A third dose of the unmodified COVID-19 mRNA vaccine CVnCoV enhances quality and quantity of immune responses

K Lenart, F Hellgren, S Ols, X Yan, A Cagigi… - … Therapy-Methods & …, 2022 - cell.com
K Lenart, F Hellgren, S Ols, X Yan, A Cagigi, RA Cerveira, I Winge, J Hanczak, SO Mueller…
Molecular Therapy-Methods & Clinical Development, 2022cell.com
A third vaccine dose is often required to achieve potent, long-lasting immune responses. We
investigated the effect of three 8-μg doses of CVnCoV, CureVac's severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) vaccine candidate containing sequence-optimized
unmodified mRNA encoding the spike (S) glycoprotein, administered at 0, 4, and 28 weeks,
on immune responses in rhesus macaques. After the third dose, S-specific binding and
neutralizing antibodies increased 50-fold compared with post-dose 2 levels, with increased …
A third vaccine dose is often required to achieve potent, long-lasting immune responses. We investigated the effect of three 8-μg doses of CVnCoV, CureVac's severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine candidate containing sequence-optimized unmodified mRNA encoding the spike (S) glycoprotein, administered at 0, 4, and 28 weeks, on immune responses in rhesus macaques. After the third dose, S-specific binding and neutralizing antibodies increased 50-fold compared with post-dose 2 levels, with increased responses also evident in the lower airways and against the SARS-CoV-2 B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), and B.1.617.2 (Delta) variants. Enhanced binding affinity of serum antibodies after the third dose correlated with higher somatic hypermutation in S-specific B cells, corresponding with improved binding properties of monoclonal antibodies expressed from isolated B cells. Administration of low-dose mRNA led to fewer cells expressing antigen in vivo at the injection site and in the draining lymph nodes compared with a 10-fold higher dose, possibly reducing engagement of precursor cells with the antigen and resulting in the suboptimal response observed after two-dose vaccination schedules in phase IIb/III clinical trials of CVnCoV. However, when immune memory is established, a third dose efficiently boosts the immunological responses and improves antibody affinity and breadth.
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