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Safety and Immunogenicity of Peru-15-pCTB in Healthy Adult Subjects

Primary Purpose

Gastroenteritis Escherichia Coli

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ciprofloxacin
Peru-15-pCTB
Sodium bicarbonate/Ascorbic Acid/Aspartame Buffer
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Gastroenteritis Escherichia Coli focused on measuring cholera, diarrhea, Escherichia coli, vaccine

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

-Male or female age 18-45, inclusive. -Healthy as judged by the Principal Investigator (PI) and determined by medical history, physical examination, vital signs, screening laboratories, and medication history. -Capable of understanding, consenting and complying with the entire study protocol including the inpatient period. -Female subjects must be of non-childbearing potential, or if of childbearing potential (as determined by the investigator) must be practicing abstinence or using an effective licensed method of birth control (e.g., oral contraceptives; diaphragm or condom in combination with contraceptive jelly, cream, or foam; intrauterine contraceptive device, or Depo-Provera; skin patch; vaginal ring or cervical cap) for 30 days prior to vaccination and must agree to continue such precautions during the study and for 30 days after the Day 28 study visit. -Male subjects must agree not to father a child during the study and for 90 days after the Day 0 study visit. -Provide voluntary written informed consent and attained at least 70% on an examination about the study on the first attempt. -Have normal screening laboratories for serum glutamic pyruvic transaminase (SGPT) alanine aminotransferase (ALT), creatinine, sodium, potassium, total white blood count (WBC), hemoglobin, neutrophils, lymphocytes, platelets, urine protein, urine glucose and urine red blood cells (RBC).

Exclusion Criteria:

-Women who are pregnant or lactating or have a positive serum pregnancy test at screening or upon admission to inpatient facility. -Subjects who are immunocompromised or immunodeficient, or have had a prior malignancy (exception: a history of basal cell or squamous cell carcinoma in remission without treatment for more than 5 years prior to study entry). -History of clinically significant chronic illness or other condition requiring chronic medication therapy. -History of malabsorption or maldigestion disorder (e.g., celiac sprue), major gastrointestinal (GI) surgery, or any other chronic GI disorders that would interfere with the study or the investigational product. -Any current or past use of immunosuppressive medications including inhaled steroids (e.g., for asthma) within 6 months of screening. -Recent (e.g., within 5 years) history of travel to a cholera or Enterotoxigenic Escherichia coli (ETEC) endemic area, raised in a cholera or ETEC endemic area or a history of raising a child from an endemic area for cholera or ETEC. Individuals who may work with Vibrio (V) cholerae or ETEC in the laboratory are also excluded. -Vaccination against or infection with cholera or E. coli, or participation in a clinical trial using cholera or ETEC vaccine or organisms at any time. -History of drug or alcohol abuse any time in the last 6 months. -Presence of HIV antibody, hepatitis C antibody, or positive hepatitis B surface antigen. -Clinically abnormal screening electrocardiogram (ECG) defined as pathologic Q waves and significant ST-T wave changes; criteria for left ventricular hypertrophy; and any non-sinus rhythm excluding isolated premature atrial contractions. -Presence of bacterial or parasitic pathogens in stool culture in a screening stool examination. -IgA (immunoglobulin) deficiency. -A change in subject's normal stool pattern within 3 months of screening visit. A normal stool pattern is defined as 3 to 21 stools per week. -Any known allergy or sensitivity to Ciprofloxacin. -Have any known allergy to components of the vaccine [M9 minimal salts, glycerin, dextrose anhydrous, sodium chloride, peptone (vegetable) acid hydrolysate, magnesium sulfate heptahydrate, and aspartame] or placebo/bicarbonate buffer (water, sodium bicarbonate, ascorbic acid, and aspartame). -Any medical illness requiring a new prescription medication or hospitalization during the screening period or having a temperature greater than or equal to 38.0 degrees Celsius during the 2 weeks prior to investigational product administration (Day 0). -Administration of any vaccine, licensed or investigational, or any investigational product within 30 days of investigational product administration (Day 0) or any plan for participation in another investigational trial during this study. -Use of antibiotics within 7 days of investigational product administration (Day 0). -Use of laxatives for hard or infrequent stools one or more times in a month in any of the 3 months prior to enrollment. -Use of any H2 receptor antagonists (e.g., Tagamet®, Zantac®, and Pepcid®), proton pump inhibitors (e.g., Prilosec® over the counter (OTC), Protonix®, and Prevacid®), or prescription acid suppression medication or OTC antacids within 72 hours of investigational product administration. -Use of prescription and OTC medications that contain acetaminophen, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs within 48 hours prior to investigational product administration. -Employment as a commercial food handler, day care worker, or health care worker involved in direct patient contact. Subjects with children less than 2 years old at home or with household contacts that are immunocompromised, pregnant or breast-feeding. -Any other condition or responsibili ty, such as a medical, psychiatric, or social condition or occupational responsibility that, in the judgment of the investigator, would interfere with or serve as a contraindication to the subject's participation in the protocol or assessment of the investigational product. -Subjects who are unwilling or unable to cease smoking for the duration of the inpatient stay. -Subjects who are unable to pass a test that describes cholera and ETEC diarrhea and explains the requirements of the clinical trial. Subjects must score a minimum of 70 percent upon the first attempt. -Subjects will be excluded if their screening laboratory test results fall outside of the laboratory normal; however, transaminase levels [alanine aminotransferase (ALT)] and creatinine levels (Cr) below the lower limit of "normal" will not be an exclusion criterion. -Subjects with Phenylketonuria (PKU) will be excluded because the investigational product (vaccine) bicarbonate buffer contains aspartame.

Sites / Locations

  • Cincinnati Children's Hospital Medical Center - Infectious Diseases

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Cohort 1: vaccine dosage level 1 or placebo

Cohort 2: vaccine dosage level 2 or placebo

Cohort 3: vaccine dosage level 3 or placebo

Cohort 4: vaccine dosage level 4 or placebo

Arm Description

Vaccine dose level 1: 1 X 10^7 colony forming unit (CFU) or placebo, treated with Cipro on days 7-11.

Vaccine dose level 2: 1 X 10^8 CFU or placebo, treated with Cipro on days 7-11.

Vaccine dose level 3: 1 X 10^9 CFU or placebo, treated with Cipro on days 7-11.

Vaccine dose level 4: 1 X 10^10 CFU or placebo, treated with Cipro on days 7-11.

Outcomes

Primary Outcome Measures

Adverse Events (AEs) will be graded according to standardized criteria.
Safety: physical examinations, interim medical history, solicited symptoms/subject memory aid, and laboratory evaluations.

Secondary Outcome Measures

Immunogenicity will be assessed by changes in vibriocidal antibody titer, anti-Cholera toxin B-subunit antibody titer, and anti-Labile toxin antibody titer.
Stool shedding of the vaccine organisms will be assessed by qualitative and quantitative cultures.

Full Information

First Posted
April 3, 2008
Last Updated
July 22, 2021
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00654108
Brief Title
Safety and Immunogenicity of Peru-15-pCTB in Healthy Adult Subjects
Official Title
A Randomized, Double-Blind, Placebo-Controlled Dose Escalation, Inpatient Phase I Study to Determine the Safety and Immunogenicity of a Single Oral Dose of a Combined Live, Attenuated, Enterotoxigenic Escherichia Coli (ETEC)-Cholera Vaccine (Peru-15 pCTB) in Healthy Adult Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
February 9, 2010
Overall Recruitment Status
Completed
Study Start Date
June 2, 2008 (Actual)
Primary Completion Date
May 30, 2010 (Actual)
Study Completion Date
December 31, 2010 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
Enterotoxigenic Escherichia (E.) coli (ETEC) bacteria are the main cause of traveler's diarrhea and are significant pathogens affecting children and elderly individuals of developing countries. The purpose of the study is to determine the safety of the ETEC-Cholera vaccine and the body's ability to protect itself against ETEC and cholera infection after receiving the vaccine. The study will enroll a total of 64 healthy volunteers, 18 to 45 years old at the Cincinnati Children's Hospital. The study will provide increasing doses of the vaccine or placebo (inactive substance) to 4 groups consisting of 16 participants each. Participants will remain in the inpatient unit for observation for about 11 days. All subjects will be treated with Cipro, an antibiotic, for 5 days. Study procedures include: blood samples, vital signs, physical examinations, and stool samples. Volunteers will be involved in the study for about 8 months including telephone contacts.
Detailed Description
Enterotoxigenic Escherichia coli (ETEC) are the principal single cause of traveler's diarrhea and are a significant pathogen affecting children and elderly individuals of developing countries. ETEC infections result in approximately 600 million total cases of diarrhea worldwide annually, with an estimated 280 million cases and over 400,000 deaths in children less than 5 years of age. The proposed study is a randomized, double-blind, placebo controlled, dose-escalation, inpatient Phase I study to determine the safety and immunogenicity of a single oral dose of a combined live, attenuated, enterotoxigenic Escherichia coli (ETEC)-cholera vaccine (Peru-15 pCTB). A total of 64 healthy subjects, 18 to 45 years old will be enrolled in this study. Subject participation duration is up to 8 months. Sequential cohorts of 16 eligible subjects will be randomized in a 3:1 ratio to receive the assigned dose of ETEC-cholera vaccine or placebo (bicarbonate buffer only), respectively. The first dose level cohort (1x10^7 colony forming units) will be divided into 2 groups. Initially, 4 subjects will be enrolled, treated, and observed to ensure the tolerability of this dose level through Day 28. In the absence of any stopping rules, enrollment and dosing will proceed with the remaining 12 subjects of this cohort. Thereafter, dose escalation and subject enrollment will proceed in a step-wise fashion. A Safety Monitoring Committee will be convened for this study, and will review available safety data through the Day 28 post-vaccination visits for each cohort prior to making a recommendation to the Sponsor on advancement to the next dose level. The study will be conducted at Cincinnati Children's Hospital. The primary objective of this study will be to assess the safety of a combined ETEC-cholera vaccine [Peru-15-pCTB (Cholera toxin B-subunit)] when administered as a single oral dose over a range of doses in healthy adult subjects compared to placebo at day 28 post-vaccination. The secondary objectives will be: to assess long-term safety follow-up from immunization through Month 6 post vaccination; to evaluate the immunogenicity of a single oral dose of ETEC-cholera vaccine over a range of doses in healthy adult subjects; and to evaluate the shedding profile of the ETEC-cholera vaccine organisms in stool for a period of 7 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroenteritis Escherichia Coli
Keywords
cholera, diarrhea, Escherichia coli, vaccine

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
62 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1: vaccine dosage level 1 or placebo
Arm Type
Experimental
Arm Description
Vaccine dose level 1: 1 X 10^7 colony forming unit (CFU) or placebo, treated with Cipro on days 7-11.
Arm Title
Cohort 2: vaccine dosage level 2 or placebo
Arm Type
Experimental
Arm Description
Vaccine dose level 2: 1 X 10^8 CFU or placebo, treated with Cipro on days 7-11.
Arm Title
Cohort 3: vaccine dosage level 3 or placebo
Arm Type
Experimental
Arm Description
Vaccine dose level 3: 1 X 10^9 CFU or placebo, treated with Cipro on days 7-11.
Arm Title
Cohort 4: vaccine dosage level 4 or placebo
Arm Type
Experimental
Arm Description
Vaccine dose level 4: 1 X 10^10 CFU or placebo, treated with Cipro on days 7-11.
Intervention Type
Drug
Intervention Name(s)
Ciprofloxacin
Intervention Description
500 milligrams(mg) will be administered orally twice daily for 5 days.
Intervention Type
Biological
Intervention Name(s)
Peru-15-pCTB
Intervention Description
Live attenuated oral combined ETEC-cholera (Peru-15 pCTB) vaccine co-administered with bicarbonate buffer solution; vaccine dose levels 1 X 10^7; 1 X 10^8; 1 X 10^9; and 1 X 10^10.
Intervention Type
Other
Intervention Name(s)
Sodium bicarbonate/Ascorbic Acid/Aspartame Buffer
Intervention Description
Buffer solution: 2.5 grams (g) Sodium Bicarbonate powder, 1.65 g Ascorbic Acid and 25 mg Aspartame, in 100 milliliters (mL) water for injection.
Primary Outcome Measure Information:
Title
Adverse Events (AEs) will be graded according to standardized criteria.
Time Frame
Through the Day 28 post-vaccination visit.
Title
Safety: physical examinations, interim medical history, solicited symptoms/subject memory aid, and laboratory evaluations.
Time Frame
Through the Day 28 post-vaccination visit.
Secondary Outcome Measure Information:
Title
Immunogenicity will be assessed by changes in vibriocidal antibody titer, anti-Cholera toxin B-subunit antibody titer, and anti-Labile toxin antibody titer.
Time Frame
Days -1, 7, 10, 14, and 28.
Title
Stool shedding of the vaccine organisms will be assessed by qualitative and quantitative cultures.
Time Frame
Qualitative: Days 1-10, 14, 21, 28: Quantitative: Days 1-10.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: -Male or female age 18-45, inclusive. -Healthy as judged by the Principal Investigator (PI) and determined by medical history, physical examination, vital signs, screening laboratories, and medication history. -Capable of understanding, consenting and complying with the entire study protocol including the inpatient period. -Female subjects must be of non-childbearing potential, or if of childbearing potential (as determined by the investigator) must be practicing abstinence or using an effective licensed method of birth control (e.g., oral contraceptives; diaphragm or condom in combination with contraceptive jelly, cream, or foam; intrauterine contraceptive device, or Depo-Provera; skin patch; vaginal ring or cervical cap) for 30 days prior to vaccination and must agree to continue such precautions during the study and for 30 days after the Day 28 study visit. -Male subjects must agree not to father a child during the study and for 90 days after the Day 0 study visit. -Provide voluntary written informed consent and attained at least 70% on an examination about the study on the first attempt. -Have normal screening laboratories for serum glutamic pyruvic transaminase (SGPT) alanine aminotransferase (ALT), creatinine, sodium, potassium, total white blood count (WBC), hemoglobin, neutrophils, lymphocytes, platelets, urine protein, urine glucose and urine red blood cells (RBC). Exclusion Criteria: -Women who are pregnant or lactating or have a positive serum pregnancy test at screening or upon admission to inpatient facility. -Subjects who are immunocompromised or immunodeficient, or have had a prior malignancy (exception: a history of basal cell or squamous cell carcinoma in remission without treatment for more than 5 years prior to study entry). -History of clinically significant chronic illness or other condition requiring chronic medication therapy. -History of malabsorption or maldigestion disorder (e.g., celiac sprue), major gastrointestinal (GI) surgery, or any other chronic GI disorders that would interfere with the study or the investigational product. -Any current or past use of immunosuppressive medications including inhaled steroids (e.g., for asthma) within 6 months of screening. -Recent (e.g., within 5 years) history of travel to a cholera or Enterotoxigenic Escherichia coli (ETEC) endemic area, raised in a cholera or ETEC endemic area or a history of raising a child from an endemic area for cholera or ETEC. Individuals who may work with Vibrio (V) cholerae or ETEC in the laboratory are also excluded. -Vaccination against or infection with cholera or E. coli, or participation in a clinical trial using cholera or ETEC vaccine or organisms at any time. -History of drug or alcohol abuse any time in the last 6 months. -Presence of HIV antibody, hepatitis C antibody, or positive hepatitis B surface antigen. -Clinically abnormal screening electrocardiogram (ECG) defined as pathologic Q waves and significant ST-T wave changes; criteria for left ventricular hypertrophy; and any non-sinus rhythm excluding isolated premature atrial contractions. -Presence of bacterial or parasitic pathogens in stool culture in a screening stool examination. -IgA (immunoglobulin) deficiency. -A change in subject's normal stool pattern within 3 months of screening visit. A normal stool pattern is defined as 3 to 21 stools per week. -Any known allergy or sensitivity to Ciprofloxacin. -Have any known allergy to components of the vaccine [M9 minimal salts, glycerin, dextrose anhydrous, sodium chloride, peptone (vegetable) acid hydrolysate, magnesium sulfate heptahydrate, and aspartame] or placebo/bicarbonate buffer (water, sodium bicarbonate, ascorbic acid, and aspartame). -Any medical illness requiring a new prescription medication or hospitalization during the screening period or having a temperature greater than or equal to 38.0 degrees Celsius during the 2 weeks prior to investigational product administration (Day 0). -Administration of any vaccine, licensed or investigational, or any investigational product within 30 days of investigational product administration (Day 0) or any plan for participation in another investigational trial during this study. -Use of antibiotics within 7 days of investigational product administration (Day 0). -Use of laxatives for hard or infrequent stools one or more times in a month in any of the 3 months prior to enrollment. -Use of any H2 receptor antagonists (e.g., Tagamet®, Zantac®, and Pepcid®), proton pump inhibitors (e.g., Prilosec® over the counter (OTC), Protonix®, and Prevacid®), or prescription acid suppression medication or OTC antacids within 72 hours of investigational product administration. -Use of prescription and OTC medications that contain acetaminophen, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs within 48 hours prior to investigational product administration. -Employment as a commercial food handler, day care worker, or health care worker involved in direct patient contact. Subjects with children less than 2 years old at home or with household contacts that are immunocompromised, pregnant or breast-feeding. -Any other condition or responsibili ty, such as a medical, psychiatric, or social condition or occupational responsibility that, in the judgment of the investigator, would interfere with or serve as a contraindication to the subject's participation in the protocol or assessment of the investigational product. -Subjects who are unwilling or unable to cease smoking for the duration of the inpatient stay. -Subjects who are unable to pass a test that describes cholera and ETEC diarrhea and explains the requirements of the clinical trial. Subjects must score a minimum of 70 percent upon the first attempt. -Subjects will be excluded if their screening laboratory test results fall outside of the laboratory normal; however, transaminase levels [alanine aminotransferase (ALT)] and creatinine levels (Cr) below the lower limit of "normal" will not be an exclusion criterion. -Subjects with Phenylketonuria (PKU) will be excluded because the investigational product (vaccine) bicarbonate buffer contains aspartame.
Facility Information:
Facility Name
Cincinnati Children's Hospital Medical Center - Infectious Diseases
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
25410205
Citation
Chen WH, Garza J, Choquette M, Hawkins J, Hoeper A, Bernstein DI, Cohen MB. Safety and immunogenicity of escalating dosages of a single oral administration of peru-15 pCTB, a candidate live, attenuated vaccine against enterotoxigenic Escherichia coli and Vibrio cholerae. Clin Vaccine Immunol. 2015 Jan;22(1):129-35. doi: 10.1128/CVI.00560-14. Epub 2014 Nov 19.
Results Reference
derived

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Safety and Immunogenicity of Peru-15-pCTB in Healthy Adult Subjects

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