RE: Human Challenge Trials22 Oct 2020 23:01
Nomlungu,
Codagenix has some really interesting technology and demonstrate how far synthetic genetic construct technology has come in the last 10-15 years or so. Their codon de-optimisation goes against the flow in some sense of the word. Globally people are always trying to optimise the coding sequence for a DNA/RNA construct to improve yields etc, so going the opposite direction is an interesting take on things.
From a first glance, there are a number of things which stand out for me - firstly, they are using an attenuated live vaccine - which in a way is probably the best in class in some sense of the word. All the proteins are folded correctly, it looks like C-19, it just doesn't replicate as well as C-19. So what immune response that is raised against their version is likely going to be as close to a normal immune response as you could see. All proteins are there, folded in the right way and presented to the immune system how they would be if you were infected with the virulent strain of C-19.
I have a few hesitations though with the set-up. Intranasal means that the control of dosage that actually reaches deep into the lungs is difficult to control. I would imagine they would dose at a higher amount than you would normally. As such, the patient may end up with a higher initial viral load early on, which you would imagine would decrease as the virus replicates slower. The virus does replicate, so in a patient with a limited/suppressed immune system may be problematic (unsure without knowing this field better). A non-replicating virus wouldn't have that same problem, though whether you would be able to obtain a robust immune response in an immunocompromised patient is difficult to say.
Live vaccine manufacture, I would assume is more difficult as there is a chance (though maybe small) that your culture is infected with something else or worse, infected with the real C-19. You also run into problems with delivery of those virus particles to the end patient. So whilst they say that the intranasal is more efficient at mass vaccination, the fact you will probably have to cold chain the vaccine from start to finish will make it difficult to do at any scale. Especially if the virus does not remain active for long after manufacture (meaning you can't bulk store vaccine doses, they're made to order). This in turn will increase costs.
IMHO, novel idea, has potential to raise good immune response, mass delivery and cost may be the issue for more broad deployment.