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
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).
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.
Exclusion Criteria:
Research specific
Prior Exposure to Shigella
10 subjects vaccinated on days 0, 14, 28
Biological: Shigella flexneri 2a InvaplexAR
10 subjects vaccinated on days 0, 14, 28
Biological: Shigella flexneri 2a InvaplexAR
10 subjects vaccinated on days 0, 14, 28
Biological: Shigella flexneri 2a InvaplexAR
10 subjects vaccinated on days 0, 14, 28
Biological: Shigella 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.
Number of Treatment Related Adverse Events
Number of adverse events related to the vaccine for each arm
Time frame: 166 days
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
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
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
| Milestone | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex |
|---|---|---|---|---|
| Started | 9 | 9 | 10 | 10 |
| Completed | 7 | 9 | 9 | 10 |
| Not completed | 2 | 0 | 1 | 0 |
| Withdrew: Lost to follow-up | 1 | 0 | 0 | 0 |
| Withdrew: Change in employment | 1 | 0 | 0 | 0 |
| Withdrew: Symptoms post-vaccination | 0 | 0 | 1 | 0 |
Number of adverse events related to the vaccine for each arm
| Adverse Events | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex |
|---|---|---|---|---|
| Number of Treatment Related Adverse Events | 27 | 37 | 41 | 46 |
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.
| titers | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 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) |
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.
| ASC per 10^6 PBMCs | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 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) |
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.
| fold change | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 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) |
Collected over Through study completion, an average of 8 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| 10 μg S. Flexneri 2a Invaplex | 0/9 (0%) | 0/9 (0%) | 9/9 (100%) |
| 50 μg S. Flexneri 2a Invaplex | 0/9 (0%) | 0/9 (0%) | 9/9 (100%) |
| 250 μg S. Flexneri 2a Invaplex | 0/10 (0%) | 0/10 (0%) | 10/10 (100%) |
| 500 μg S. Flexneri 2a Invaplex | 0/10 (0%) | 0/10 (0%) | 10/10 (100%) |
| Event | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex |
|---|---|---|---|---|
| Nasal CongestionRespiratory, thoracic and mediastinal disorders | 6/9 | 5/9 | 6/10 | 10/10 |
| Post-Nasal DripRespiratory, thoracic and mediastinal disorders | 2/9 | 4/9 | 6/10 | 9/10 |
| EpistaxisRespiratory, thoracic and mediastinal disorders | 0/9 | 7/9 | 4/10 | 3/10 |
| PharyngitisInfections and infestations | 3/9 | 1/9 | 4/10 | 7/10 |
| RhinorrheaRespiratory, thoracic and mediastinal disorders | 4/9 | 5/9 | 7/10 | 6/10 |
| Nasal Mucosal HyperemiaRespiratory, thoracic and mediastinal disorders | 2/9 | 1/9 | 6/10 | 2/10 |
| HeadacheNervous system disorders | 3/9 | 2/9 | 4/10 | 5/10 |
| SneezingRespiratory, thoracic and mediastinal disorders | 4/9 | 3/9 | 5/10 | 5/10 |
| Nasal ItchingRespiratory, thoracic and mediastinal disorders | 1/9 | 4/9 | 1/10 | 2/10 |
| FatigueGeneral disorders | 3/9 | 2/9 | 2/10 | 4/10 |
| Age, Continuous(years) | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex | Total |
|---|---|---|---|---|---|
| Median | 24 (22 to 28) | 34 (26 to 42) | 28 (27 to 31) | 28 (24 to 36) | 28 (24 to 34) |
| Sex: Female, Male(Participants) | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex | Total |
|---|---|---|---|---|---|
| Female | 2 | 5 | 1 | 2 | 10 |
| Male | 7 | 4 | 9 | 8 | 28 |
| Ethnicity (NIH/OMB)(Participants) | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 0 | 1 | 1 | 0 | 2 |
| Not Hispanic or Latino | 9 | 8 | 9 | 10 | 36 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 2 | 3 | 0 | 4 | 9 |
| White | 7 | 6 | 9 | 6 | 28 |
| More than one race | 0 | 0 | 1 | 0 | 1 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 | 0 |
| Region of Enrollment(participants) | 10 μg S. Flexneri 2a Invaplex | 50 μg S. Flexneri 2a Invaplex | 250 μg S. Flexneri 2a Invaplex | 500 μg S. Flexneri 2a Invaplex | Total |
|---|---|---|---|---|---|
| United States | 9 | 9 | 10 | 10 | 38 |
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U.S. Army Medical Research and Development Command