A Heterologous Prime/Boost Vaccination Strategy Enhances the Immunogenicity of Therapeutic Vaccines for Hepatitis C Virus

After acute hepatitis C virus (HCV) infection, 20% of individuals clear the virus, which is dependent on sustained Th1 CD4+ T lymphocyte–mediated responses together with polyfunctional CD8+ T cells [1–4]. HCV is highly efficient in establishing persistent infections, and the specific T-cell responses are impaired during chronic infection [5–8] due to appearance of escape mutants [4, 9], inhibitory effects exerted by viral proteins [10], or expression of coinhibitory receptors resulting in T-cell exhaustion [11, 12]. One way to prime T cells and/or reactivate impaired T cells is to express HCV antigens under a more “immunogenic” setting than natural infection where massive antigen expression appears in the tolerogenic liver environment. Therapeutic vaccination has been tested with some success in HCV-infected patients showing evidence of T-cell activation [13, 14]. Vectored vaccines tailored to generate robust T-cell immunity have recently reached the clinic. MVATG16643, a modified virus Ankara (MVA)–based vaccine [15], has shown in a phase I trial good safety and the capacity to induce interferon γ (IFN-γ)–producing T cells with significant although transient viral load decrease in chronically infected patients [16]. Used in combination with pegylated (PEG)–interferon α (IFN-α)/ribavirin in a phase II clinical trial, MVATG16643 resulted in a significant early viral response [17]. The DNA vaccine ChronVac-C [18] has also shown the capacity to induce T cells, which had transient effects on viral load in a phase I/IIa trial [19], and it has been suggested that it improves cure rates when given before PEG–IFN-α/ribavirin treatment [19]. The combined use of DNA vaccines with viral vectors in a prime/boost regimen has been proven useful for enhancing response levels in clinical studies [20–22]. Similarly, in vivo electroporation (EP)–mediated delivery of DNA vaccines either as stand-alone or in a prime/boost setting with viral vectors has also served to enhance the development of polyfunctional CD8+ T-cell responses [23, 24]. Here we have performed a proof-of-concept study to define the extent of improvement that could result from a prime/boost approach based on ChronVac-C and MVATG16643—2 individual vaccines currently in the clinic. These 2 vaccine regimens have been optimized extensively individually previously, and we wanted to investigate whether the combination of 2 regimens could confer additional benefits over the individual regimens. This study thus combines for the first time in the HCV setting approaches previously shown individually to enhance immunogenicity (ie, DNA vaccine delivery with in vivo EP and prime/boost using viral vectors). We performed an exhaustive evaluation of this concept in wild-type C57BL/6J and human leucocyte antigen (HLA)–A2 transgenic mice. This strategy was found very potent for the improvement of polyfunctional CD4+ and CD8+ HCV-specific responses and resulted in a significant increase of epitope recognition.