This is an open-label evaluation of the safety, tolerability, immunogenicity and efficacy of PfSPZ Vaccine administered by direct venous inoculation (DVI) in healthy, malaria-naïve adult subjects.
The study will be conducted as a collaborative effort between the NMRC, UMB CVD, WRAIR and Sanaria, Inc. The study screening, immunizations, and follow-ups for Groups 1 \& 2 will take place at the UMB CVD. The study screening, immunizations, and follow-ups for Groups 3 \& 4 will take place at the NMRC CTC in Bethesda, MD. The controlled human malaria infections (CHMI) will be conducted at WRAIR Entomology, Silver Spring, MD for NMRC subjects, and at UMB CVD for UMB CVD subjects. There will be 4 groups and a total of 92 subjects (60 immunized subjects and 32 infectivity controls). Group 1 (n = 15) subjects will receive PfSPZ Vaccine administered by direct venous inoculation (DVI), with 4 doses of 4.5 x 10\^5 PfSPZ given every two days, followed by a single, boosting dose of 4.5 x 10\^5 PfSPZ given 16 weeks later. For participants who were not protected after the first CHMI, an additional boosting dose of 4.5x10\^5 PfSPZ will be given 21 weeks later. Group 2 (n = 15) subjects will receive PfSPZ Vaccine administered by DVI, with 3 doses of 9.0 x 10\^5 PfSPZ administered every 8 weeks. For participants who were not protected after the first CHMI, a boosting dose of 9.0 x 10\^5 PfSPZ will be given 21 weeks later. Group 3 (n = 15) subjects will receive PfSPZ Vaccine administered by DVI, with 3 doses of 18 x 10\^5 PfSPZ administered every 8 weeks. Following CHMI at 40 weeks, protected subjects and one-half of unprotected subjects will receive a final, boosting dose of 18 x 10\^5 PfSPZ. The remaining half of unprotected subjects will receive a final, boosting dose of 4.5 x 10\^5 PfSPZ. Group 4 (n = 15) subjects will receive PfSPZ Vaccine administered by DVI, with 27 x 10\^5 PfSPZ administered once as a priming dose, followed by 2 doses of 9.0 x 10\^5 PfSPZ administered every 8 weeks. Following CHMI at 40 weeks, protected subjects and one-half of unprotected subjects will receive a final, boosting dose of 9 x 10\^5 PfSPZ. The remaining half of unprotected subjects will receive a final, boosting dose of 2.25 x 10\^5 PfSPZ. Protective efficacy will be assessed by CHMI, conducted by exposure to the bites of three to five mosquitoes infected with heterologous (7G8 or NF135.C10) Pf parasites, with the number of mosquitoes depending on the infection intensity in the mosquitoes). At UMB CVD, protective efficacy will be assessed at both 28 and 40 weeks after the first immunization, in Groups 1 and 2, along with 8 infectivity controls for each CHMI. At NMRC, protective efficacy will be assessed at 40 weeks (7G8 infected mosquitoes), and 66 weeks (NF135.C10 infected mosquitoes) after the first immunization, in Groups 3 and 4. Unprotected subjects in Groups 1 and 2, and all subjects in Groups 3 and 4, will be invited to receive a booster vaccination 21 days prior to the second CHMI at the respective sites, in order to assess the efficacy of a booster dose in previously vaccinated persons. These vaccine subjects may participate in the second CHMI whether or not they were protected in the first CHMI, and independent of their decision to receive the booster immunization, to serve as controls for the effect of the first CHMI on immunity. Subjects may proceed to CHMI provided they have received at least two of the three immunizations scheduled for Groups 2-4, or at least two of the four priming immunizations as well as the boost scheduled for Group 1. 7G8-infected mosquitoes may be substituted for NF135.C10 mosquitoes in case of difficulties with mosquito production. Two subjects in each group will serve as "pilot subjects" in the event of first in human dosing, and will be immunized approximately 24 hours prior to the rest of the subjects in the respective group. If there are no safety concerns identified in the pilot subjects that trigger the stopping rules, then the remainder of subjects will be immunized the day after the pilot subjects are immunized. Subjects will be followed for 56 days beyond both the week 40 and week 66 CHMIs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
92
Aseptic, purified, cryopreserved, radiation-attenuated, Plasmodium falciparum (Pf) sporozoites
CHMI is conducted by exposure to the bites of five mosquitoes infected with heterologous (7G8) Pf parasites.
CHMI is conducted by exposure to the bites of three to five mosquitoes infected with heterologous (NF135.C10) Pf parasites.
University of Maryland-Baltimore, Center for Vaccine Development
Baltimore, Maryland, United States
Naval Medical Research Center
Silver Spring, Maryland, United States
Incidence and type of Adverse Events
Incidence and type of adverse events (including breakthrough infections), vital signs, clinical laboratory assessments, physical examination findings post first immunization onwards.
Time frame: 52 weeks
Efficacy
Evidence of vaccine-mediated protection against CHMI at 28 and 40 weeks in Groups 1 and 2 by preventing blood stage infection for 28 days (as detected by qPCR) following CHMI. Evidence of vaccine-mediated protection against CHMI at 40 and 66 weeks in Groups 3 and 4 by preventing blood stage infection for 28 days (as detected by blood smear analysis) following CHMI.
Time frame: 28 days post-CHMI
Immunological response
Antibody responses by PfCSP ELISA two weeks after the second, third and booster immunizations (Groups 2-4) or after the fourth, fifth and booster immunizations (Group 1) (serum dilution at which the optical density is 1.0 referred to as the OD 1.0) Positive predictive values for anti-PfCSP antibody responses at or above a threshold for predicting sterile protection following CHMI (threshold = OD 1.0 of 2,000)
Time frame: 2 weeks post-immunization and 28 days post-CHMI
Immunological outcomes
1. Antibody titers to other Pf proteins by ELISA 2. Antibody titers to Pf parasite stages by IFA 3. Capacity of sera from immunized volunteers to inhibit sporozoite invasion (ISI) of hepatocytes in vitro by ISI assay 4. Analysis of antibodies to any of the thousands of proteins in the Pf proteome using proteome array chips 5. Analysis of cellular immune responses against PfSPZ, Pf-infected erythrocytes and/or synthetic peptides and/or recombinant proteins from defined Pf proteins by multi-parameter intracellular staining (ICS) by flow cytometry 6. Analysis of cellular immune responses against PfSPZ, Pf-infected erythrocytes and/or synthetic peptides and/or recombinant proteins from defined Pf proteins by fluorospot assays 7. Human gene expression profiling focusing on immune response genes 8. Analysis of host cellular, cytokine and other host responses by Luminex or Luminex-type assays
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Time frame: Day of immunization till 28 days post-CHMI