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Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

Primary Purpose

Influenza, Influenza Immunisation

Status

Terminated

Phase

Phase 4

Locations

United States

Study Type

Interventional

Intervention

Influenza Virus Vaccine Inactivated

About this trial

This is an interventional prevention trial for Influenza focused on measuring HA (hemagglutinin) -specific plasmablasts, humoral immunity, influenza, memory B cells

Eligibility Criteria

18 Years - 49 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Male or non-pregnant female subjects between 18 and 49 years of age (inclusive).
Subjects capable of providing written informed consent prior to initiation of any study procedures.
Subjects able to understand and comply with planned study procedures and be available for all study visits.
Safety labs:
- White blood cell count (WBC), within reference range of lower limit of normal of 4,000 per microliter (uL), and upper limit of normal of 10,000 per microliter (uL).
- Hemoglobin, within reference range of lower limit of normal of 11.4 grams per deciliter (gm/dL) and upper limit of normal of 16.1 grams per deciliter (gm/dL).
- Hematocrit, within reference range of lower limit of normal of 33.3 percent and an upper limit of normal of 46.5 percent.
- Platelet Count, within reference range of lower limit of normal of 150,000 per microliter (uL) and upper limit of normal of 400,000 per microliter (uL).
- Prothrombin Time (PT/INR), PT below or equal to the upper limit of normal of 13.1 seconds; International Normalized Ratio (INR) within normal reference range of less than 1.5 (normal range for non-anti-coagulated patients).
- Creatinine within reference range of lower limit of normal of 0.4 milligrams per deciliter (mg / dL) and upper limit of normal of 1.2 milligrams per deciliter (mg / dL).
- Potassium, within reference range of lower limit of normal of 3.6 millimolar (mM) and upper limit of normal of 5.1 millimolar (mM).
Heart rate > / = 55 to < / = 100 per minute.
Systolic blood pressure > / = 90 to < / = 150 millimeters of mercury (mmHg).
Diastolic blood pressure < 90 millimeters of mercury (mmHg).
Oral temperature < 100 degrees Fahrenheit.
Respirations even, unlabored, and > 10 / minute to < 20 / minute.
Female subjects of child bearing potential must have a negative urine pregnancy test at the screening visit, enrollment visit and prior to subsequent bone marrow aspirate procedures. Female subjects of childbearing potential must agree to practice abstinence, use a barrier method of birth control, or use an U.S. Food and Drug Administration (FDA) approved form of birth control.
Subjects who have not received seasonal flu vaccine for the current year (September - June).

Exclusion Criteria:

If female, active pregnancy or breast-feeding or plans to become pregnant during study participation.
Subject report of having any medical disease or condition that, in the opinion of the site principal investigator or appropriate sub-investigator, is a contraindication to study participation. This includes any acute or chronic medical disease or condition, defined as persisting 3 months (defined as 90 days) or longer, that would place the subject at an unacceptable risk of injury, render the subject unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or the subject's successful completion of this study.
Subject report of taking anticoagulants, or long-term (greater than 14 days) systemic steroids or other immunosuppressive medications.
Subject report of known allergy to lidocaine.
Subject report of known hypersensitivity or allergy to eggs, egg or chicken protein, report of allergy to components of the study vaccine or other components of the study vaccine.
Subject report of known latex allergy.
Subject report of a history of severe reactions following previous immunization with licensed or unlicensed influenza virus vaccines.
Subject report of a history of Guillain-Barre syndrome.
Subjects who believe they cannot tolerate the bone marrow aspirations without sedation.
Subjects with an active infection or that have an acute illness within 72 hours prior to study vaccination. Subject having had an acute illness which is nearly resolved with only minor residual symptoms remaining is allowable if, in the opinion of the site principal investigator or appropriate sub-investigator, the residual symptoms will not interfere with the ability to assess safety parameters as required by the protocol.
Subjects who are participating in another clinical trial involving the use of investigational agents or vaccines.

Sites / Locations

Emory Clinic - Winship Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Influenza Virus Vaccine Inactivated

Arm Description

All study participants received licensed inactivated influenza vaccine intramuscularly (IM) on Day 0.

Outcomes

Primary Outcome Measures

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Blood

Blood Immunoglobulin G (IgG) ASC specific for the seasonal influenza vaccine were measured by enzyme-linked immunosorbent spot (ELISPOT) using vaccine-coated plates. Numbers of influenza-specific ASC per million peripheral blood mononuclear cells are reported.

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with influenza vaccine or total IgG capture antibody. Influenza-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

Number of Influenza-specific Memory B Cells Present in the Blood

Influenza-specific memory B cells were assayed by ELISPOT after polyclonal stimulation of peripheral blood mononuclear cells to generate ASC. The influenza-specific memory B cell frequencies are reported as the percentage of IgG secreting cells found in the stimulated cultures.

Number of Influenza-specific Memory B Cells Present in the Blood

Number of Subjects Who Initially Seroconverted and Maintained Seroconversion at 1 Year Post Vaccination

Initial seroconversion is defined as having a pre-vaccination (day 0) hemagglutination inhibition (HAI) titer < 1:40 against a particular strain and a day 28 post-vaccination titer > / = 1:40 against the same strain OR a pre-vaccination HAI titer >1:40 and an increase in titer of at least 4-fold on day 28 relative to day 0. Maintenance of seroconversion in those who initially seroconverted is defined as maintaining an HAI titer >/= 40 at 1 year in those with day 0 titers < 40 OR maintaining a >/= 4-fold increase in HAI titer at one year compared to day 0. HAI assays were performed using 0.75% guinea pig red blood cells and virus stocks matched to the strains in the vaccines received by each donor.

Number of Subjects Achieving Seroconversion to Each of the Strains in the Vaccine

Seroconversion defined as having a pre-vaccination (day 0) hemagglutination inhibition (HAI) titer < 1:40 against a particular strain and a Day 28 post-vaccination titer > / = 1:40 against the same strain OR a pre-vaccination HAI titer >1:40 and an increase in titer of at least 4-fold on day 28. HAI assays were performed using 0.75% guinea pig red blood cells and virus stocks matched to the strains in the vaccines received by each donor.

Secondary Outcome Measures

Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among Blood Plasmablasts

Blood IgG ASC specific for the seasonal influenza vaccine were measured by ELISPOT using plates coated with chimeric hemagglutinin antigen containing the pandemic H1 stem domain fused to the head domain of an H9 influenza virus. Numbers of stem-specific ASC per million peripheral blood mononuclear cells are reported.

Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among the Bone Marrow Plasma Cells

Influenza-specific IgG ASC and total IgG ASC were measured in bone marrow samples by ELISPOT using plates coated with H9 head/H1 stem chimeric hemagglutinin antigen or total IgG capture antibody. Stem-specific bone marrow IgG ASC numbers are expressed as a percentage of the total bone marrow IgG ASC number.

Full Information

NCT ID

NCT02485639

First Posted

June 11, 2015

Last Updated

October 5, 2023

Sponsor

National Institute of Allergy and Infectious Diseases (NIAID)

1. Study Identification

Unique Protocol Identification Number

NCT02485639

Brief Title

Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

Official Title

Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

Study Type

Interventional

2. Study Status

Record Verification Date

March 2021

Overall Recruitment Status

Terminated

Why Stopped

Study was terminated due to CoronaVIrus Disease of 2019 (COVID-19) pandemic.

Study Start Date

December 23, 2015 (Actual)

Primary Completion Date

March 31, 2020 (Actual)

Study Completion Date

March 31, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

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

Product Manufactured in and Exported from the U.S.

Data Monitoring Committee

5. Study Description

Brief Summary

Detailed Description

This was a Phase IV open label and single arm study, with the aim of enrolling up to 55 healthy males and non-pregnant females in a single site, age 18-49 years old, inclusive. This study was designed to assess the humoral response to influenza vaccination and the longevity of humoral immunity to influenza vaccination in healthy adults. Total enrollment was 27 participants. The laboratory technique used in this study characterized persistence and clonotype of antigen specific B-cells and plasmablasts in blood and bone marrow. Enrolled participants received licensed seasonal inactivated influenza vaccine (administered as a part of the study). The vaccine was administered according to the package insert, and study participants donated serial samples of blood and bone marrow aspirate for immunology monitoring. Safety was assessed from the time of study enrollment through the last study visit, via monitoring of vital signs, change in health status, and targeted physical exam with safety labs prior to each bone marrow aspirate procedure. Repeated measurements of humoral immunity were obtained at 7 days, 14 days, 28 days, 90 days and at one year post-vaccination to assess the magnitude, clonal diversity and persistence of B-cell responses to influenza vaccination. This was a multi-year study. After one year of participation, participants were offered the opportunity to participate in the study for up to 3 consecutive years, provided eligibility criteria was met each year. Participants who elected to continue in the study after first year of participation were rescreened to verify continued eligibility and re-consented prior to subsequent participation. Re-enrolling participants received new subject identifiers and will count towards the total enrollment number for subsequent years of participation. A separate subject record will be maintained each year a subject re-enrolls in the study. Enrollment for the next year will begin with the availability of the seasonal flu vaccine. For participants who elect to re-enroll in the study, the Day 365 visit (+/- 3 month window) would also be the Day 0 visit for the subsequent year. The primary study objective is to investigate the longevity of humoral immunity to influenza virus in humans. The secondary study objective is the longitudinal tracking of vaccine-induced B cell responses with special emphasis on broadly neutralizing HA (hemagglutinin) stem-reactive responses. Note: Due to the Coronavirus Disease of 2019 (COVID-19) pandemic, all non-essential research was halted in mid-March 2020. New enrollments were placed on hold for this study. Follow-up visits were also halted, which impacted the timing of participants' subsequent follow-up visits. Participant visits for Day 7 and Day 14 were not impacted. For this study, there are participants whose Day 28 and Day 90 visits were impacted by the temporary halting of non-essential research studies. As such, a request was submitted to the Emory University Institutional Review Board to extend the missed visit windows for the Day 28 and Day 90 visits for a maximum of up to 180 days, to ensure that ample time was available to bring participants back for their missed visits. Enrollment for this study ended on March 31, 2020, before research activities could resume at Emory.

6. Conditions and Keywords

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

Influenza, Influenza Immunisation

Keywords

HA (hemagglutinin) -specific plasmablasts, humoral immunity, influenza, memory B cells

7. Study Design

Primary Purpose

Prevention

Study Phase

Phase 4

Interventional Study Model

Single Group Assignment

Masking

None (Open Label)

Allocation

N/A

Enrollment

27 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Influenza Virus Vaccine Inactivated

Arm Type

Experimental

Arm Description

All study participants received licensed inactivated influenza vaccine intramuscularly (IM) on Day 0.

Intervention Type

Biological

Intervention Name(s)

Influenza Virus Vaccine Inactivated

Intervention Description

A synthetic vaccine consisting of three inactivated influenza viruses: two different influenza type A strains and one influenza type B strain. Trivalent influenza vaccine is formulated annually, based on influenza strains projected to be prevalent in the upcoming flu season. All participants received vaccine intramuscularly (IM) on Day 0.

Primary Outcome Measure Information:

Title

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Blood

Description

Time Frame

Day 7

Title

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

Description

Time Frame

Day 0

Title

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

Description

Time Frame

Day 28

Title

Number of Influenza-specific Antibody Secreting Cells (ASC) Present in the Bone Marrow

Description

Time Frame

Day 365

Title

Number of Influenza-specific Memory B Cells Present in the Blood

Description

Time Frame

Day 0

Title

Number of Influenza-specific Memory B Cells Present in the Blood

Description

Time Frame

Day 28

Title

Number of Influenza-specific Memory B Cells Present in the Blood

Description

Time Frame

Day 365

Title

Number of Subjects Who Initially Seroconverted and Maintained Seroconversion at 1 Year Post Vaccination

Description

Time Frame

Day 365

Title

Number of Subjects Achieving Seroconversion to Each of the Strains in the Vaccine

Description

Time Frame

Day 28

Secondary Outcome Measure Information:

Title

Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among Blood Plasmablasts

Description

Time Frame

Day 7

Title

Frequency of Hemagglutinin Stem Reactive Responses to Influenza Vaccine Among the Bone Marrow Plasma Cells

Description

Time Frame

Day 365

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

49 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Male or non-pregnant female subjects between 18 and 49 years of age (inclusive). Subjects capable of providing written informed consent prior to initiation of any study procedures. Subjects able to understand and comply with planned study procedures and be available for all study visits. Safety labs: White blood cell count (WBC), within reference range of lower limit of normal of 4,000 per microliter (uL), and upper limit of normal of 10,000 per microliter (uL). Hemoglobin, within reference range of lower limit of normal of 11.4 grams per deciliter (gm/dL) and upper limit of normal of 16.1 grams per deciliter (gm/dL). Hematocrit, within reference range of lower limit of normal of 33.3 percent and an upper limit of normal of 46.5 percent. Platelet Count, within reference range of lower limit of normal of 150,000 per microliter (uL) and upper limit of normal of 400,000 per microliter (uL). Prothrombin Time (PT/INR), PT below or equal to the upper limit of normal of 13.1 seconds; International Normalized Ratio (INR) within normal reference range of less than 1.5 (normal range for non-anti-coagulated patients). Creatinine within reference range of lower limit of normal of 0.4 milligrams per deciliter (mg / dL) and upper limit of normal of 1.2 milligrams per deciliter (mg / dL). Potassium, within reference range of lower limit of normal of 3.6 millimolar (mM) and upper limit of normal of 5.1 millimolar (mM). Heart rate > / = 55 to < / = 100 per minute. Systolic blood pressure > / = 90 to < / = 150 millimeters of mercury (mmHg). Diastolic blood pressure < 90 millimeters of mercury (mmHg). Oral temperature < 100 degrees Fahrenheit. Respirations even, unlabored, and > 10 / minute to < 20 / minute. Female subjects of child bearing potential must have a negative urine pregnancy test at the screening visit, enrollment visit and prior to subsequent bone marrow aspirate procedures. Female subjects of childbearing potential must agree to practice abstinence, use a barrier method of birth control, or use an U.S. Food and Drug Administration (FDA) approved form of birth control. Subjects who have not received seasonal flu vaccine for the current year (September - June). Exclusion Criteria: If female, active pregnancy or breast-feeding or plans to become pregnant during study participation. Subject report of having any medical disease or condition that, in the opinion of the site principal investigator or appropriate sub-investigator, is a contraindication to study participation. This includes any acute or chronic medical disease or condition, defined as persisting 3 months (defined as 90 days) or longer, that would place the subject at an unacceptable risk of injury, render the subject unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or the subject's successful completion of this study. Subject report of taking anticoagulants, or long-term (greater than 14 days) systemic steroids or other immunosuppressive medications. Subject report of known allergy to lidocaine. Subject report of known hypersensitivity or allergy to eggs, egg or chicken protein, report of allergy to components of the study vaccine or other components of the study vaccine. Subject report of known latex allergy. Subject report of a history of severe reactions following previous immunization with licensed or unlicensed influenza virus vaccines. Subject report of a history of Guillain-Barre syndrome. Subjects who believe they cannot tolerate the bone marrow aspirations without sedation. Subjects with an active infection or that have an acute illness within 72 hours prior to study vaccination. Subject having had an acute illness which is nearly resolved with only minor residual symptoms remaining is allowable if, in the opinion of the site principal investigator or appropriate sub-investigator, the residual symptoms will not interfere with the ability to assess safety parameters as required by the protocol. Subjects who are participating in another clinical trial involving the use of investigational agents or vaccines.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Edmund K Waller, MD, PhD

Organizational Affiliation

Emory University

Official's Role

Principal Investigator

Facility Information:

Facility Name

Emory Clinic - Winship Cancer Institute

City

Atlanta

State/Province

Georgia

ZIP/Postal Code

30322-1059

Country

United States

12. IPD Sharing Statement

Plan to Share IPD

Citations:

PubMed Identifier

12517228

Citation

Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003 Jan 8;289(2):179-86. doi: 10.1001/jama.289.2.179.

Results Reference

background

PubMed Identifier

24048214

Citation

Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014. MMWR Recomm Rep. 2013 Sep 20;62(RR-07):1-43. Erratum In: MMWR Recomm Rep. 2013 Nov 15;62(45):906.

Results Reference

background

PubMed Identifier

8911005

Citation

Kunzel W, Glathe H, Engelmann H, Van Hoecke C. Kinetics of humoral antibody response to trivalent inactivated split influenza vaccine in subjects previously vaccinated or vaccinated for the first time. Vaccine. 1996 Aug;14(12):1108-10. doi: 10.1016/0264-410x(96)00061-8.

Results Reference

background

PubMed Identifier

23327522

Citation

Pica N, Palese P. Toward a universal influenza virus vaccine: prospects and challenges. Annu Rev Med. 2013;64:189-202. doi: 10.1146/annurev-med-120611-145115.

Results Reference

background

PubMed Identifier

18449194

Citation

Wrammert J, Smith K, Miller J, Langley WA, Kokko K, Larsen C, Zheng NY, Mays I, Garman L, Helms C, James J, Air GM, Capra JD, Ahmed R, Wilson PC. Rapid cloning of high-affinity human monoclonal antibodies against influenza virus. Nature. 2008 May 29;453(7195):667-71. doi: 10.1038/nature06890. Epub 2008 Apr 30.

Results Reference

background

PubMed Identifier

9529153

Citation

Slifka MK, Antia R, Whitmire JK, Ahmed R. Humoral immunity due to long-lived plasma cells. Immunity. 1998 Mar;8(3):363-72. doi: 10.1016/s1074-7613(00)80541-5.

Results Reference

background

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Analysis of Bone Marrow and Blood B Cell Immune Responses to Influenza Vaccination

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