (MeSH)</term><term>Vaccines, Conjugate (administration & dosage)</term><term>Vaccines, Conjugate (adverse effects)</term><term>Vaccines, Conjugate (immunology)</term><term>Virulence Factors (genetics)</term><term>Virulence Factors (immunology)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Shigella Vaccines</term><term>Vaccines, Conjugate</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Shigella Vaccines</term><term>Vaccines, Conjugate</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Antibodies, Bacterial</term></keywords><keywords scheme="MESH" type="chemical" qualifier="genetics" xml:lang="en"><term>ADP Ribose Transferases</term><term>Bacterial Toxins</term><term>Exotoxins</term><term>Virulence Factors</term></keywords><keywords scheme="MESH" type="chemical" qualifier="immunology" xml:lang="en"><term>ADP Ribose Transferases</term><term>Antibodies, Bacterial</term><term>Bacterial Proteins</term><term>Bacterial Toxins</term><term>Exotoxins</term><term>Immunoglobulin A</term><term>Lipopolysaccharides</term><term>O Antigens</term><term>Shigella Vaccines</term><term>Vaccines, Conjugate</term><term>Virulence Factors</term></keywords><keywords scheme="MESH" qualifier="immunology" xml:lang="en"><term>Dysentery, Bacillary</term><term>Shigella flexneri</term><term>Shigella sonnei</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Dysentery, Bacillary</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Female</term><term>Healthy Volunteers</term><term>Humans</term><term>Immunogenicity, Vaccine</term><term>Male</term><term>Middle Aged</term><term>Single-Blind Method</term><term>Young Adult</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Several candidate vaccines against Shigella spp. are in development, but the lack of a clear correlate of protection from challenge with the induction of adequate immune responses among the youngest age groups in the developing world has hampered Shigella vaccine development over the past several decades. Bioconjugation technology, exploited here for an Shigella flexneri 2a candidate vaccine, offers a novel and potentially cost-effective way to develop and produce vaccines against a major pathogen of global health importance. Flexyn2a, a novel S. flexneri 2a bioconjugate vaccine made of the polysaccharide component of the S. flexneri 2a O-antigen, conjugated to the exotoxin protein A of Pseudomonas aeruginosa (EPA), was evaluated for safety and immunogenicity among healthy adults in a single-blind, phase I study with a staggered randomization approach. Thirty subjects (12 receiving 10 μg Flexyn2a, 12 receiving Flexyn2a with aluminum adjuvant, and 6 receiving placebo) were administered two injections 4 weeks apart and were followed for 168 days. Flexyn2a was well-tolerated, independently of the adjuvant and number of injections. The Flexyn2a vaccine elicited statistically significant S. flexneri 2a lipopolysaccharide (LPS)-specific humoral responses at all time points postimmunization in all groups that received the vaccine. Elicited serum antibodies were functional, as evidenced by bactericidal activity against S. flexneri 2a. The bioconjugate candidate vaccine Flexyn2a has a satisfactory safety profile and elicited a robust humoral response to S. flexneri 2a LPS with or without inclusion of an adjuvant. Moreover, the bioconjugate also induced functional antibodies, showing the technology's features in producing a promising candidate vaccine. (This study has been registered at ClinicalTrials.gov under registration no. NCT02388009.).</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">27581434</PMID><DateCompleted><Year>2017</Year><Month>09</Month><Day>06</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Electronic-Print"><Journal><ISSN IssnType="Electronic">1556-679X</ISSN><JournalIssue CitedMedium="Internet"><Volume>23</Volume><Issue>12</Issue><PubDate><Year>2016</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Clinical and vaccine immunology : CVI</Title><ISOAbbreviation>Clin Vaccine Immunol</ISOAbbreviation></Journal><ArticleTitle>Safety and Immunogenicity of a Candidate Bioconjugate Vaccine against Shigella flexneri 2a Administered to Healthy Adults: a Single-Blind, Randomized Phase I Study.</ArticleTitle><Pagination><MedlinePgn>908-917</MedlinePgn></Pagination><Abstract><AbstractText>Several candidate vaccines against Shigella spp. are in development, but the lack of a clear correlate of protection from challenge with the induction of adequate immune responses among the youngest age groups in the developing world has hampered Shigella vaccine development over the past several decades. Bioconjugation technology, exploited here for an Shigella flexneri 2a candidate vaccine, offers a novel and potentially cost-effective way to develop and produce vaccines against a major pathogen of global health importance. Flexyn2a, a novel S. flexneri 2a bioconjugate vaccine made of the polysaccharide component of the S. flexneri 2a O-antigen, conjugated to the exotoxin protein A of Pseudomonas aeruginosa (EPA), was evaluated for safety and immunogenicity among healthy adults in a single-blind, phase I study with a staggered randomization approach. Thirty subjects (12 receiving 10 μg Flexyn2a, 12 receiving Flexyn2a with aluminum adjuvant, and 6 receiving placebo) were administered two injections 4 weeks apart and were followed for 168 days. Flexyn2a was well-tolerated, independently of the adjuvant and number of injections. The Flexyn2a vaccine elicited statistically significant S. flexneri 2a lipopolysaccharide (LPS)-specific humoral responses at all time points postimmunization in all groups that received the vaccine. Elicited serum antibodies were functional, as evidenced by bactericidal activity against S. flexneri 2a. The bioconjugate candidate vaccine Flexyn2a has a satisfactory safety profile and elicited a robust humoral response to S. flexneri 2a LPS with or without inclusion of an adjuvant. Moreover, the bioconjugate also induced functional antibodies, showing the technology's features in producing a promising candidate vaccine. (This study has been registered at ClinicalTrials.gov under registration no. NCT02388009.).</AbstractText><CopyrightInformation>Copyright © 2016 Riddle et al.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Riddle</LastName><ForeName>Mark S</ForeName><Initials>MS</Initials><AffiliationInfo><Affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA mark.s.riddle10.mil@mail.mil veronica.gambillara@lmtbio.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kaminski</LastName><ForeName>Robert W</ForeName><Initials>RW</Initials><AffiliationInfo><Affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Di Paolo</LastName><ForeName>Claudio</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>LimmaTech Biologics, Schlieren, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Porter</LastName><ForeName>Chad K</ForeName><Initials>CK</Initials><AffiliationInfo><Affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gutierrez</LastName><ForeName>Ramiro L</ForeName><Initials>RL</Initials><AffiliationInfo><Affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Clarkson</LastName><ForeName>Kristen A</ForeName><Initials>KA</Initials><AffiliationInfo><Affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Weerts</LastName><ForeName>Hailey E</ForeName><Initials>HE</Initials><AffiliationInfo><Affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Duplessis</LastName><ForeName>Christopher</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Castellano</LastName><ForeName>Amy</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alaimo</LastName><ForeName>Cristina</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>LimmaTech Biologics, Schlieren, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Paolino</LastName><ForeName>Kristopher</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Walter Reed Army Institute of Research, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gormley</LastName><ForeName>Robert</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Naval Medical Research Center, Silver Spring, Maryland, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gambillara Fonck</LastName><ForeName>Veronica</ForeName><Initials>V</Initials><AffiliationInfo><Affiliation>LimmaTech Biologics, Schlieren, Switzerland mark.s.riddle10.mil@mail.mil veronica.gambillara@lmtbio.com.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><DataBankList CompleteYN="Y"><DataBank><DataBankName>ClinicalTrials.gov</DataBankName><AccessionNumberList><AccessionNumber>NCT02388009</AccessionNumber></AccessionNumberList></DataBank></DataBankList><PublicationTypeList><PublicationType UI="D017426">Clinical Trial, Phase I</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>12</Month><Day>05</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Clin Vaccine Immunol</MedlineTA><NlmUniqueID>101252125</NlmUniqueID><ISSNLinking>1556-679X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000907">Antibodies, Bacterial</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001426">Bacterial Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001427">Bacterial Toxins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005098">Exotoxins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007070">Immunoglobulin A</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D008070">Lipopolysaccharides</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019081">O Antigens</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D022281">Shigella Vaccines</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D018074">Vaccines, Conjugate</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D037521">Virulence Factors</NameOfSubstance></Chemical><Chemical><RegistryNumber>EC 2.4.2.-</RegistryNumber><NameOfSubstance UI="D036002">ADP Ribose Transferases</NameOfSubstance></Chemical><Chemical><RegistryNumber>EC 2.4.2.31</RegistryNumber><NameOfSubstance UI="C012519">toxA protein, Pseudomonas 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