8/25/2020

RAPID COVID-19 VACCINE DEVELOPMENT ENABLED BY PROTOTYPE PATHOGEN PREPAREDNESS

AVAC eSeminar August 25, 2020

Barney S. Graham, MD, PhD Deputy Director Vaccine Research Center, NIAID, NIH 1

NIAID Vaccine Research Center

Basic Research Process Development Nucleic acid

Vectors

VLPs

• AIDS/HIV • Influenza Proteins and cGMP Manufacturing nanoparticles • Ebola/Marburg • RSV • Malaria Monoclonal antibodies • Tuberculosis • EID GLP Analysis • West Nile virus, Zika • Chikungunya • W/E/V equine encephalitis viruses • MERS‐CoV, SARS, and other CoV • Nipah and other paramyxoviruses • EV‐D68 and other picornaviruses Clinical Trials • Smallpox

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Vaccine Development Strategies for Pandemic Preparedness

• Platform approach Novel Vaccine Technologies Essential Components of an Adequate Response • Plug‐and‐play to Emerging Viral Diseases BS Graham, JR Mascola, AS Fauci • Priority‐pathogen • Selected pathogens of concern • Prototype‐pathogen • Systematic preparedness • All virus families of concern

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New Technologies are Transforming Vaccinology

• Structure-based vaccine design Structural analysis of antigenic sites on viral • Single-cell sorting, sequencing, and bioinformatics surface glycoproteins – Rapid isolation of human mAbs Isolation of human monoclonal – Definition of antibody lineages antibodies from single B cells – Analysis of immune responses • Protein engineering of self-assembling nanoparticles • Rapid DNA synthesis

• Recombinant DNA and genetic engineering technology Epitope-specific phenotyping

– Rapid cell line development Sequencing for viral diversity and escape mutations – Animal model development • Nucleic acid and vector-based delivery of vaccine antigen

Sequencing B cells to define clonal lineages; TCR & BCR-specific transcriptome 4

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Preserving Apical Epitopes Improves Immunogenicity

~2‐fold ~14‐fold

Post‐F Vaccine Clinical Trial Pre‐F Vaccine Clinical Trial (Hum Vacc & Immuno June 2019) (Science August 2019)

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Summary

• Solving atomic structure of prefusion RSV F revealed a new target of vulnerability

• Stabilized RSV pre‐F candidate trimeric subunit vaccine (DS‐Cav1) provides a clinical proof‐of‐concept for structure‐based vaccine design by preserving neutralization‐sensitive epitopes on the vaccine antigen

• The concept of stabilizing the prefusion conformation of class I fusion proteins can be generalized across other virus families

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Structure-guided Stabilization of HKU1 CoV Spike

V1060P L1061P

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Stabilized CoV Spike Protein Improve Expression

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Coronavirus Origins and Phylogeny MERS-CoV

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mRNA immunization strategy

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mRNA immunization strategy

Protein expression affected by mRNA chemistry and manufacturing process

Nelson et al. Sci Adv 2020

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MERS S-2P protects against mouse-adapted MERS CoV challenge in hDPP4 transgenic mice

Week 0203451 6 7

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Summary

• Proline mutations in S from multiple CoV strains stabilizes prefusion S

• Stabilized prefusion S trimers are more immunogenic and protective than WT trimers or monomeric subunits

• May be a general solution for beta‐CoV vaccine antigen design

• mRNA suitable delivery approach and rapid manufacturing platform

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COVID-19 VACCINE DEVELOPMENT

2013-2019 2020 SARS-CoV-2 Outbreak

2013-2019 Jan 6, 2020 Jan 11, 2020 Jan 14, 2020 Jan 31, 2020 Feb 3, 2020 Feb 4, 2020 Feb 19, 2020 Feb 21, 2020 Mar 16, 2020 Jul 27, 2020

Spike Extensive work Wuhan 2019-nCoV Moderna VRC makes UT-Austin Moderna Moderna Phase 1 Phase 3 structure on MERS and outbreak may constructs receives nCoV spike solves spike vials vaccine ships vaccine Clinical trial Clinical trial published in other CoV be CoV ordered sequence for protein structure to DMID Starts Starts Science GMP production

Dec 31, 2019 Jan 10, 2020 Jan 13, 2020 Jan 23, 2020 Feb 1, 2020 Feb 4 2020 Feb 18, 2020 Feb 20, 2020 Mar 2, 2020 May 29, 2020

st 1 report of 2019-nCoV VRC decides DMID First nCoV VRC Immunogenicity DMID FDA safe-to- Phase 2 clinical respiratory virus sequences on vaccine initiates spike ELISA vaccinates confirmed in submits IND proceed trial starts outbreak in published sequence clinical and for cross- mice mice Wuhan, China with Moderna regulatory reactivity process

3 days 38 days 24 days

Clinical Phase 1 Phase 2 Phase 3 Non‐clinical immunogenicity protection safety 15

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CORONAVIRUS BIOLOGY AND NOMENCLATURE

corona = crown or circle of light

Spike Protein

Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, Graham BS, McLellan JS. Cryo‐EM structure of the 2019‐nCoV spike in the prefusion conformation. Science. 2020 Feb 19:eabb2507. doi: 10.1126/science.abb2507.

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High Quality Protein is the Basis for Next Steps

Isolation of monoclonal antibodies

Vaccines

Assay development

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Global COVID-19 Vaccine Landscape

28 Vaccine Candidates in 139 Vaccine Candidates Clinical Evaluation in Pre-clinical Evaluation

Nucleic acid Nanoparticle display of structurally DNA defined proteins mRNA live attenuated virus

Whole‐inactivated virus Recombinant Vectors Recombinant Adenovirus Vectors Recombinant or chimeric viruses

Recombinant proteins or subdomains Virus‐like particles

Peptides Source: WHO 7 July 2020 18

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mRNA-1273 mouse immunogenicity and protection

Week 02341 5 67891011 12 1314 15 16 BALB/c d 1x105 pfu challenge dose mRNA‐1273 Stabilized spike –S‐2P Week 0203451 6 7 MA2 SARS‐CoV‐2 RBD‐modified virus that infects WT mice 1x105 pfu challenge dose

Days 02341 weightweightweight weight weight PFU lung PFU lung PFU nose PFU nose Cytokines lung Cytokines lung Pathology lung Pathology lung

Corbett et al BioRxiv 2020

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mRNA-1273 is immunogenic and protective

Post prime and post‐boost serology Viral Load day 2

2‐dose



1‐dose



2‐dose 1‐dose














7 6 10 106 5 10





Post-Prime 10 6 5 10 Post-Boost



10 105 105



104



104 104 4



10 103 ELISA 103 Lung 3 2 PFU/Lobe 10 PFU/Lobe 10 103 102 101 101 102 2 10 100 100 Reciprocal Serum EndpointTiter 0.01 0.1 1 Reciprocal Endpoint Serum Titer 0.1 1 10 PBS 0.01 0.1 1 0.1 1 10 mRNA -1273 Dose (µg) mRNA -1273 Dose (µg) mRNA-1273 mRNA-1273 Dose (g) Dose (g) D Neutralizing Antibodies mRNA-1273 Immunized BALB/c y

4 10 105

104 Titer 103 50 NT103 N/A Nose 102 102

PFU/Turbinate 1

Reciprocal IC Reciprocal 10

1 10 100 0.1 1 PBS 0.01 0.1 1 mRNA -1273 Dose (µg) mRNA-1273 Dose (g) Corbett et al BioRxiv 2020 20

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mRNA-1273 protects up to 13 weeks post-boost without immunopathology Lung Nose Breakthrough Pathology

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5 6 4 5 3 4 2 3

PFU/Lobe (log10) 2 1 PFU/Turbinate (log10) PFU/Turbinate 1 0 naive 0.01 0.1 1 naive 0.01 0.1 1 mRNA-1273 mRNA-1273 Dose (g) Dose (g)

Corbett et al BioRxiv 2020 21

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Immunization of Aged Mice with ERD Controls

Week 0 Week 3 Week 7 DIV SARS‐CoV‐1 Group Animal # Vaccine Immunization Immunization Challenge 04/20/20 05/11/20 06/08/20 double‐inactivated Formalin/UV 1 10 Control mRNA 1 µg 1 µg SARS‐1 virus in alum historically 210mRNA‐1273 1 µg 1 µg associated with VAERD in mice MA10 103 pfu 310mRNA‐1273 0.1 µg 0.1 µg mRNA‐1273 410DIV SARS‐CoV‐1 in alum 10µl 10µl Stabilized spike –S‐2P

MA10 SARS‐CoV‐2 1x103 pfu challenge dose RBD‐modified 10 serial passages Week 02341 5 67 Days 024 Virulent in mice Daily weights Lung & nose PFU Lung Cytokines & Path

Confidential to NIAID/VRC - unpublished 22

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mRNA-1273 in NHP - Experimental Design

Week 0 Week 4 Week 8 Day 0 Day 7/8

Immunization Immunization Challenge Lung Pathology (7.6 x 105 PFU SARS-CoV-2)

Immunizations W0/W4: Post-challenge sampling- PBS • Blood: Days 0, 2, 4 and 7 10 µg mRNA-1273 • Nasal swabs: Days 1, 2, 4 and 7 100 µg mRNA-1273 • Bronchoalveolar lavage: Days 2, 4 and 7 Kizzmekia Corbett Bob Seder Mario Roederer Nancy Sullivan Kathy Foulds Tracy Ruckwardt Ian Moore Martha Nason JP Todd Corbett et al. NEJM July 28 23

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Binding Antibody Responses to Spike Protein

Binding IgG 6 RBD-specific Binding S1_NTD-specific Binding 10 µg mRNA-1273 4 Weeks Post-boost 4 Weeks Post-boost 5 100 µg mRNA-1273 15 12

4 9 10 3 6 2 AUC (log10) AUC 5 AUC (log10) AUC (log10) 3 1

0 0 0 Pre- 2 4 2 4 PBS 10 100 Conv. PBS 10 100 Conv. mRNA-1273 mRNA-1273 Weeks Weeks Dose (g) Dose (g) Post-prime Post-boost

Kizzmekia Corbett Barbara Flynn Joe Francica 24

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Functional Antibody Responses

ACE2 Binding Inhibition Live Virus Neutralization 4 Weeks Post-boost 4 Weeks Post-boost

4 4 ~100x

3 3 Titer (log10) Titer

2 50 ~10x 2 1 Fold Reduction of of Reduction Fold Reciprocal ID Reciprocal ACE2-RBD Binding (log10) 0 1 PBS 10 100 Conv. PBS 10 100 Conv. mRNA-1273 mRNA-1273 Dose (g) Dose (g) Britta Flach Adrian McDermott David Martinez Ralph Baric 25

mRNA-1273 Elicits Th1-biased Responses and Tfh

A B Th1 Th2

0.6 0/7 4/8 7/7 0.6 0/7 0/8 2/7

0.4 0.4

0.2 0.2 % Memory CD4 T CellsT % Memory CD4 0.0 CellsT Memory% CD4 0.0

PBS 10 100 PBS 10 100

C D CD40L Tfh IL-21

0.6 0/7 3/8 7/7 0.6 0/7 4/8 7/7

0.4 0.4

0.2 0.2 % Tfh Tfh Cells %

% Memory CD4T Cells 0.0 0.0

PBS 10 100 PBS 10 100

Immunization: Moderna, Inc. Corbett et al. NEJM July 28 Neutralization: Seyhan Boyoglu-Barnum, Rebecca Gillespie, Rebecca Loomis Analysis: Lauren Chang, Emily Phung 26

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Rapid Clearance of SARS-CoV-2 in Upper and Lower Airways

B A BAL Nasal Swab sgRNA sgRNA Days Post-challenge Days Post-challenge 247 2 4 7247 142 7 1472 1 2 4 7 7 7

6 6

5 5

4 4



3 3

2 2
Genome CopiesGenome (log10) Genome Copies(log10) Genome 1 1 PBS 10 100 PBS 10 100 mRNA-1273 mRNA-1273 Dose (g) Dose (g)

Corbett et al. NEJM July 28 27

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Day 7 Pathology Post-Challenge

Corbett et al. NEJM July 28 28

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Correlations with Virus Clearance

Binding IgG vs. NS PCR RBD-specific ELISA vs. NS PCR S1_NTD-specific ELISA vs. NS PCR Day 2 Day 2 Day 2 7 7 7

6 6 6

5 5 5

4 4 4

3 3 3 r = -0.77 r = -0.8 r = -0.8 2 p < 0.001 2 p < 0.001 2 p < 0.001 RNA Copies/mL(log10) RNA RNA Copies/mL(log10) RNA RNA Copies/mL(log10)RNA 1 1 1 3458 10121416 4681012 AUC (log10) RBD ELISA AUC (log10) NTD ELISA AUC (log10)

Pseudovirus Neut vs. NS PCR Live Virus Neut vs. NS PCR Day 2 Day 2 7 7

6 6

5 5

4 4

3 3 r = -0.70 r = -0.81 2 p < 0.01 2 p < 0.001 RNA Copies/mL(log10) RNA RNA Copies/mL(log10) RNA 1 1 1234 1234 Pseudovirus Live Virus Reciprocal IC50 Titer (log10) Reciprocal IC50 Titer (log10)

Corbett et al. NEJM July 28 29

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mRNA-1273 Phase 1

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Safety

No serious adverse events and no pre-specified study halting rules were met through Day 43

Solicited systemic and local adverse events in >50% included fatigue, chills, headache, myalgia, and pain at the injection site

Dose effect and reactions greater after 2nd dose. 3/14 severe

Confidential to NIAID/VRC 31 31

Spike- and RBD-specific IgG

18‐55 18‐55 N=15/dose group N=15/dose group

25µg 100µg 250µg

Confidential to NIAID/VRC Jackson et al. NEJM 2020 32 32

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Neutralizing Activity

Pseudovirus ID50 NT PRNT 80

4th

3rd

2nd

1st

25µg 100µg 250µg 25µg 100µg 100µg

Confidential to NIAID/VRC Jackson et al. NEJM 2020 33 33

T Cell Analysis – mRNA-1273

CD4 CD8

Th1 Th2

1 29 43 1 29 43 1 29 43

Confidential to NIAID/VRC Jackson et al. NEJM 2020 34

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5

4



Titer Titer (log10)

50 3

Immunogenicity NT 2

Reciprocal IC Reciprocal 1 0.1 1

6 Days Post-challenge 10 247 2 4 7247 7 105 6 104 5

Lobe 3 / 10 4 Lung



2 PFU 10 3

101 2 Genome CopiesGenome (log10)

0 1 10 PBS 10 100 PBS 0.01 0.1 1 Protection y T cells Safety

105

104 Nose 103 102 PFU/Turbinate 101

100 PBS 0.01 0.1 1

Nature Aug 6NEJM July 28 NEJM July 14 35

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U.S. SARS-CoV-2 Vaccine Candidates

Phase I Phase II Phase III Scale Up 105 Subjects 600 Subjects 30,000 subjects 2 million doses by 2021 March 16, 2020 June 2020 July 2020 Plus Lonza Mfr.

Phase I Phase II Phase III Scale Up April 2020

Phase I/II Phase III Scale up May 2020

Phase I Phase II Phase III Scale up May 2020

Phase I Phase II Phase III Scale Up May 2020

Phase I Phase II-III Scale Up

Phase I-460 Subjects Phase II-III Scale Up

NHP Studies Phase I- II-III Scale Up July 2020 TBD 36

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Operation Warp Speed (OWS)

NIH BARDA CDC

• Preclinical animal models • Immune assay development and standardization • Phase 3 Clinical Trials 37 37

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COVID-19 Prevention Network

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Summary

• Product development and clinical evaluation started in record time • Prior fundamental basic and translational research • Precision vaccinology and new technologies • Prototype pathogen preparedness planning • Pre‐established public‐private partnership • mRNA‐1273 is immunogenic and well‐tolerated in mice, NHP, and humans • Protective in mice and NHP in upper and lower airway • Immunogenic in older age groups • Phase 3 trial started July 27

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