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Study of Safety and Effectiveness of Intravenous Immunization With PfSPZ Vaccine in Healthy African Adults

Primary Purpose

Malaria

Status
Completed
Phase
Phase 1
Locations
Mali
Study Type
Interventional
Intervention
PfSPZ Vaccine
Placebo
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malaria focused on measuring Randomized, Double Blinded, Mali, Malaria, Transmission

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesAccepts Healthy Volunteers
  • INCLUSION CRITERIA

The subject must satisfy all the following criteria to be eligible for the study:

  1. Signed informed consent form (ICF)
  2. Aged 18 to 35 years
  3. Long term resident of study site (living there for at least 4 years)
  4. Willingness to remain resident in the village and to abstain from travel for prolonged periods during the study
  5. Willingness to undergo an HIV test and other tests needed for determining exclusion. (In case of a positive test, the clinician will issue a referral letter to the participant to guide him/her to HIV specialist care for appropriate management and follow up).
  6. Willingness to take a curative anti-malarial regimen when prescribed by the investigator
  7. Willingness to provide blood for safety data.
  8. For females: agreement to use reliable contraception (in the setting where this trial takes place documented depot injection of contraceptives, surgical sterilization ; or an implanted device (all with written evidence provided by an appropriately trained physician) is considered reliable contraception) for the duration of the vaccination phase (i.e., from 1 month prior to first vaccination until 1 month after last vaccination)
  9. For females: negative pregnancy test at screening and before each vaccination; women found pregnant will not be given subsequent doses but will be followed up for safety reasons

EXCLUSION CRITERIA

  1. Use of antimalarials (other than that prescribed by the investigator) or systemic antibiotics with known antimalarial activity within 30 days prior to the first vaccine dose (e.g. Trimethoprim-Sulfamethoxazole, Doxycycline, Tetracycline, Clindamycin, Erythromycin, Fluoroquinolones, or Azithromycin)
  2. Receipt of an investigational product in the 30 days preceding enrolment, or planned receipt during the study period
  3. Prior receipt of a malaria vaccine candidate
  4. Recurrent, severe infections other than malaria, and chronic (more than 14 days) immunosuppressant medication within the past 6 months (inhaled and topical steroids are allowed)
  5. Use of immunoglobulins or blood products within 3 months prior to enrolment
  6. A history of allergic disease or significant reactions against mosquito bites
  7. Known allergies or contraindications against Artemether/Lumefantrine, or

    Atovaquone/Proguanil, such as:

    1. Concurrent medication with Neuroleptics, Antidepressants (i.e., Imipramine, Amitryptilline, Clomipramine and others), Drugs used to treat tuberculosis, including Rifampicin and Rifabutine, Macrolide antibiotics (i.e., Erythromycin, Clarithromycin, Azithromycin, Roxitromycin), Fluoroquinolones (i.e., Ciprofloxacin, Moxifloxacin, Levofloxacin), Antimykotics (i.e., Ketoconazole, Itraconazole), Cimetidine, Class IA and class III antiarrhythmics (i.e., Quinidine, Ajmalin, Disopyramid, Amiodaron, Sotalol), Flecainid, Metoprolol, Cisaprid, Terfenadin, Astemizole, and Metoclopramide
    2. Renal impairment
    3. Symptoms of low potassium, and/or low magnesium
    4. A family history of sudden cardiac death, which in the opinion of the investigator was caused by a pre-existing arrhythmia
    5. Known diagnosis or family history of long QT syndrome
    6. Heart disease (i.e., heart failure, arrhythmias)
  8. History of cancer (except basal cell carcinoma)
  9. History of serious psychiatric condition that may affect participation in the study
  10. If female: currently pregnant, lactating and / or breast-feeding
  11. Any other serious chronic illness requiring hospital specialist supervision such as diabetes mellitus type 2.
  12. Suspected or known current alcohol abuse as defined by an alcohol intake of greater than 60 g per day
  13. Suspected or known injecting drug abuse in the 5 years preceding enrolment
  14. Any confirmed or suspected immunosuppressive or immune modulating disorder (i.e., asplenia, lupus, rheumatoid arthritis, vasculitis, sclerodermia, diabetes mellitus)
  15. Hematuria, proteinuria, glucosuria as detected by urine dip stick above the levels defined in Appendix F
  16. Any clinically significant abnormalities on a 12 lead ECG
  17. Seropositive for Hepatitis B surface antigen (HBsAg)
  18. Seropositive for Hepatitis C virus (antibodies to HCV)
  19. Seropositive for HIV
  20. Seropositive for Syphilis
  21. Sickle cell trait carriage or sickle cell disease
  22. Any clinically significant abnormal finding on biochemistry or hematology blood tests, urinalysis or clinical examination
  23. Any other significant disease, disorder or finding which, in the opinion of the investigator, may significantly increase the risk to the subject because of participation in the study, affect the ability of the subject to participate in the study or impair interpretation of the study data.

Sites / Locations

  • University of Bamako

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Placebo Comparator

Arm Label

Group 1

Group 4

Group 5

Arm Description

Pilot Safety Group- 135000 PfSPZ + 270000 PfSPZ; staggered at Day 0 and 2 weeks

Group to start at week 4 after Group 1 is deemed safe - 5 immunizations of 270000 PfSPZ at weeks 4, 8, 12, 16 and 24

Group to receive placebo at same points as Group 4 - 5 immunizations of normal saline at weeks 4, 8, 12, 16 and 24

Outcomes

Primary Outcome Measures

Assess the safety of repeated IV immunizations with PfSPZ Vaccine

Secondary Outcome Measures

Full Information

First Posted
November 9, 2013
Last Updated
November 30, 2019
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Malaria Research and Training Center, Bamako, Mali, Sanaria Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01988636
Brief Title
Study of Safety and Effectiveness of Intravenous Immunization With PfSPZ Vaccine in Healthy African Adults
Official Title
Assessment of Safety and Immunogenicity of Intravenous Immunization With Radiation Attenuated Plasmodium Falciparum NF54 Sporozoites (PfSPZ Vaccine) in Healthy African Adults
Study Type
Interventional

2. Study Status

Record Verification Date
August 20, 2015
Overall Recruitment Status
Completed
Study Start Date
October 29, 2013 (undefined)
Primary Completion Date
August 20, 2015 (Actual)
Study Completion Date
August 20, 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Malaria Research and Training Center, Bamako, Mali, Sanaria Inc.

4. Oversight

5. Study Description

Brief Summary
Background: - Malaria is caused by small germs carried by mosquitoes. People can get malaria if an infected mosquito bites them. Malaria destroys red blood cells and reduces oxygen in the blood. Most malaria is mild, but severe malaria kills at least 660,000 people each year. About 75% of these are children in Sub-Saharan Africa, most under age 5. Researchers want to find a safe vaccine that helps prevent malaria. Objectives: - To see if a new malaria vaccine is well tolerated and effective. Eligibility: - Healthy adults 18 35 years old who are not pregnant and live in Mali. Design: Participants will be screened with medical history, physical exam, and blood test. They will also have an ECG. Soft electrodes will be stuck to the skin. A machine will record the heart s electrical signals. Study participation will last about 1 year. Participants will be randomly placed in 5 groups. Some will get 2 doses of the PfSPZ vaccine weeks apart; some will get 3 or 5 doses of vaccine; some will get 3 or 5 doses of placebo. Doses will be given through a needle in the arm directly into the bloodstream. Then participants must stay at the clinic for 2 hours. After each dose, participants will return to the clinic several times for blood tests and physical exam. A week before the first dose and 2 weeks after the last, participants will take a full course of anti-malaria drugs. If a participant gets malaria during the study, they will take another course of anti-malaria drugs.
Detailed Description
For decades it is known that humans can be protected against malaria by repeated immunization with radiation-attenuated sporozoites. Traditionally, those sporozoites are administered by exposing the vaccinee to at least 1000 bites of sporozoite-infected irradiated mosquitoes, an approach that is unsuitable for mass vaccination campaigns. Recently, Sanaria Inc. 1 has developed a process for manufacturing, in compliance with current Good Manufacturing Practices (cGMPs) aseptic, purified, radiation attenuated cryopreserved sporozoites from a wellcharacterized isolate of P. falciparum. This product, which is called PfSPZ Vaccine, can be administered by needle and syringe. Previous studies conducted by the Vaccine Research Center, National Institutes of Health (NIH) and the Navy have established that IV administration of PfSPZ Vaccine can induce sterile protection against controlled human malaria infection (CHMI) with a homologous strain of P. falciparum in up to 100% of malaria na(SqrRoot) ve individuals. The next logical step is to test the safety and immunogenicity of PfSPZ Vaccine in malaria experienced individuals. As an exploratory objective, this study will collect initial data to find out if the vaccine can protect against naturally occurring infection. Here, we propose a randomized double blind controlled trial to assess the safety and immunogenicity of IV administration of PfSPZ Vaccine in African adults. Subjects will be recruited from a rural village in Mali. The study will be conducted as collaboration among the Malaria Research and Training Center (MRTC, Mali), the Laboratory of Malaria Immunology and Vaccinology (LMIV) National Institute of Allergy and Infectious Diseases (NIAID), and Sanaria, Inc. Group 1 (n=12), will receive 135,000 PfSPZ Vaccine, followed by 270,000 PfSPZ Vaccine 2 weeks later for safety purposes. An independent Data Safety Monitoring Board (DSMB) will determine whether it is safe to proceed with 270,000 PfSPZ Vaccine. At Study Week 4, Group 4 (n=50) will receive their first of 5 doses of 270,000 PfSPZ Vaccine given at 4, 8, 12, 16, and 24 weeks, alongside Group 5 (n=50) receiving a similar volume placebo. Safety data will be collected at defined time points after each immunization. From Week 28 until Week 48 all subjects will be monitored for parasitemia detected by slide microscopy every 14 days and by passive case detection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria
Keywords
Randomized, Double Blinded, Mali, Malaria, Transmission

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Factorial Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
296 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
Pilot Safety Group- 135000 PfSPZ + 270000 PfSPZ; staggered at Day 0 and 2 weeks
Arm Title
Group 4
Arm Type
Active Comparator
Arm Description
Group to start at week 4 after Group 1 is deemed safe - 5 immunizations of 270000 PfSPZ at weeks 4, 8, 12, 16 and 24
Arm Title
Group 5
Arm Type
Placebo Comparator
Arm Description
Group to receive placebo at same points as Group 4 - 5 immunizations of normal saline at weeks 4, 8, 12, 16 and 24
Intervention Type
Biological
Intervention Name(s)
PfSPZ Vaccine
Intervention Description
Aseptic, purified, vialed, cryopreserved, radiation attenuated NF54 p.falciparum sporozoites produced by Sanaria, Inc.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
Assess the safety of repeated IV immunizations with PfSPZ Vaccine
Time Frame
28 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 The subject must satisfy all the following criteria to be eligible for the study: Signed informed consent form (ICF) Aged 18 to 35 years Long term resident of study site (living there for at least 4 years) Willingness to remain resident in the village and to abstain from travel for prolonged periods during the study Willingness to undergo an HIV test and other tests needed for determining exclusion. (In case of a positive test, the clinician will issue a referral letter to the participant to guide him/her to HIV specialist care for appropriate management and follow up). Willingness to take a curative anti-malarial regimen when prescribed by the investigator Willingness to provide blood for safety data. For females: agreement to use reliable contraception (in the setting where this trial takes place documented depot injection of contraceptives, surgical sterilization ; or an implanted device (all with written evidence provided by an appropriately trained physician) is considered reliable contraception) for the duration of the vaccination phase (i.e., from 1 month prior to first vaccination until 1 month after last vaccination) For females: negative pregnancy test at screening and before each vaccination; women found pregnant will not be given subsequent doses but will be followed up for safety reasons EXCLUSION CRITERIA Use of antimalarials (other than that prescribed by the investigator) or systemic antibiotics with known antimalarial activity within 30 days prior to the first vaccine dose (e.g. Trimethoprim-Sulfamethoxazole, Doxycycline, Tetracycline, Clindamycin, Erythromycin, Fluoroquinolones, or Azithromycin) Receipt of an investigational product in the 30 days preceding enrolment, or planned receipt during the study period Prior receipt of a malaria vaccine candidate Recurrent, severe infections other than malaria, and chronic (more than 14 days) immunosuppressant medication within the past 6 months (inhaled and topical steroids are allowed) Use of immunoglobulins or blood products within 3 months prior to enrolment A history of allergic disease or significant reactions against mosquito bites Known allergies or contraindications against Artemether/Lumefantrine, or Atovaquone/Proguanil, such as: Concurrent medication with Neuroleptics, Antidepressants (i.e., Imipramine, Amitryptilline, Clomipramine and others), Drugs used to treat tuberculosis, including Rifampicin and Rifabutine, Macrolide antibiotics (i.e., Erythromycin, Clarithromycin, Azithromycin, Roxitromycin), Fluoroquinolones (i.e., Ciprofloxacin, Moxifloxacin, Levofloxacin), Antimykotics (i.e., Ketoconazole, Itraconazole), Cimetidine, Class IA and class III antiarrhythmics (i.e., Quinidine, Ajmalin, Disopyramid, Amiodaron, Sotalol), Flecainid, Metoprolol, Cisaprid, Terfenadin, Astemizole, and Metoclopramide Renal impairment Symptoms of low potassium, and/or low magnesium A family history of sudden cardiac death, which in the opinion of the investigator was caused by a pre-existing arrhythmia Known diagnosis or family history of long QT syndrome Heart disease (i.e., heart failure, arrhythmias) History of cancer (except basal cell carcinoma) History of serious psychiatric condition that may affect participation in the study If female: currently pregnant, lactating and / or breast-feeding Any other serious chronic illness requiring hospital specialist supervision such as diabetes mellitus type 2. Suspected or known current alcohol abuse as defined by an alcohol intake of greater than 60 g per day Suspected or known injecting drug abuse in the 5 years preceding enrolment Any confirmed or suspected immunosuppressive or immune modulating disorder (i.e., asplenia, lupus, rheumatoid arthritis, vasculitis, sclerodermia, diabetes mellitus) Hematuria, proteinuria, glucosuria as detected by urine dip stick above the levels defined in Appendix F Any clinically significant abnormalities on a 12 lead ECG Seropositive for Hepatitis B surface antigen (HBsAg) Seropositive for Hepatitis C virus (antibodies to HCV) Seropositive for HIV Seropositive for Syphilis Sickle cell trait carriage or sickle cell disease Any clinically significant abnormal finding on biochemistry or hematology blood tests, urinalysis or clinical examination Any other significant disease, disorder or finding which, in the opinion of the investigator, may significantly increase the risk to the subject because of participation in the study, affect the ability of the subject to participate in the study or impair interpretation of the study data.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sara A Healy, M.D.
Organizational Affiliation
National Institute of Allergy and Infectious Diseases (NIAID)
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Bamako
City
Bamako
Country
Mali

12. IPD Sharing Statement

Citations:
PubMed Identifier
19946222
Citation
Hoffman SL, Billingsley PF, James E, Richman A, Loyevsky M, Li T, Chakravarty S, Gunasekera A, Chattopadhyay R, Li M, Stafford R, Ahumada A, Epstein JE, Sedegah M, Reyes S, Richie TL, Lyke KE, Edelman R, Laurens MB, Plowe CV, Sim BK. Development of a metabolically active, non-replicating sporozoite vaccine to prevent Plasmodium falciparum malaria. Hum Vaccin. 2010 Jan;6(1):97-106. doi: 10.4161/hv.6.1.10396. Epub 2010 Jan 21.
Results Reference
background
PubMed Identifier
23929949
Citation
Seder RA, Chang LJ, Enama ME, Zephir KL, Sarwar UN, Gordon IJ, Holman LA, James ER, Billingsley PF, Gunasekera A, Richman A, Chakravarty S, Manoj A, Velmurugan S, Li M, Ruben AJ, Li T, Eappen AG, Stafford RE, Plummer SH, Hendel CS, Novik L, Costner PJ, Mendoza FH, Saunders JG, Nason MC, Richardson JH, Murphy J, Davidson SA, Richie TL, Sedegah M, Sutamihardja A, Fahle GA, Lyke KE, Laurens MB, Roederer M, Tewari K, Epstein JE, Sim BK, Ledgerwood JE, Graham BS, Hoffman SL; VRC 312 Study Team. Protection against malaria by intravenous immunization with a nonreplicating sporozoite vaccine. Science. 2013 Sep 20;341(6152):1359-65. doi: 10.1126/science.1241800. Epub 2013 Aug 8.
Results Reference
background
PubMed Identifier
21903775
Citation
Epstein JE, Tewari K, Lyke KE, Sim BK, Billingsley PF, Laurens MB, Gunasekera A, Chakravarty S, James ER, Sedegah M, Richman A, Velmurugan S, Reyes S, Li M, Tucker K, Ahumada A, Ruben AJ, Li T, Stafford R, Eappen AG, Tamminga C, Bennett JW, Ockenhouse CF, Murphy JR, Komisar J, Thomas N, Loyevsky M, Birkett A, Plowe CV, Loucq C, Edelman R, Richie TL, Seder RA, Hoffman SL. Live attenuated malaria vaccine designed to protect through hepatic CD8(+) T cell immunity. Science. 2011 Oct 28;334(6055):475-80. doi: 10.1126/science.1211548. Epub 2011 Sep 8.
Results Reference
background
PubMed Identifier
28216244
Citation
Sissoko MS, Healy SA, Katile A, Omaswa F, Zaidi I, Gabriel EE, Kamate B, Samake Y, Guindo MA, Dolo A, Niangaly A, Niare K, Zeguime A, Sissoko K, Diallo H, Thera I, Ding K, Fay MP, O'Connell EM, Nutman TB, Wong-Madden S, Murshedkar T, Ruben AJ, Li M, Abebe Y, Manoj A, Gunasekera A, Chakravarty S, Sim BKL, Billingsley PF, James ER, Walther M, Richie TL, Hoffman SL, Doumbo O, Duffy PE. Safety and efficacy of PfSPZ Vaccine against Plasmodium falciparum via direct venous inoculation in healthy malaria-exposed adults in Mali: a randomised, double-blind phase 1 trial. Lancet Infect Dis. 2017 May;17(5):498-509. doi: 10.1016/S1473-3099(17)30104-4. Epub 2017 Feb 16.
Results Reference
derived

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Study of Safety and Effectiveness of Intravenous Immunization With PfSPZ Vaccine in Healthy African Adults

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