Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
Primary Purpose
Malaria, Plasmodium Falciparum
Status
Completed
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
Chloroquine prophylaxis
Mefloquine prophylaxis
Immunization
Controlled Human Malaria Infection
Malarone
Sponsored by
About this trial
This is an interventional basic science trial for Malaria
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
- Signing of the informed consent form, thereby demonstrating understanding of the meaning and procedures of the study
- Agreement to inform the general practitioner and to sign a request to release medical information concerning contra-indications for participation in the study
- Willingness to undergo a Pf controlled infection through mosquito bites
- Agreement to stay in a hotel room close to the trial center during a part of the study (Day 5 after challenge till treatment is finished)
- Reachable (24/7) by mobile phone during the whole study period
- Available to attend all study visits
- Agreement to refrain from blood donation to Sanquin or for other purposes, during the whole study period
- Willingness to undergo HIV, hepatitis B and hepatitis C tests
- Negative urine toxicology screening test at screening visit and the day before challenge
- Willingness to take a prophylactic regime of chloroquine or mefloquine 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 events < 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 20 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
- For women: pregnancy or lactation
- Volunteers unable to give written informed consent
- Volunteers unable to be closely followed for social, geographic or psychological reasons
- History of drug or alcohol abuse interfering with normal social function
- A history of treatment for psychiatric disease or moderate or severe psychological episode in volunteer
- A history of convulsions in volunteer
- Severe depression, anxiety disorder of psychosis in first or second degree family
- Contra-indications to Malarone®, chloroquine or mefloquine including hypersensitivity or treatment taken by the volunteer that interferes with Malarone®, chloroquine or mefloquine
- The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids and oral anti-histaminic are allowed) and during the study period
- Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia
- Co-workers or trainees of the departments of Medical Microbiology, Parasitology, or Internal Medicine of the Leiden University medical Centre
- A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency
Sites / Locations
- Leiden University Medical Centre
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Experimental
Placebo Comparator
Arm Label
Chloroquine immunisation
Mefloquine immunisation
Mefloquine control
Arm Description
This group will receive chloroquine prophylaxis, and three times infected mosquito-bites.
This group will receive mefloquine prophylaxis and infected mosquito-bites.
This group will receive mefloquine prophylaxis, and uninfected mosquito-bites.
Outcomes
Primary Outcome Measures
Duration of prepatent period after challenge infection as measured by microscopy
Secondary Outcome Measures
Development of parasitemia as measured by PCR
Frequency of signs or symptoms in study groups
Cellular immune responses between study groups
Humoral immune responses between study groups
Full Information
NCT ID
NCT01422954
First Posted
August 23, 2011
Last Updated
April 26, 2013
Sponsor
Radboud University Medical Center
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development
1. Study Identification
Unique Protocol Identification Number
NCT01422954
Brief Title
Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
Official Title
Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
Study Type
Interventional
2. Study Status
Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
January 2012 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
April 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Radboud University Medical Center
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development
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 800.000 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 controlled human malaria infections (CHMIs). CHMIs 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, P. falciparum malaria can be radically cured at the earliest stages of blood infection when risks of complications are virtually absent.
The investigators have shown previously that healthy human volunteers can be protected from a malaria mosquito (sporozoite) challenge by immunization with sporozoites (by mosquito bites) under chloroquine prophylaxis (CPS immunization). Interestingly, sterile protection in 100% of the human CPS immunized volunteers was achieved by a relatively miniscule dose, i.e. a total of 45 infectious mosquito bites, strikingly 20-fold more potent than the 1000 bites needed in a model using irradiated mosquitoes. One possible explanation for this efficient induction of protective immunity, is the immune modulating effect of chloroquine. The investigators aim to assess this possible immune modulating effect in CPS immunization by comparing immunization with P. falciparum sporozoites under chloroquine with immunization under mefloquine prophylaxis, which has the same antimalarial effect, but not the immune modulating effects known from chloroquine.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria, Plasmodium Falciparum
7. Study Design
Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
20 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Chloroquine immunisation
Arm Type
Active Comparator
Arm Description
This group will receive chloroquine prophylaxis, and three times infected mosquito-bites.
Arm Title
Mefloquine immunisation
Arm Type
Experimental
Arm Description
This group will receive mefloquine prophylaxis and infected mosquito-bites.
Arm Title
Mefloquine control
Arm Type
Placebo Comparator
Arm Description
This group will receive mefloquine prophylaxis, and uninfected mosquito-bites.
Intervention Type
Drug
Intervention Name(s)
Chloroquine prophylaxis
Intervention Description
Standard prophylactic regime: a loading dose of 300 mg on day 14 and day 17 and then 300 mg once a week, starting on day 21, for a total duration of 13 weeks. On day 0, day 3, day 7 and day 10, this group will receive a placebo.
Intervention Type
Drug
Intervention Name(s)
Mefloquine prophylaxis
Intervention Description
Mefloquine prophylaxis, starting with a loading regime of split doses during the first three weeks: 125 mg on day 0, day 3, day 7, day 10, day 14 and day 17 and 250 mg once a week from day 21 onwards for a total duration of 13 weeks.
Intervention Type
Biological
Intervention Name(s)
Immunization
Intervention Description
Group 1 and 2 will receive three immunizations with Plasmodium falciparum infected mosquito-bites. Group 3 will receive an equal number of uninfected mosquito-bites.
Intervention Type
Biological
Intervention Name(s)
Controlled Human Malaria Infection
Intervention Description
Exposure to the bites of 5 Plasmodium falciparum infected mosquitoes.
Intervention Type
Drug
Intervention Name(s)
Malarone
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 after challenge infection as measured by microscopy
Time Frame
21 days after challenge (day 239 of the study)
Secondary Outcome Measure Information:
Title
Development of parasitemia as measured by PCR
Time Frame
21 days after challenge (day 239 of study)
Title
Frequency of signs or symptoms in study groups
Time Frame
Day 0 - day 358 of study
Title
Cellular immune responses between study groups
Time Frame
Day 0 -day 358 of study
Title
Humoral immune responses between study groups
Time Frame
Day 0 - 358
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
Signing of the informed consent form, thereby demonstrating understanding of the meaning and procedures of the study
Agreement to inform the general practitioner and to sign a request to release medical information concerning contra-indications for participation in the study
Willingness to undergo a Pf controlled infection through mosquito bites
Agreement to stay in a hotel room close to the trial center during a part of the study (Day 5 after challenge till treatment is finished)
Reachable (24/7) by mobile phone during the whole study period
Available to attend all study visits
Agreement to refrain from blood donation to Sanquin or for other purposes, during the whole study period
Willingness to undergo HIV, hepatitis B and hepatitis C tests
Negative urine toxicology screening test at screening visit and the day before challenge
Willingness to take a prophylactic regime of chloroquine or mefloquine 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 events < 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 20 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
For women: pregnancy or lactation
Volunteers unable to give written informed consent
Volunteers unable to be closely followed for social, geographic or psychological reasons
History of drug or alcohol abuse interfering with normal social function
A history of treatment for psychiatric disease or moderate or severe psychological episode in volunteer
A history of convulsions in volunteer
Severe depression, anxiety disorder of psychosis in first or second degree family
Contra-indications to Malarone®, chloroquine or mefloquine including hypersensitivity or treatment taken by the volunteer that interferes with Malarone®, chloroquine or mefloquine
The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids and oral anti-histaminic are allowed) and during the study period
Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia
Co-workers or trainees of the departments of Medical Microbiology, Parasitology, or Internal Medicine of the Leiden University medical Centre
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
Leo G Visser, MD, PhD
Organizational Affiliation
Leiden University Medical Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Leiden University Medical Centre
City
Leiden
ZIP/Postal Code
2333 ZA
Country
Netherlands
12. IPD Sharing Statement
Citations:
PubMed Identifier
25396417
Citation
Bijker EM, Schats R, Obiero JM, Behet MC, van Gemert GJ, van de Vegte-Bolmer M, Graumans W, van Lieshout L, Bastiaens GJ, Teelen K, Hermsen CC, Scholzen A, Visser LG, Sauerwein RW. Sporozoite immunization of human volunteers under mefloquine prophylaxis is safe, immunogenic and protective: a double-blind randomized controlled clinical trial. PLoS One. 2014 Nov 14;9(11):e112910. doi: 10.1371/journal.pone.0112910. eCollection 2014.
Results Reference
derived
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Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
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