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Experimental Human Malaria Infection After Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Prophylaxis (EHMI9)

Primary Purpose

Plasmodium Falciparum Malaria

Status
Completed
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
Chloroquine prophylaxis
Immunization
Plasmodium falciparum Bloodstage challenge
Plasmodium falciparum mosquito challenge
Malarone treatment
Sponsored by
Radboud University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Plasmodium Falciparum Malaria focused on measuring Plasmodium, falciparum, malaria, chloroquine, immunity

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age > 18 and < 35 years healthy volunteers (males or females)
  2. Good health based on history and clinical examination
  3. Negative pregnancy test
  4. Use of adequate contraception for females
  5. All volunteers must sign the informed consent form demonstrating their understanding of the meaning and procedures of the study
  6. Volunteer agrees to inform the general practitioner and agrees to sign a request to release medical information concerning contra-indications for participation in the study
  7. Willingness to undergo a Pf mosquito or blood stage challenge
  8. For volunteers not living in Nijmegen: agreement to stay in a hotel room close to the trial center during a part of the study (for groups 1 and 3 from challenge day till 3 days after treatment, for groups 2 and 4 from 5 days after challenge till 3 days after treatment)
  9. Reachable (24/7) by mobile phone during the whole study period
  10. Living with a third party that could contact the clinicians in case of alteration of consciousness or agreement to stay in a hotel room close to the trial center during a part of the study (for groups 1 and 3 from challenge day till 3 days after treatment, for groups 2 and 4 from 5 days after challenge till 3 days after treatment)
  11. Available to attend all study visits
  12. Agreement to refrain from blood donation to Sanquin or for other purposes, during the study period until 393
  13. Willingness to undergo HIV, hepatitis B and hepatitis C tests
  14. Negative urine toxicology screening test at screening visit and day before challenge
  15. Willingness to take a prophylactic regime of chloroquine and curative regimen of Malarone®

Exclusion Criteria:

  1. History of malaria
  2. Plans to travel to malaria endemic areas during the study period
  3. Plans to travel outside of the Netherlands during the challenge period
  4. Previous participation in any malaria vaccine study and/or positive serology for Pf
  5. Symptoms, physical signs and laboratory values suggestive of systemic disorders including renal, hepatic, cardiovascular, pulmonary, skin, immunodeficiency, psychiatric, and other conditions which could interfere with the interpretation of the study results or compromise the health of the volunteers
  6. History of diabetes mellitus or cancer (except basal cell carcinoma of the skin)
  7. History of arrhythmias or prolonged QT-interval
  8. Positive family history in 1st and 2nd degree relatives for cardiac disease < 50 years old
  9. An estimated, ten year risk of fatal cardiovascular disease of ≥5%, as estimated by the Systematic Coronary Risk Evaluation (SCORE) system
  10. Clinically significant abnormalities in electrocardiogram (ECG) at screening
  11. Body Mass Index (BMI) below 18 or above 30 kg/m2
  12. Any clinically significant deviation from the normal range in biochemistry or hematology blood tests or in urine analysis
  13. Positive HIV, HBV or HCV tests
  14. Participation in any other clinical study within 30 days prior to the onset of the study
  15. Enrollment in any other clinical study during the study period
  16. Pregnant or lactating women
  17. Volunteers unable to give written informed consent
  18. Volunteers unable to be closely followed for social, geographic or psychological reasons
  19. Previous history of drug or alcohol abuse interfering with normal social function during a period of one year prior to enrolment in the study
  20. A history of psychiatric disease
  21. Known hypersensitivity to anti-malaria drugs
  22. The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids are allowed) and during the study period
  23. Contra-indications to Malarone® or chloroquine including treatment taken by the volunteer that interferes with Malarone® or chloroquine
  24. Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia
  25. Co-workers of the departments of Medical Microbiology or Internal Medicine of the RUNMC
  26. A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency

Sites / Locations

  • Radboud University Nijmegen Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Active Comparator

Placebo Comparator

Placebo Comparator

Arm Label

Immunization + bloodstage challenge

Immunization + mosquito challenge

Control - Bloodstage challenge

Control - Mosquito challenge

Arm Description

Outcomes

Primary Outcome Measures

Duration of prepatent period as measured by microscopy
Parasitemia and kinetics of parasitemia as measured by PCR
Frequency of signs or symptoms in study groups

Secondary Outcome Measures

Antibody production in groups 1, 2, 3 and 4
Cellular immune response in groups 1, 2, 3 and 4
Cytokine profile in groups 1, 2, 3 and 4

Full Information

First Posted
November 4, 2010
Last Updated
January 20, 2014
Sponsor
Radboud University Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT01236612
Brief Title
Experimental Human Malaria Infection After Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Prophylaxis
Acronym
EHMI9
Official Title
Experimental Human Malaria Infection After Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Prophylaxis
Study Type
Interventional

2. Study Status

Record Verification Date
January 2014
Overall Recruitment Status
Completed
Study Start Date
April 2011 (undefined)
Primary Completion Date
June 2012 (Actual)
Study Completion Date
June 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Radboud University Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Malaria is one of the major infectious diseases in the world with a tremendous impact on the quality of life significantly contributing to the ongoing poverty in endemic countries. It causes almost one million deaths per year, the majority of which are children under the age of five. The malaria parasite enters the human body through the skin, by the bite of an infected mosquito. Subsequently, it invades the liver and develops and multiplies inside the hepatocytes. After a week, the hepatocytes burst open and the parasites are released in the blood stream, causing the clinical phase of the disease. As a unique opportunity to study malaria immunology and efficacy of immunisation strategies, a protocol has been developed in the past to conduct experimental human malaria infections (EHMIs). EHMIs generally involve small groups of malaria-naïve volunteers infected via the bites of P. falciparum infected laboratory-reared Anopheline mosquitoes. Although potentially serious or even lethal, Plasmodium falciparum (P.falciparum) malaria can be radically cured at the earliest stages of blood infection where risks of complications are virtually absent. The investigators have shown previously, that healthy human volunteers can be protected from a malaria mosquito challenge by immunization with mosquito-bites under chloroquine prophylaxis (CPS immunization). However, it is unknown whether this protection is based on immunity directed towards the liver- or the blood stage of the disease. For future development of vaccines and understanding of protective immunity to malaria, it is important to investigate at which level protective immunity is generated by CPS immunization. Therefore, we aim to investigate whether CPS immunization confers protection to a blood-stage challenge.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Plasmodium Falciparum Malaria
Keywords
Plasmodium, falciparum, malaria, chloroquine, immunity

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Immunization + bloodstage challenge
Arm Type
Experimental
Arm Title
Immunization + mosquito challenge
Arm Type
Active Comparator
Arm Title
Control - Bloodstage challenge
Arm Type
Placebo Comparator
Arm Title
Control - Mosquito challenge
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Chloroquine prophylaxis
Intervention Description
The chloroquine dose used will be 300mg for the first two days, followed by 300mg per week, for 13 weeks.
Intervention Type
Biological
Intervention Name(s)
Immunization
Intervention Description
Groups 1 and 2 will be immunized with 3 times 15 bites of Pf infected mosquitoes under chloroquine prophylaxis.
Intervention Type
Biological
Intervention Name(s)
Plasmodium falciparum Bloodstage challenge
Intervention Description
Groups 1 and 3 will be challenged by intravenous administration of Plasmodium falciparum infected erythrocytes.
Intervention Type
Biological
Intervention Name(s)
Plasmodium falciparum mosquito challenge
Intervention Description
Groups 2 and 4 will be challenged by the bites of 5 Plasmodium falciparum infected mosquitoes.
Intervention Type
Drug
Intervention Name(s)
Malarone treatment
Other Intervention Name(s)
atovaquon/proguanil
Intervention Description
When thick smear positive, of ar day 21 after challenge, all volunteers will be treated with malarone.
Primary Outcome Measure Information:
Title
Duration of prepatent period as measured by microscopy
Time Frame
21 days after challenge
Title
Parasitemia and kinetics of parasitemia as measured by PCR
Time Frame
21 days after challenge
Title
Frequency of signs or symptoms in study groups
Time Frame
21 days after challenge
Secondary Outcome Measure Information:
Title
Antibody production in groups 1, 2, 3 and 4
Time Frame
393 days
Title
Cellular immune response in groups 1, 2, 3 and 4
Time Frame
393 days
Title
Cytokine profile in groups 1, 2, 3 and 4
Time Frame
393 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age > 18 and < 35 years healthy volunteers (males or females) Good health based on history and clinical examination Negative pregnancy test Use of adequate contraception for females All volunteers must sign the informed consent form demonstrating their understanding of the meaning and procedures of the study Volunteer agrees to inform the general practitioner and agrees to sign a request to release medical information concerning contra-indications for participation in the study Willingness to undergo a Pf mosquito or blood stage challenge For volunteers not living in Nijmegen: agreement to stay in a hotel room close to the trial center during a part of the study (for groups 1 and 3 from challenge day till 3 days after treatment, for groups 2 and 4 from 5 days after challenge till 3 days after treatment) Reachable (24/7) by mobile phone during the whole study period Living with a third party that could contact the clinicians in case of alteration of consciousness or agreement to stay in a hotel room close to the trial center during a part of the study (for groups 1 and 3 from challenge day till 3 days after treatment, for groups 2 and 4 from 5 days after challenge till 3 days after treatment) Available to attend all study visits Agreement to refrain from blood donation to Sanquin or for other purposes, during the study period until 393 Willingness to undergo HIV, hepatitis B and hepatitis C tests Negative urine toxicology screening test at screening visit and day before challenge Willingness to take a prophylactic regime of chloroquine and curative regimen of Malarone® Exclusion Criteria: History of malaria Plans to travel to malaria endemic areas during the study period Plans to travel outside of the Netherlands during the challenge period Previous participation in any malaria vaccine study and/or positive serology for Pf Symptoms, physical signs and laboratory values suggestive of systemic disorders including renal, hepatic, cardiovascular, pulmonary, skin, immunodeficiency, psychiatric, and other conditions which could interfere with the interpretation of the study results or compromise the health of the volunteers History of diabetes mellitus or cancer (except basal cell carcinoma of the skin) History of arrhythmias or prolonged QT-interval Positive family history in 1st and 2nd degree relatives for cardiac disease < 50 years old An estimated, ten year risk of fatal cardiovascular disease of ≥5%, as estimated by the Systematic Coronary Risk Evaluation (SCORE) system Clinically significant abnormalities in electrocardiogram (ECG) at screening Body Mass Index (BMI) below 18 or above 30 kg/m2 Any clinically significant deviation from the normal range in biochemistry or hematology blood tests or in urine analysis Positive HIV, HBV or HCV tests Participation in any other clinical study within 30 days prior to the onset of the study Enrollment in any other clinical study during the study period Pregnant or lactating women Volunteers unable to give written informed consent Volunteers unable to be closely followed for social, geographic or psychological reasons Previous history of drug or alcohol abuse interfering with normal social function during a period of one year prior to enrolment in the study A history of psychiatric disease Known hypersensitivity to anti-malaria drugs The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids are allowed) and during the study period Contra-indications to Malarone® or chloroquine including treatment taken by the volunteer that interferes with Malarone® or chloroquine Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia Co-workers of the departments of Medical Microbiology or Internal Medicine of the RUNMC A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert W Sauerwein, MD, PhD
Organizational Affiliation
Radboud University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Radboud University Nijmegen Medical Centre
City
Nijmegen
ZIP/Postal Code
6500 HB
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
19641203
Citation
Roestenberg M, McCall M, Hopman J, Wiersma J, Luty AJ, van Gemert GJ, van de Vegte-Bolmer M, van Schaijk B, Teelen K, Arens T, Spaarman L, de Mast Q, Roeffen W, Snounou G, Renia L, van der Ven A, Hermsen CC, Sauerwein R. Protection against a malaria challenge by sporozoite inoculation. N Engl J Med. 2009 Jul 30;361(5):468-77. doi: 10.1056/NEJMoa0805832.
Results Reference
background
PubMed Identifier
23599283
Citation
Bijker EM, Bastiaens GJ, Teirlinck AC, van Gemert GJ, Graumans W, van de Vegte-Bolmer M, Siebelink-Stoter R, Arens T, Teelen K, Nahrendorf W, Remarque EJ, Roeffen W, Jansens A, Zimmerman D, Vos M, van Schaijk BC, Wiersma J, van der Ven AJ, de Mast Q, van Lieshout L, Verweij JJ, Hermsen CC, Scholzen A, Sauerwein RW. Protection against malaria after immunization by chloroquine prophylaxis and sporozoites is mediated by preerythrocytic immunity. Proc Natl Acad Sci U S A. 2013 May 7;110(19):7862-7. doi: 10.1073/pnas.1220360110. Epub 2013 Apr 18.
Results Reference
result
PubMed Identifier
28081133
Citation
Coffeng LE, Hermsen CC, Sauerwein RW, de Vlas SJ. The Power of Malaria Vaccine Trials Using Controlled Human Malaria Infection. PLoS Comput Biol. 2017 Jan 12;13(1):e1005255. doi: 10.1371/journal.pcbi.1005255. eCollection 2017 Jan.
Results Reference
derived
PubMed Identifier
24970846
Citation
Nahrendorf W, Scholzen A, Bijker EM, Teirlinck AC, Bastiaens GJ, Schats R, Hermsen CC, Visser LG, Langhorne J, Sauerwein RW. Memory B-cell and antibody responses induced by Plasmodium falciparum sporozoite immunization. J Infect Dis. 2014 Dec 15;210(12):1981-90. doi: 10.1093/infdis/jiu354. Epub 2014 Jun 25.
Results Reference
derived

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Experimental Human Malaria Infection After Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Prophylaxis

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