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Malaria Vaccine for Children in Mali

Primary Purpose

Malaria, Malaria Infection

Status
Completed
Phase
Phase 1
Locations
Mali
Study Type
Interventional
Intervention
AMA1-C1/Alhydrogel plus CPG 7909
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malaria focused on measuring Malaria, Reactogenicity, Safety, Immunogenicity, Maleria Endemic, Plasmodium Falciparum, Dose Escalating

Eligibility Criteria

1 Year - 3 Years (Child)All SexesAccepts Healthy Volunteers
  • INCLUSION CRITERIA:

Males or females aged greater than or equal to 1 to less than 4 years

Known residents of the village of Bancoumana, Mali or its surrounding area

Good general health as determined by means of the screening procedure

Available for the duration of the trial (24 months from enrollment)

Willingness to have child participate in the study as evidenced by parents/legal guardians signing or fingerprinting the informed consent document

EXCLUSION CRITERIA:

Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, chronic infectious or renal disease by history, physical examination, and/or laboratory studies including urinalysis.

Behavioral, cognitive, or psychiatric disease that in the opinion of the investigator affects the ability of the volunteer or the parent/legal guardian to understand and cooperate with the study protocol.

Pre-existing known autoimmune diseases including but not limited to: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjogren's syndrome, or autoimmune thrombocytopenia.

Laboratory evidence of possible autoimmune disease determined by anti-dsDNA titer that equals or exceeds 25 IU.

Laboratory evidence of liver disease (alanine aminotransferase [ALT] greater than the upper limit of normal of the testing laboratory).

Laboratory evidence of renal disease (serum creatinine greater than the upper limit of normal of the testing laboratory, or more than trace protein or blood on urine dipstick testing confirmed by repeat testing).

Laboratory evidence of hematologic disease (absolute leukocyte count less than 3000/mm(3) or greater than 14,500/mm(3), absolute lymphocyte count less than 1000/mm(3), platelet count less than 120,000/mm(3), or hemoglobin less than 8.5 g/dL).

Other condition that, in the opinion of the investigator, would jeopardize the safety or rights of a volunteer participating in the trial or would render the subject unable to comply with the protocol.

Participation in another investigational vaccine or drug trial within 30 days of starting this study, or while this study is ongoing.

History of a severe allergic reaction or anaphylaxis.

History of allergy to nickel.

Severe asthma. This will be defined as:

Asthma that is unstable or required emergent care, urgent care, hospitalization or intubation during the past two years or that requires the use of oral or parenteral corticosteroids.

Clinically significant reactive airway disease that does not respond to bronchodilators.

Positive screening test for anti-Hepatitis C virus (anti-HCV).

Positive screening test for Hepatitis B surface antigen (HBsAg).

Known immunodeficiency syndrome.

Use of systemic corticosteroids (excluding topical or nasal) or immunosuppressive drugs within 30 days of starting this study.

History of a surgical splenectomy.

Receipt of blood products within the past 6 months.

Previous receipt of an investigational malaria vaccine or of rabies vaccine.

History of use of chloroquine or related compounds (amodiaquine or primaquine) within 8 weeks of study entry. Chloroquine and related compounds have the potential to interfere with CPG-induced activation of B cells and plasma dendritic cells.

Previous administration of Verorab Trademark vaccine.

Known thrombocytopenia or bleeding disorders.

Known allergy to neomycin (a component of Verorab Trademark).

Sites / Locations

  • Malaria Research and Training Center

Outcomes

Primary Outcome Measures

The incidence and severity of systemic and local adverse events.

Secondary Outcome Measures

Antibody response determined by ELISA, to the AMA1-FVO and AMA1-3D7 proteins at selected time points. Inhibition of P. falciparum FVO and 3D7 parasite growth in vitro determined at selected time points.

Full Information

First Posted
August 21, 2008
Last Updated
June 30, 2017
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT00740090
Brief Title
Malaria Vaccine for Children in Mali
Official Title
Phase 1, Randomized, Double-Blind, Dose-Escalating Study of the Safety, Reactogenicity, and Immunogenicity of the AMA1-C1/Alhydrogel+CPG 7909 Vaccine for Plasmodium Falciparum Malaria in Children in Mali
Study Type
Interventional

2. Study Status

Record Verification Date
June 9, 2009
Overall Recruitment Status
Completed
Study Start Date
August 11, 2008 (undefined)
Primary Completion Date
June 9, 2009 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

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

4. Oversight

5. Study Description

Brief Summary
This study will evaluate the safety and immune response of children to an experimental malaria vaccine called AMA1-C1/Alhydrogel® (Registered Trademark) + CPG 7909. Malaria is an infection of red blood cells caused by a parasite, Plasmodium falciparum, that is spread by certain kinds of mosquitoes. It affects at least 300 million people worldwide each year, with more than 1 million deaths, mostly among children less than 5 years of age in sub-Saharan Africa. Malaria is the leading cause of death and illness among the general population of Mali in West Africa. Increasing drug resistance to P. falciparum and widespread resistance of mosquitoes to pesticides are reducing the ability to control the disease through these strategies. AMA1 C1 is made from a synthetic protein similar to a P. falciparum protein. It is combined with Alhydrogel and CPG 7909, substances added to vaccines to make them work better. Children between 1 and 4 years of age who live in Bancoumana, Mali, and are in general good health may be eligible for this study. Candidates are screened with a medical history, physical examination, and blood and urine tests. Participants are randomly assigned to receive three injections (shots) of either AMA1-C1 or a control rabies inactivated vaccine called Imovax® (Registered Trademark). The shots are given in the thigh muscle on study days 0, 56 and 180. After each shot, participants are observed in the clinic for 30 minutes. They return to the clinic for a physical examination six or seven times between each shot and then four more times over a 9-month period after the last shot. Blood samples are drawn at several of these visits to check for side effects of the vaccine and to measure the response to it. The total duration of the study is 21 months. ...
Detailed Description
Globally, the Plasmodium falciparum parasite is responsible for at least 300 million acute cases of malaria each year, with more than 1 million deaths. Approximately 90 percent of these deaths, the majority in children under 5 years of age, occur in Africa due to infection with Plasmodium falciparum. Morbidity and mortality caused by malaria also has significant direct and indirect costs on the economic development of the endemic countries. It is estimated that malaria accounts for 40 percent of public health expenditures, more than 30 percent of inpatient admissions, and approximately 50 percent of outpatient visits in some African countries. These factors, as well as growing drug resistance of the parasite, widespread resistance of mosquitoes to insecticide, and increased human travel necessitate the need for new approaches to malaria control and eradication. A vaccine that could reduce both mortality and morbidity secondary to Plasmodium falciparum infection would be a valuable resource in the fight against this disease. Over time, people living in endemic areas develop natural immunity to Plasmodium falciparum as a result of repeated infection. Consequently, children who survive to 7 to 10 years of age rarely succumb to life-threatening disease despite frequent infection. This acquired immunity is mediated in part by blood-stage parasite-specific antibodies. Thus, parasite proteins expressed during the blood-stage have been proposed to be good candidates for inclusion in a vaccine. The purpose of a blood-stage vaccine is to elicit immune responses that either destroy the parasite in the blood stream or inhibit the parasite from infecting red blood cells, thus reducing or preventing complications of the disease. A number of Plasmodium falciparum merozoite antigens have been identified as promising blood-stage vaccine candidates, including Apical Membrane Antigen 1 (AMA1). The precise role of AMA1 in the parasite is unknown; however, it is critical in the erythrocyte invasion process across divergent Plasmodium species and for blood-stage multiplication of the parasite. Recent analysis of the Plasmodium falciparum proteome detected expression of AMA1 in the sporozoite stage and suggests an additional role for AMA1 during the liver-stage invasion. Therefore, an immune response against AMA1 may have an effect on liver-stage parasites as well as having an impact on blood-stage parasites, thus protecting the host by multiple immune mechanisms. Human and animal anti-AMA1 antibodies inhibit merozoite invasion in vitro and correlate with protection against parasite challenge in animal models. T-cells specific for Plasmodium falciparum AMA1 have also been demonstrated in individuals living in endemic areas. At least 68 known amino acid polymorphisms of AMA1 have been demonstrated, and animal studies have shown that the polymorphisms in AMA1 are not immunologically silent. The combination of two or more divergent AMA1 sequences within a single vaccine formulation may reduce evasion of the host immune response by some Plasmodium falciparum field isolates.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria, Malaria Infection
Keywords
Malaria, Reactogenicity, Safety, Immunogenicity, Maleria Endemic, Plasmodium Falciparum, Dose Escalating

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
Double
Allocation
Randomized
Enrollment
200 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
AMA1-C1/Alhydrogel plus CPG 7909
Primary Outcome Measure Information:
Title
The incidence and severity of systemic and local adverse events.
Secondary Outcome Measure Information:
Title
Antibody response determined by ELISA, to the AMA1-FVO and AMA1-3D7 proteins at selected time points. Inhibition of P. falciparum FVO and 3D7 parasite growth in vitro determined at selected time points.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
3 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
INCLUSION CRITERIA: Males or females aged greater than or equal to 1 to less than 4 years Known residents of the village of Bancoumana, Mali or its surrounding area Good general health as determined by means of the screening procedure Available for the duration of the trial (24 months from enrollment) Willingness to have child participate in the study as evidenced by parents/legal guardians signing or fingerprinting the informed consent document EXCLUSION CRITERIA: Evidence of clinically significant neurologic, cardiac, pulmonary, hepatic, rheumatologic, chronic infectious or renal disease by history, physical examination, and/or laboratory studies including urinalysis. Behavioral, cognitive, or psychiatric disease that in the opinion of the investigator affects the ability of the volunteer or the parent/legal guardian to understand and cooperate with the study protocol. Pre-existing known autoimmune diseases including but not limited to: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, Sjogren's syndrome, or autoimmune thrombocytopenia. Laboratory evidence of possible autoimmune disease determined by anti-dsDNA titer that equals or exceeds 25 IU. Laboratory evidence of liver disease (alanine aminotransferase [ALT] greater than the upper limit of normal of the testing laboratory). Laboratory evidence of renal disease (serum creatinine greater than the upper limit of normal of the testing laboratory, or more than trace protein or blood on urine dipstick testing confirmed by repeat testing). Laboratory evidence of hematologic disease (absolute leukocyte count less than 3000/mm(3) or greater than 14,500/mm(3), absolute lymphocyte count less than 1000/mm(3), platelet count less than 120,000/mm(3), or hemoglobin less than 8.5 g/dL). Other condition that, in the opinion of the investigator, would jeopardize the safety or rights of a volunteer participating in the trial or would render the subject unable to comply with the protocol. Participation in another investigational vaccine or drug trial within 30 days of starting this study, or while this study is ongoing. History of a severe allergic reaction or anaphylaxis. History of allergy to nickel. Severe asthma. This will be defined as: Asthma that is unstable or required emergent care, urgent care, hospitalization or intubation during the past two years or that requires the use of oral or parenteral corticosteroids. Clinically significant reactive airway disease that does not respond to bronchodilators. Positive screening test for anti-Hepatitis C virus (anti-HCV). Positive screening test for Hepatitis B surface antigen (HBsAg). Known immunodeficiency syndrome. Use of systemic corticosteroids (excluding topical or nasal) or immunosuppressive drugs within 30 days of starting this study. History of a surgical splenectomy. Receipt of blood products within the past 6 months. Previous receipt of an investigational malaria vaccine or of rabies vaccine. History of use of chloroquine or related compounds (amodiaquine or primaquine) within 8 weeks of study entry. Chloroquine and related compounds have the potential to interfere with CPG-induced activation of B cells and plasma dendritic cells. Previous administration of Verorab Trademark vaccine. Known thrombocytopenia or bleeding disorders. Known allergy to neomycin (a component of Verorab Trademark).
Facility Information:
Facility Name
Malaria Research and Training Center
City
Bamako
Country
Mali

12. IPD Sharing Statement

Citations:
PubMed Identifier
11832956
Citation
Sachs J, Malaney P. The economic and social burden of malaria. Nature. 2002 Feb 7;415(6872):680-5. doi: 10.1038/415680a.
Results Reference
background
PubMed Identifier
11832958
Citation
Richie TL, Saul A. Progress and challenges for malaria vaccines. Nature. 2002 Feb 7;415(6872):694-701. doi: 10.1038/415694a.
Results Reference
background
PubMed Identifier
11115107
Citation
Triglia T, Healer J, Caruana SR, Hodder AN, Anders RF, Crabb BS, Cowman AF. Apical membrane antigen 1 plays a central role in erythrocyte invasion by Plasmodium species. Mol Microbiol. 2000 Nov;38(4):706-18. doi: 10.1046/j.1365-2958.2000.02175.x.
Results Reference
background

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Malaria Vaccine for Children in Mali

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