All Covid-19 vaccines on the market are given in injection form by healthcare professionals and require transport and storage at low temperatures. Inhalation company Iconovo and immunotherapy company ISR want to change this by developing an inhaled Covid-19 vaccine that can be stored at room temperature and is easily administered by the patients themselves with Iconovo’s disposable inhaler ICOone. The inhaled vaccine reaches the affected area of the lungs directly, which is expected to create a protective effect against the virus.
Lund-based Iconovo develops inhalers with associated drug preparations that are mainly used to develop treatments for asthma and COPD, but also new types of inhaled drugs such as vaccines.
At the end of March, the company announced signing an agreement with ISR Immune System Regulation for the development of an inhaled Covid-19 vaccine. The agreement means that ISR has exclusive global rights touse Iconovo’s single-use inhaler ICOone for vaccination against SARS-CoV-2 using a technology based on thespike protein on the surface of the virus along with adjuvant (substances that enhance the immune response). The vaccine project has received a lot of attention, especially after a feature in TV 4 where Iconovo’s founder Orest Lastow and CEO Johan Wäborg talked about the benefits of the inhalable Covid-19 vaccine.
ISR develops the vaccine and Iconovo provides the inhaler
Stockholm-based ISR has developed the candidate Covid-19 vaccine ISR52, which will now be used in a powder formulation in Iconovo’s disposable inhaler ICOone. An inhaled preparation has several advantages: ease of use, not requiring the presence of healthcare professionals to administer the vaccine, cheaper transportation and storage without the requirement of refrigeration or freezing. In addition, the risk of transmission of blood-borne viruses through needles and syringes is avoided.
Another advantage is that the vaccine reaches the affected area of the lung tissue directly, which is expected to give a more adequate and local immune response in the lung in addition to the systemic immune reaction.
Iconovo and ISR believe that an inhaled vaccine will be of greatest use in developing countries with restricted access to refrigeration and where the vaccination programs have not advanced yet. In the TV 4 feature, Iconovo’s CEO said that he sees a future where inhalable vaccines can be distributed to large parts of the population so that millions of people can take the vaccine at the same time.
Several Covid-19 vaccines already approved
However, there are many other Covid-19 vaccines in development, and several have already received market approval. In the EU, the vaccines from Pfizer/BioNTech, Moderna, AstraZeneca/University of Oxford and Janssen/Johnson & Johnson have been approved.
Both Pfizer’s and Moderna’s Covid-19 vaccines are based on a relatively new technology using mRNA (messenger RNA) encoding the spike protein on the surface of the SARS-CoV-2 virus. The body’s immune system identifies the spike protein as something foreign and begins to produce antibodies to the protein, creating protection against the virus.
AstraZeneca’s and Janssen’s/Johnson & Johnson’s Covid-19 vaccines send instructions for the formation of the spike protein via double-stranded DNA encoded into an adenovirus vector – a common and harmless coldvirus. These vaccines do not need to be stored as cold as those based on mRNA, which require storage atvery low temperatures (-20 degrees for Modern and -70 degrees for Pfizer).
Iconovo’s/ISR’s vaccine is a subunit vaccine
There is also another type of vaccine technology called subunit vaccine, which means that the vaccinecontains certain harmless parts of the virus. The US company Novavax is developing the subunit vaccine NVX-CoV2373 containing the spike protein located on the surface of the SARS-CoV-2 virus that is synthetically produced and not taken directly from the virus.
In June, Novavax presented positive results from a phase III study showing that the company’s vaccine candidate has 90.4 per cent efficacy, and that it has a 100 per cent protection against severe and moderate Covid-19.
The Covid-19 vaccine developed by Iconovo and ISR is similar to Novavax’s vaccine technology, with the difference being that it is inhaled instead of injected.
Respiratory tract and lungs – the virus’s doorway into the body
The nose, airways and lungs are the most common entryways to the body for SARS-CoV-2 and other respiratory viruses. Iconovo/ISR want to take advantage of this fact by generating protection against the virus already in the lungs with the inhalation vaccine.
However, Iconovo and ISR are not alone in researching the opportunity to develop an inhalable Covid-19 vaccine. The Chinese company CanSino Biologics also has an inhalable Covid-19 vaccine under development. CanSino Biologics believes that an inhaled variant may be more effective than in injection form, as the inhaled vaccine also activates antibodies and T-cells in the airways, according to Pharmaceutical Technology.
There are also a number of companies and researchers who want to develop nasal spray Covid-19 vaccines, such as AstraZeneca and the University of Helsinki and the University of Eastern Finland. Finnish researchers believe that a Covid-19 vaccine in this form can create immunity to the virus in the mucous membranes of the upper respiratory tract and nose, which can stop the virus at an early stage.
Great future potential for inhaled vaccines
ISR has previously shown in mouse studies that the Covid-19 vaccine candidate gives good protection against the virus. ISR and Iconovo are now planning to start a clinical trial with the inhalable Covid-19 vaccine using ICOone during the second half of 2021. The goal is to take rapid steps in the development in order to reach the market as quickly as possible and take a strong position in the ongoing race for vaccine development.
The technology of Inhaled vaccines may also be applicable to other respiratory viruses. ISR has a future option to use its vaccine technology in ICOone to create vaccines against influenza, respiratory syncytial virus and new coronaviruses. According to Iconovo’s CEO Johan Wäborg, there is a huge market potential for inhalation vaccines, an area in which the company is a pioneer in according to a press release regarding the agreement with ISR:
»The potential for an innovation like this will be huge if it reaches the market. We believe that ICOone has the potential to replace injections of vaccines and other important molecules, thereby offering a smarter way to administer these pharmaceuticals. Iconovo is a global leader and wants to act as a driving force in this development« — Johan Wäborg, CEO Iconovo
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