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Safety and Immunogenicity of Artificial Invaplex (Shigella Flexneri 2a InvaplexAR)

Primary Purpose

Shigellosis, Bacillary Dysentery

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Shigella flexneri 2a InvaplexAR
Sponsored by
U.S. Army Medical Research and Development Command
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Shigellosis

Eligibility Criteria

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

Inclusion Criteria:

  • Healthy, adult, male or female, age 18 to 45 years (inclusive) at the time of enrollment.
  • Completion and review of comprehension test (achieved > 70% accuracy).
  • Signed informed consent document.
  • Available for the required follow-up period and scheduled clinic visits.
  • Women: Negative pregnancy test with understanding (through informed consent process) to not become pregnant nor to breastfeed during the study or within 3 months following last vaccination

Exclusion Criteria:

  • Health problems (for example, chronic medical conditions such as psychiatric conditions, diabetes mellitus, hypertension, or any other conditions that might place the subjects at increased risk of adverse events)- study clinicians, in consultation with the PI, will use clinical judgment on a case-by-case basis to assess safety risks under this criterion. The PI will consult with the Research Monitor as appropriate.
  • Clinically significant abnormalities on physical examination (chronic sinusitis or seasonal rhinitis) which compromise identification and interpretation of potential vaccine associated adverse effects.
  • Use of immunosuppressive and/or immunomodulative drugs such as corticosteroids or chemotherapeutics that may influence antibody development.
  • Immunosuppressive illnesses (including IgA deficiency defined by serum IgA below level of detection or <7mg/dL).
  • Participation in research involving another investigational product (defined as receipt of an investigational product or exposure to an invasive investigational device) 30 days before planned date of first vaccination or anytime throughout the duration of the study until the last study safety visit.
  • Positive blood test for HBsAG, HCV, HIV-1/HIV-2.
  • Clinically significant abnormalities on basic laboratory screening.
  • Presence of significant unexplained laboratory abnormalities that in the opinion of the PI may potentially confound the analysis of the study results.
  • Current smoker or smoker in past 1 year ('smoker' defined as daily cigarette, cigar, or pipe use for a period of at least 1 month).

Research specific

  • Structural abnormalities on sinus/nasal cavity examination.
  • Rhinoplasty.
  • Nasal polyps.
  • Nasal ulcers.
  • Deviated nasal septum. This question is being used to determine whether the volunteer has a clinically significant deviated septum that causes nasal obstruction (thereby causing difficulty breathing), interferes with normal sinus drainage, or obscures visualization of the posterior nasal cavity complicating examination and safety monitoring..
  • Chronic sinusitis/rhinitis.
  • Current or planned use of nasal topical corticosteroids and/or nasal spray medications in the 4 weeks prior to dosing or during the study vaccination period.
  • Current or recent history (in the past 5 years) of reactive airway disease (asthma), chronic obstructive pulmonary disease, or chronic bronchitis.
  • History of Bell's palsy.
  • Chronic use (weekly or more often) of anti-diarrheal, anti-constipation, or antacid therapy (excluding use associated with spicy meals).
  • Abnormal stool pattern (fewer than 3 stools per week or more than 3 stools per day) on a regular basis; loose or liquid stools on other than an occasional basis.
  • Personal or family history of inflammatory arthritis.
  • Positive blood test for HLA-B27.
  • History of allergy to any vaccine.

Prior Exposure to Shigella

  • Serum IgG titer ≥ 2500 to Shigella flexneri 2a LPS.
  • History of microbiologically confirmed Shigella infection in the past 3 years.
  • Received previous experimental Shigella vaccine or live Shigella challenge.
  • Travel to countries with symptoms of travelers' diarrhea where Shigella or other enteric infections are endemic (most of the developing world) within the past 6 months prior to dosing.
  • Occupation involving handling of Shigella bacteria currently, or in the past 3 years.

Sites / Locations

  • Walter Reed Army Institute of Research, Clinical Trials Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

10 μg S. flexneri 2a Invaplex

50 μg S. flexneri 2a Invaplex

250 μg S. flexneri 2a Invaplex

500 μg S. flexneri 2a Invaplex

Arm Description

10 subjects vaccinated on days 0, 14, 28

10 subjects vaccinated on days 0, 14, 28

10 subjects vaccinated on days 0, 14, 28

10 subjects vaccinated on days 0, 14, 28

Outcomes

Primary Outcome Measures

Number of Treatment Related Adverse Events
Number of adverse events related to the vaccine for each arm
Antibody Titers Against IgG and IgA Immunizing Antigens
Serum samples will be assayed for antibody titers against the immunizing antigens LPS, IpaB, IpaC, and S. flexneri 2a Invaplex at screening, and Days 0, 14, 28, 35, 42, and 56 for 36 subjects. Previously established high-titer specimens will be included on each plate to track day to day interassay variation. For each antigen, pre- and post-vaccination serum samples will be assayed side-by-side. The antibody titer assigned to each sample will represent the geometric mean of duplicate tests performed on 2 different days. Reciprocal endpoint titers < 5 will be assigned a value of 2.5 for computational purposes. Seroconversion will be defined as a > 4-fold increase in endpoint titer between pre-and post-vaccination samples AND a post-vaccination reciprocal titer >10.

Secondary Outcome Measures

IgG and IgA Antigen-Specific Antibody Secreting Cell (ASC) Mucosal Responses
ASC responses were assessed using isolated peripheral blood mononuclear cells (PBMCs). For each antigen, pre- and post-vaccination samples were tested on the same plates for total and vaccine-specific numbers. The ASC responses indirectly reflect intestinal immune responses through measurement of antigen-specific B-lymphocytes in systemic circulation before homing to gut effector sites. An ASC response was defined as > 10 ASCs above baseline.
IgG and IgA Antigen-Specific Antibody Lymphocyte Supernatant (ALS) Mucosal Responses
ALS responses were assessed using isolated peripheral blood mononuclear cells (PBMCs). For each antigen, pre- and post-vaccination samples were tested on the same plates for total and vaccine-specific numbers. The ALS responses indirectly reflect intestinal immune responses through measurement of antigen-specific B-lymphocytes in systemic circulation before homing to gut effector sites. An ALS response was defined as a ≥ 4-fold increase over baseline ALS titers.

Full Information

First Posted
May 13, 2015
Last Updated
February 10, 2021
Sponsor
U.S. Army Medical Research and Development Command
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1. Study Identification

Unique Protocol Identification Number
NCT02445963
Brief Title
Safety and Immunogenicity of Artificial Invaplex (Shigella Flexneri 2a InvaplexAR)
Official Title
A Phase 1 Open-label, Dose Escalating Study of Artificial Shigella Flexneri 2a InvaplexAR Administered Intranasally to Healthy, Adult Volunteers to Evaluate Safety and Immunogenicity
Study Type
Interventional

2. Study Status

Record Verification Date
February 2021
Overall Recruitment Status
Completed
Study Start Date
October 1, 2015 (Actual)
Primary Completion Date
May 13, 2016 (Actual)
Study Completion Date
May 13, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
U.S. Army Medical Research and Development Command

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is an open-label, dose-escalating Phase 1 investigation of S. flexneri 2a InvaplexAR vaccine. A total of up to 40 subjects will receive one of four S. flexneri 2a InvaplexAR vaccine doses. The vaccine will be administered intranasally (without adjuvant).
Detailed Description
The vaccine will be administered on Days 0,14, and 28. Volunteers (10 per group [8 minimum]) will receive the same dose at each vaccination dependent upon group assignment. Groups will be divided according to the table below. An interval no less than 1 week will separate the third dose of a group from the first dose of the next group (receiving an increased InvaplexAR dose). Blood, stool, and saliva specimens will be collected at pre-specified intervals to examine systemic and mucosal vaccine antigen-specific immune responses. Ocular tear samples will be collected in groups C and D. Vaccine safety will be actively monitored during vaccination and for 28 days following the third vaccine dose. The decision to advance to the next dose level is based on the safety assessment (not immunogenicity). A dose level with no occurrence of stopping criteria in the 7 days following the last vaccine dose will prompt moving to the next higher level. All safety data will be summarized and reviewed with the research monitor prior to dose escalation. In addition, a report of all safety data will be provided to the sponsor's safety office for informational purposes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Shigellosis, Bacillary Dysentery

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
38 (Actual)

8. Arms, Groups, and Interventions

Arm Title
10 μg S. flexneri 2a Invaplex
Arm Type
Active Comparator
Arm Description
10 subjects vaccinated on days 0, 14, 28
Arm Title
50 μg S. flexneri 2a Invaplex
Arm Type
Active Comparator
Arm Description
10 subjects vaccinated on days 0, 14, 28
Arm Title
250 μg S. flexneri 2a Invaplex
Arm Type
Active Comparator
Arm Description
10 subjects vaccinated on days 0, 14, 28
Arm Title
500 μg S. flexneri 2a Invaplex
Arm Type
Active Comparator
Arm Description
10 subjects vaccinated on days 0, 14, 28
Intervention Type
Biological
Intervention Name(s)
Shigella flexneri 2a InvaplexAR
Intervention Description
The investigational product is S. flexneri 2a InvaplexAR. The product is composed of three individual components IpaB, IpaC, and LPS. The components were assembled into the high molecular weight S. flexneri 2a InvaplexAR complex and subsequently purified by ion-exchange chromatography yielding a bulk lot.
Primary Outcome Measure Information:
Title
Number of Treatment Related Adverse Events
Description
Number of adverse events related to the vaccine for each arm
Time Frame
166 days
Title
Antibody Titers Against IgG and IgA Immunizing Antigens
Description
Serum samples will be assayed for antibody titers against the immunizing antigens LPS, IpaB, IpaC, and S. flexneri 2a Invaplex at screening, and Days 0, 14, 28, 35, 42, and 56 for 36 subjects. Previously established high-titer specimens will be included on each plate to track day to day interassay variation. For each antigen, pre- and post-vaccination serum samples will be assayed side-by-side. The antibody titer assigned to each sample will represent the geometric mean of duplicate tests performed on 2 different days. Reciprocal endpoint titers < 5 will be assigned a value of 2.5 for computational purposes. Seroconversion will be defined as a > 4-fold increase in endpoint titer between pre-and post-vaccination samples AND a post-vaccination reciprocal titer >10.
Time Frame
At screening and Days 0, 14, 28, 35, 42, and 56
Secondary Outcome Measure Information:
Title
IgG and IgA Antigen-Specific Antibody Secreting Cell (ASC) Mucosal Responses
Description
ASC responses were assessed using isolated peripheral blood mononuclear cells (PBMCs). For each antigen, pre- and post-vaccination samples were tested on the same plates for total and vaccine-specific numbers. The ASC responses indirectly reflect intestinal immune responses through measurement of antigen-specific B-lymphocytes in systemic circulation before homing to gut effector sites. An ASC response was defined as > 10 ASCs above baseline.
Time Frame
56 Days
Title
IgG and IgA Antigen-Specific Antibody Lymphocyte Supernatant (ALS) Mucosal Responses
Description
ALS responses were assessed using isolated peripheral blood mononuclear cells (PBMCs). For each antigen, pre- and post-vaccination samples were tested on the same plates for total and vaccine-specific numbers. The ALS responses indirectly reflect intestinal immune responses through measurement of antigen-specific B-lymphocytes in systemic circulation before homing to gut effector sites. An ALS response was defined as a ≥ 4-fold increase over baseline ALS titers.
Time Frame
56 Days

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: Healthy, adult, male or female, age 18 to 45 years (inclusive) at the time of enrollment. Completion and review of comprehension test (achieved > 70% accuracy). Signed informed consent document. Available for the required follow-up period and scheduled clinic visits. Women: Negative pregnancy test with understanding (through informed consent process) to not become pregnant nor to breastfeed during the study or within 3 months following last vaccination Exclusion Criteria: Health problems (for example, chronic medical conditions such as psychiatric conditions, diabetes mellitus, hypertension, or any other conditions that might place the subjects at increased risk of adverse events)- study clinicians, in consultation with the PI, will use clinical judgment on a case-by-case basis to assess safety risks under this criterion. The PI will consult with the Research Monitor as appropriate. Clinically significant abnormalities on physical examination (chronic sinusitis or seasonal rhinitis) which compromise identification and interpretation of potential vaccine associated adverse effects. Use of immunosuppressive and/or immunomodulative drugs such as corticosteroids or chemotherapeutics that may influence antibody development. Immunosuppressive illnesses (including IgA deficiency defined by serum IgA below level of detection or <7mg/dL). Participation in research involving another investigational product (defined as receipt of an investigational product or exposure to an invasive investigational device) 30 days before planned date of first vaccination or anytime throughout the duration of the study until the last study safety visit. Positive blood test for HBsAG, HCV, HIV-1/HIV-2. Clinically significant abnormalities on basic laboratory screening. Presence of significant unexplained laboratory abnormalities that in the opinion of the PI may potentially confound the analysis of the study results. Current smoker or smoker in past 1 year ('smoker' defined as daily cigarette, cigar, or pipe use for a period of at least 1 month). Research specific Structural abnormalities on sinus/nasal cavity examination. Rhinoplasty. Nasal polyps. Nasal ulcers. Deviated nasal septum. This question is being used to determine whether the volunteer has a clinically significant deviated septum that causes nasal obstruction (thereby causing difficulty breathing), interferes with normal sinus drainage, or obscures visualization of the posterior nasal cavity complicating examination and safety monitoring.. Chronic sinusitis/rhinitis. Current or planned use of nasal topical corticosteroids and/or nasal spray medications in the 4 weeks prior to dosing or during the study vaccination period. Current or recent history (in the past 5 years) of reactive airway disease (asthma), chronic obstructive pulmonary disease, or chronic bronchitis. History of Bell's palsy. Chronic use (weekly or more often) of anti-diarrheal, anti-constipation, or antacid therapy (excluding use associated with spicy meals). Abnormal stool pattern (fewer than 3 stools per week or more than 3 stools per day) on a regular basis; loose or liquid stools on other than an occasional basis. Personal or family history of inflammatory arthritis. Positive blood test for HLA-B27. History of allergy to any vaccine. Prior Exposure to Shigella Serum IgG titer ≥ 2500 to Shigella flexneri 2a LPS. History of microbiologically confirmed Shigella infection in the past 3 years. Received previous experimental Shigella vaccine or live Shigella challenge. Travel to countries with symptoms of travelers' diarrhea where Shigella or other enteric infections are endemic (most of the developing world) within the past 6 months prior to dosing. Occupation involving handling of Shigella bacteria currently, or in the past 3 years.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christopher Duplessis, MD, MPH, MS
Organizational Affiliation
Enteric Diseases Department Naval Medical Research Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Walter Reed Army Institute of Research, Clinical Trials Center
City
Silver Spring
State/Province
Maryland
ZIP/Postal Code
20910
Country
United States

12. IPD Sharing Statement

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Safety and Immunogenicity of Artificial Invaplex (Shigella Flexneri 2a InvaplexAR)

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