FLU-v is a broad spectrum influenza vaccine that targets regions conserved among multiple influenza strains. FLU-v adjuvanted with Montanide ISA-51 was shown to be safe in previous trials. This study aims to assess efficacy of adjuvanted FLU-v vaccine in protecting healthy volunteers against an influenza challenge delivered intranasally under quarantine. Efficacy of FLU-v will be assessed by measuring the incidence and severity of the disease in the treatment groups compared to the placebo group. In addition, the immune responses of the volunteers to FLU-v will also be explored.
Influenza is a highly variable virus. Most of the variability comes from the proteins on the viral capsid surface; NA and HA. Current vaccines use these highly variable, immunogenic proteins to induce production of neutralising antibodies, however because these proteins are different for each strain, and can also change over time within strains due to antigenic drift, a new vaccine is required each year designed specifically to the strain predicted to circulate that year. In the event of a mismatch between predicted and actual circulating strains, or the emergence of a new strain due to antigenic shift, the effectiveness of the annual vaccine is drastically reduced. These limitations are further compounded by the short manufacturing window between strain prediction and the start of the influenza season, as well as the limited supply of suitable eggs used for vaccine production. As a result of these issues, only a limited supply of annual vaccine is available. FLU-v, a novel peptide vaccine, aims to provide a broad-spectrum response using peptide antigens matching immunogenic regions of conserved viral proteins found inside the viral capsid. These antigens have been shown to induce cytotoxic T-cell responses and non-neutralising antibodies in both pre-clinical and clinical studies. The FLU-v vaccine administered with and without adjuvant has been demonstrated to be safe in previous trials, and addition of adjuvant Montanide ISA-51 was shown to produce superior immunological responses compared to non-adjuvanted FLU-v. Data from a previous phase IIb study conducted as part of the UNISEC consortium suggest that the cellular and/or humoral responses resulting from vaccination with adjuvanted FLU-v may reduce influenza symptom severity and duration, although the study was not powered to assess these efficacy measures. Presently, efficacy will be evaluated as a primary endpoint alongside safety as part of a single centre, placebo controlled, phase IIb viral challenge study, using influenza A 2009 H1N1 human virus, in suitable healthy subjects aged 18-60 years. Two dosing regimens will be explored. In addition, immunological endpoints will be addressed as exploratory endpoints.
Study Type
Subcutaneous injection in the upper arm with 500mcg of FLU-v as 0.5ml emulsion in 0.25ml of WFI and 0.25ml of adjuvant Montanide ISA-51
Subcutaneous injection in the upper arm with 0.5ml emulsion made of 0.25ml of WFI and 0.25ml of adjuvant Montanide ISA-51
On day 0, administration with an intranasal sprayer of 1ml of PBS containing 10(7) TCID50 of Influenza A 2009 H1N1 human virus manufactured under GMP in certified Vero cells.
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London, United Kingdom
Number of Participants With Mild to Moderate Influenza Disease (MMID)
To determine the effect of FLU-v on reducing the incidence of Mild to Moderate Influenza Disease (MMID) defined as detectable viral shedding by Luminex Respiratory Pathogen Panel Test (RPP) in the presence of at least one influenza symptom.
Time frame: From 24h post-viral inoculation (Day 1) until the end of the quarantine phase on Day 7
Number of Treatment Emergent Adverse Events (TEAEs) Per Subject.
To determine the number of TEAEs that were reported after the first administration of the vaccine until the end of the study (overall) and then separated into pre-inoculation (events reported from the time of first vaccination up to Day 0 prior to time of inoculation) and post-inoculation (Day 0 inoculation time through study completion).
Time frame: From the first vaccination on day -43 to the last follow up visit on day 63.
Number of Subjects With Treatment Emergent Adverse Event Classified by Relatedness and Severity.
Number of subjects with one or more AE are reported by severity (mild, moderate and severe) and relatedness to vaccine or challenge virus inoculation (definitely, probably, possibly, unlikely, not related).
Time frame: From the day of the first vaccination up to the end of the study on day +63.
Number of Subjects With Detectable Viral Shedding and Number of Subjects With Recorded Influenza Symptoms During the Quarantine Period.
Number of subjects experiencing at least one influenza symptom and at least two influenza symptoms. Number of subjects with detectable shedding by RPP (Luminex) test from nasal swabs. Number asymptomatic subjects with detectable virus by RPP (Luminex) test from nasal swabs.
Time frame: Quarantine period from day 1 to day 7 post-inoculation.
Viral Shedding Duration
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INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
153
Number of days with detectable viral shedding measured using the Luminex Respiratory Pathogen Panel test.
Time frame: starting from evening of Day 1 post-inoculation up to Day 7.
Total Viral Shedding (Area Under the Curve)
Shedding is quantified by RT-PCR from nasal swabs taken twice daily (am/pm) during the quarantine period. Plotting the log copy number/ml for each time point against time is done to calculate the area under the curve (AUC) using the trapezoidal rule.
Time frame: from the evening of Day 1 post-inoculation to the morning of Day 7 (last timepoint before expected quarantine discharge)
Peak Viral Load
Shedding is quantified by RT-PCR from nasal swabs taken twice daily (am/pm) during the quarantine period. Peak viral load is the highest recorded log10copy number/ml.
Time frame: from the evening of Day 1 post-inoculation to the morning of Day 7 (last timepoint before expected quarantine discharge)
Duration of Influenza Symptoms
Subjects were assessed by the physician whilst under quarantine post-inoculation. The number of days subjects experienced influenza symptoms was recorded.
Time frame: from the evening of Day 1 post-inoculation to the morning of Day 7 (last timepoint before expected quarantine discharge)
Number of Symptoms Experienced Per Subject Per Day.
Mean of total number of symptoms (upper and lower respiratory and systemic symptoms) experienced calculated as the total sum of symptoms experienced divided by the number of days in which symptoms were collected.
Time frame: from the evening of Day 1 post-inoculation to the morning until the day of last symptom noted during the expected quarantine period (up tp Day 7)
Peak Number of Symptoms Experienced Per Subject in a Single Day.
The highest level of the total sum of all upper and lower respiratory tract and systemic symptoms recorded on any day starting from the evening of Day 1 post-inoculation until the day of last symptom noted during the expected quarantine period (up to Day 7).
Time frame: from the evening of Day 1 post-inoculation until the day of last symptom noted during the expected quarantine period (up to Day 7).
Assessment of Self-reported Influenza Symptoms by FLU-PRO Questionnaire.
FLU-PRO assesses 32 influenza symptoms. Subjects rate each symptom on a 5-point ordinal scale, with higher scores indicating a more frequent sign or symptom. For 27 of the items, the scale is as follows: 0 ("Not at all"), 1 ("A little bit"), 2 ("Somewhat"), 3 ("Quite a bit"), and 4 ("Very much"). For 5 items, severity is assessed in terms of numerical frequency, i.e., vomiting or diarrhea (0 times, 1 time, 2 times, 3 times, or 4 or more times); with frequency of sneezing, coughing, and coughed up mucus or phlegm evaluated on a scale from 0 ("Never") to 4 ("Always").The FLU-PRO total score is computed as a mean score across all 32 items comprising the instrument. Total scores can range from 0 (symptom free) to 4 (very severe symptoms).
Time frame: from Day 1 post-inoculation until the day 7.