CClinicalTrials.gg
CompletedNCT02445963Updated Feb 12, 2021Results posted

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

A Phase 1 interventional study of Shigella flexneri 2a InvaplexAR in Shigellosis and Bacillary Dysentery, sponsored by U.S. Army Medical Research and Development Command. Completed at 1 site in United States. Open to participants aged 18 Years to 45 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2021-02-12.

Sponsored by U.S. Army Medical Research and Development Command · Phase 1, Interventional, and Prevention

Phase
Phase 1
Study type
Interventional
Enrollment
38
Allocation
Non-randomized
Ages
18 Years to 45 Years
Sex
All
01

Study 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).

Read the 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.

02

Conditions studied

  • Shigellosis
  • Bacillary Dysentery
03

Who can participate

Ages eligible
18 Years to 45 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

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

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.
04

Study design

Phase
Phase 1
Primary purpose
Prevention
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
38 participants (actual)

Study arms

  • Active comparator
    10 μg S. flexneri 2a Invaplex

    10 subjects vaccinated on days 0, 14, 28

    Biological: Shigella flexneri 2a InvaplexAR

  • Active comparator
    50 μg S. flexneri 2a Invaplex

    10 subjects vaccinated on days 0, 14, 28

    Biological: Shigella flexneri 2a InvaplexAR

  • Active comparator
    250 μg S. flexneri 2a Invaplex

    10 subjects vaccinated on days 0, 14, 28

    Biological: Shigella flexneri 2a InvaplexAR

  • Active comparator
    500 μg S. flexneri 2a Invaplex

    10 subjects vaccinated on days 0, 14, 28

    Biological: Shigella flexneri 2a InvaplexAR

Interventions

  • BiologicalShigella flexneri 2a InvaplexAR

    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.

05

What researchers measure

Primary outcomes

  1. Number of Treatment Related Adverse Events

    Number of adverse events related to the vaccine for each arm

    Time frame: 166 days

  2. 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.

    Time frame: At screening and Days 0, 14, 28, 35, 42, and 56

Secondary outcomes

  1. 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.

    Time frame: 56 Days

  2. 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.

    Time frame: 56 Days

06

Results

Posted Jul 22, 2020

Participant flow

Participant flow — Overall Study
Milestone10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
Started991010
Completed79910
Not completed2010
Withdrew: Lost to follow-up1000
Withdrew: Change in employment1000
Withdrew: Symptoms post-vaccination0010

Outcome measures

PrimaryNumber of Treatment Related Adverse Events

Number of adverse events related to the vaccine for each arm

Time frame:
166 days
Reported as:
Number · Adverse Events
Number of Treatment Related Adverse Events
Adverse Events10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
Number of Treatment Related Adverse Events27374146
PrimaryAntibody 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.

Time frame:
At screening and Days 0, 14, 28, 35, 42, and 56
Reported as:
Geometric mean · titers
Antibody Titers Against IgG and IgA Immunizing Antigens
titers10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
Serum IgG (Invaplex)1345.4 (805.0 to 2248.8)4703.2 (2104.6 to 10510.2)5486.4 (2199.0 to 13688.0)5571.5 (2680.3 to 11581.5)
Serum IgA (Invaplex)259.4 (108.4 to 620.7)800.0 (330.7 to 1935.6)685.8 (192.3 to 2445.5)606.3 (259.3 to 1417.4)
Serum IgG (LPS)1902.7 (1138.4 to 3180.2)4703.2 (2434.3 to 9086.5)4703.2 (2939.8 to 7524.2)6400 (3056.1 to 13402.8)
Serum IgA (LPS)259.4 (108.4 to 620.7)635.0 (330.6 to 1219.4)544.3 (207.5 to 1428.2)527.8 (233.3 to 1194.1)
Serum IgG (IpaB)183.4 (103.3 to 325.7)740.7 (228.8 to 2397.8)342.9 (86.4 to 1361.0)229.7 (102.9 to 512.8)
Serum IgA (IpaB)50.0 (NA to NA)73.5 (36.1 to 149.5)85.7 (42.8 to 171.5)50.0 (NA to NA)
Serum IgG (IpaC)336.4 (171.2 to 660.7)2539.8 (1049.8 to 6145.1)1728.1 (353.8 to 8440.5)2599.2 (1049.6 to 6436.6)
Serum IgA (IpaC)70.7 (38.1 to 131.4)317.5 (72.0 to 1399.2)272.2 (84.9 to 872.2)400.0 (144.4 to 1108.0)
SecondaryIgG 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.

Time frame:
56 Days
Reported as:
Median · ASC per 10^6 PBMCs
IgG and IgA Antigen-Specific Antibody Secreting Cell (ASC) Mucosal Responses
ASC per 10^6 PBMCs10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
ASC IgG (Invaplex)0.5 (0.0 to 4.5)4.0 (3.0 to 9.0)5.0 (5.0 to 12.0)9.0 (4.0 to 17.0)
ASC IgA (Invaplex)1.00 (1.0 to 2.0)27.0 (20.0 to 96.0)23.0 (15.0 to 62.0)41.5 (24.0 to 73.0)
ASC IgG (LPS)0.0 (0.0 to 0.5)0.0 (0.0 to 0.0)1.0 (0.0 to 3.0)2.0 (0.0 to 9.0)
ASC IgA (LPS)0.0 (0.0 to 0.0)4.0 (1.0 to 23.0)1.0 (0.0 to 7.0)3.0 (0.0 to 12.0)
SecondaryIgG 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.

Time frame:
56 Days
Reported as:
Median · fold change
IgG and IgA Antigen-Specific Antibody Lymphocyte Supernatant (ALS) Mucosal Responses
fold change10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
ALS IgG (Invaplex)1.2 (0.8 to 1.8)8.6 (2.5 to 29.7)9.3 (2.9 to 30.5)7.0 (2.8 to 17.6)
ALS IgA (Invaplex)1.3 (0.7 to 2.4)8.6 (2.4 to 30.5)3.7 (1.3 to 10.9)4.3 (1.7 to 10.7)
ALS IgG (LPS)1.2 (0.8 to 1.8)2.9 (1.4 to 6.0)4.0 (1.9 to 8.5)3.5 (1.8 to 6.7)
ALS IgA (LPS)1.1 (0.9 to 1.3)3.2 (1.5 to 6.7)2.0 (1.2 to 3.4)2.1 (1.2 to 3.9)

Adverse events

Collected over Through study completion, an average of 8 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
10 μg S. Flexneri 2a Invaplex0/9 (0%)0/9 (0%)9/9 (100%)
50 μg S. Flexneri 2a Invaplex0/9 (0%)0/9 (0%)9/9 (100%)
250 μg S. Flexneri 2a Invaplex0/10 (0%)0/10 (0%)10/10 (100%)
500 μg S. Flexneri 2a Invaplex0/10 (0%)0/10 (0%)10/10 (100%)
Most frequent other events
Showing 10 of 55
Most frequent other events
Event10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a Invaplex
Nasal CongestionRespiratory, thoracic and mediastinal disorders6/95/96/1010/10
Post-Nasal DripRespiratory, thoracic and mediastinal disorders2/94/96/109/10
EpistaxisRespiratory, thoracic and mediastinal disorders0/97/94/103/10
PharyngitisInfections and infestations3/91/94/107/10
RhinorrheaRespiratory, thoracic and mediastinal disorders4/95/97/106/10
Nasal Mucosal HyperemiaRespiratory, thoracic and mediastinal disorders2/91/96/102/10
HeadacheNervous system disorders3/92/94/105/10
SneezingRespiratory, thoracic and mediastinal disorders4/93/95/105/10
Nasal ItchingRespiratory, thoracic and mediastinal disorders1/94/91/102/10
FatigueGeneral disorders3/92/92/104/10

Baseline characteristics

Age, Continuous
Age, Continuous(years)10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a InvaplexTotal
Median24 (22 to 28)34 (26 to 42)28 (27 to 31)28 (24 to 36)28 (24 to 34)
Sex: Female, Male
Sex: Female, Male(Participants)10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a InvaplexTotal
Female251210
Male749828
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a InvaplexTotal
Hispanic or Latino01102
Not Hispanic or Latino9891036
Unknown or Not Reported00000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a InvaplexTotal
American Indian or Alaska Native00000
Asian00000
Native Hawaiian or Other Pacific Islander00000
Black or African American23049
White769628
More than one race00101
Unknown or Not Reported00000
Region of Enrollment
Region of Enrollment(participants)10 μg S. Flexneri 2a Invaplex50 μg S. Flexneri 2a Invaplex250 μg S. Flexneri 2a Invaplex500 μg S. Flexneri 2a InvaplexTotal
United States99101038
07

Study locations

1 site
  • Walter Reed Army Institute of Research, Clinical Trials Center
    Silver Spring, Maryland 20910, United States
08

Registry details

Key details

Study ID
NCT02445963
Lead sponsor
U.S. Army Medical Research and Development Command
Responsible party
Sponsor
First posted
May 15, 2015
Start date
Oct 1, 2015
Primary completion
May 13, 2016
Completion
May 13, 2016
Results posted
Jul 22, 2020
Last update
Feb 12, 2021

Study contacts

Christopher Duplessis, MD, MPH, MS
principal investigator · Enteric Diseases Department Naval Medical Research Center

Oversight

Data monitoring committee
No
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