An Early Phase 1 interventional study of GA2 and BCG in Malaria,Falciparum, sponsored by Leiden University Medical Center. Status unknown at 1 site in Netherlands. Open to participants aged 18 Years to 35 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-02-10.
Sponsored by Leiden University Medical Center · Early Phase 1, Interventional, and Prevention
This study will assess the coadministration of genetically attenuated Plasmodium falciparum ∆mei2 (GA2) sporozoites with adjuvants (BCG and YF-17D vaccination and imiquimod cream). Primary outcomes will be safety, tolerability and protective efficacy against CHMI.
This will be an adaptive design single center, randomized controlled partly blinded, partly open-label clinical proof-of-principle trial of the genetically attenuated parasite GA2 co-administered with adjuvants in healthy, malaria-naïve male and female participants with no prior history of BCG or YF-17D vaccination. A total of 45 participants will be immunized by the bites of 50 GA2 infected mosquitos. Additionally, ten participants will serve as infectivity controls and will be exposed to the bites of 50 uninfected mosquitoes in the immunization phase.
During the 42 days following the immunization, there will be four out-patient visits and one phone call visit to evaluate adverse events and for hematology, biochemistry and immunology laboratory assessment. Six weeks after immunization, all 45 participants will undergo a CHMI through the bites of 5 mosquitos infected with wild-type 3D7 sporozoites. From day 6 to 21 after CHMI, participants will be followed daily on an out-patient basis to determine parasite loads detected by a quantitative polymerase chain reaction (qPCR). As soon as parasitemia is detected (cut-off >100p/mL), or at the latest 28 days after CHMI, participants will be treated with a curative regimen of antimalarials. The trial will be held in two cohorts: the second cohort starting 4 weeks after the first. The first cohort will consist of 10 participants and the second cohort will consist of 15 participants. Both cohorts will be block randomized to the five different study groups.
The study will consist of three stages. In stage A of the study, ten GA2 immunized participants will be compared to five infectivity controls in a blinded design. If the protective efficacy of the GA2 immunized group is ≤7/10 and some efficacy is seen in stage A (either ≥10% protection or significant increase in time to parasitemia) then the study will progress to stage B. In this stage, BCG (n=5), YF-17D (n=5) or imiquimod (n=5) will be applied/administered to the GA2 administration site. Additionally, two infectivity controls will participate in stage B. Stage B will be open label.
Based on the data on safety, tolerability and immunogenicity, the most favorable adjuvant of stage B can be chosen to be further assessed in stage C. In stage C, additional participants will be immunized with 50 GA2 infected mosquitoes in combination with the selected adjuvant. Additionally, a group of five unadjuvanted GA2 immunized participants and three infectivity controls will participate. The adjuvanted group of stage C will be open-label, the unadjuvanted group and the infectivity controls will be blinded.
384 studies on the registry are indexed under Malaria, Falciparum; 38 are open to participants now.
This study's planned enrollment of 45 is below the median of 132 across 319 interventional studies indexed under Malaria, Falciparum.
Browse Malaria, Falciparum studies →Leiden University Medical Center is the lead sponsor of 326 studies on the registry; 106 are open to participants now.
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Exclusion Criteria:
a. Body Mass Index (BMI) >35.0 kg/m2 at screening. b. An elevated risk of cardiovascular disease, defined as: i. An estimated ten-year risk of fatal cardiovascular disease of ≥5% at screening, as determined by the Systematic Coronary Risk Evaluation 2 (SCORE2) .
ii. History, or evidence at screening, of clinically significant arrhythmia's, prolonged QT-interval or other clinically relevant ECG abnormalities; or iii. A positive family history of cardiac events in first- or second-degree relatives (according to the system used in medical genetics) \<50 years old.
c. Known functional asplenia, sickle cell trait/disease, thalassemia trait/disease or G6PD deficiency.
d. History of epilepsy in the period of five years prior to study onset, even if no longer on medication.
e. Positive HIV, HBV or HCV screening tests. f. Chronic use of i) immunosuppressive drugs, ii) antibiotics, iii) or other drugs that might have an influence on the immune system (excluding inhaled and topical corticosteroids and incidental use of oral anti-histamines), within three months prior to study onset or expected use of such during the study period.
g. Skin disease affecting the site of administration in such a way that administration of mosquito bites or adjuvants is deemed impossible by investigator.
h. History of malignancy of any organ system (other than localized basal cell carcinoma of the skin), treated or untreated, within the past five years.
i. Any history of treatment for severe psychiatric disease by a psychiatrist in the past year.
j. History of drug or alcohol abuse interfering with normal social functioning in the period of one year prior to study onset, positive urine toxicology test for cocaine or amphetamines at screening.
Immunization with 50 GA2-infected mosquito bites
Biological: GA2
Mock-immunization with 50 uninfected-mosquito bites
Other: Mock immunization
Immunization with 50 GA2-infected mosquito bites and a standard intradermal BCG vaccination (0.1 mL)
Biological: GA2 · Biological: BCG
Immunization with 50 GA2-infected mosquito bites and a one fifth fractional (0.1 mL) intradermal YF-17D vaccination
Biological: GA2 · Biological: YF-17D (fractional ID dose)
Immunization with 50 GA2-infected mosquito bites and 250mg imiquimod cream 5%
Biological: GA2 · Drug: Imiquimod
GA2 sporozoites administered by 50 mosquito bites
0.1 mL BCG vaccine intradermally
0.1 mL YF17D vaccine intradermally
Also known as: Stamaril
250mg imiquimod 5% cream topical
Also known as: Aldara
50 bites by uninfected mosquitoes
Time to parasitemia
The time to parasitemia (qPCR \>100p/mL) (prepatent period) after CHMI in participants immunized with the GA2 parasite co-administered with an adjuvant compared to the unadjuvanted group and the infectivity controls.
Time frame: Moment of CHMI to antimalarial treatment (28 days post CHMI)
Safety and tolerability: frequency and magnitude of adverse events in all study groups.
The number of graded adverse events occurring in each group will be calculated as absolute numbers. Frequencies will be calculated by dividing the number of graded adverse events occurring in each group by the total number of volunteers in each group
Time frame: Moment of immunization to 35 days post CHMI
Protective efficacy
Proportion of participants immunized with the GA2 parasite co-administered with an adjuvant that do not develop parasitemia (qPCR \>100p/mL) (sterile protection) after CHMI comparted the unadjuvanted group and the infectivity controls.
Time frame: Moment of CHMI to antimalarial treatment (28 days post CHMI)
Humoral immune responses of volunteers exposed to different intervention arms
Difference in concentration of anti-CSP antibodies between intervention arms as assessed by ELISA.
Time frame: Moment of immunization, pre-CHMI and up to 182 days post CHMI
Cellular immune responses of volunteers exposed to different intervention arms
Difference in percentage of CD4+ and CD8+ T-cells producing IFN-γ between intervention arms as assessed by flow cytometry.
Time frame: Moment of immunization, pre-CHMI and up to 182 days post CHMI
Plan to share: No
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Leiden University Medical Center