The purpose of this clinical trial is to evaluate the safety and immunogenicity of BW-1014. BW-1014 is a nanoemulsion (NE) adjuvanted recombinant Hemagglutinin 5 (rH5) that would protect against pandemic flu. The study will be conducted in 40 healthy adults volunteers, age 18 - 45, in one center in the United States. The study will compare 3 different dose levels of rH5 (25µg, 50µg and 100µg rH5 in 20% NE adjuvant using a pipette dropper with rH5 control (100µg without NE adjuvant) and placebo control (saline). The investigational product will be administered in 2 doses intranasally (IN). This will be followed 6 months later with a licensed H5N1 IIV IM vaccine. In addition to safety outcome, homologous and heterologous immunological outcomes will be tested in nasal wash, serum, and blood cells.
This study is a single center, phase 1, first-in-human, single-center, randomized, placebo-controlled, double-blind study to assess the safety, tolerability, and immunogenicity of a primary series of intranasal recombinant H5 influenza vaccine with and without nanoemulsion adjuvant followed by boosting dose of licensed, intramuscular influenza A (H5N1) vaccine. Participants will be randomized in one of the following 5 arms: A. BW-1014: 25 µg / 20% NE; 8 participants. B. BW-1014: 50 µg / 20% NE; 8 participants. C. BW-1014: 100 µg / 20% NE; 8 participants. D. rH5 control: 100µg; 8 participants. E. Saline (Placebo); 8 participants. Because this is a dose escalation trial, our study has four stages with one cohort receiving vaccines at each stage. Up to 40 participants will be randomized to one of the five study groups at an allocation ratio depending on the escalation stage. If all participants proceed to vaccination, the final vaccine allocation ratio will be 1:1:1:1:1. Subjects will receive a primary series of two intranasal vaccinations of study treatment administered on Days 1 and 29. Subject dosing will proceed in a stepwise process. Each dose of adjuvanted study vaccine will be assessed in sentinel participants before the remainder of the study group is vaccinated and before proceeding to vaccination of sentinel participants with the next higher dose of adjuvanted study vaccine. Following receipt of the first vaccine dose, sentinel participants will be followed for 7 days for halting criteria and SMC data review prior to proceeding with vaccination of the remainder of the study group. All participants will subsequently receive a third dose of intramuscular, heterologous influenza A (H5N1) vaccine on Day 197. Participants will be followed for safety and immunology endpoints for one year following their second study treatment vaccination. Participants will be assessed for production of specific mucosal and humoral antibodies in addition to cellular immune response in mononuclear cells collected from peripheral blood and from nasal wash fluid throughout the study. These assessments will be to both homologous H5N1 clade 2.1 and heterologous H5N1 clade 1.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
40
20% Nanoemulsion and 25 µg recombinant H5 antigen administered intranasally by an electronic pipette (500µL) Two doses administered 4 weeks apart
20% Nanoemulsion and 50 µg recombinant H5 antigen administered intranasally by an electronic pipette (500µL) Two doses administered 4 weeks apart
20% Nanoemulsion and 100 µg recombinant H5 antigen administered intranasally by an electronic pipette (500µL) Two doses administered 4 weeks apart
100 µg recombinant H5 antigen (without adjuvant) administered intranasally by an electronic pipette (500µL) Two doses administered 4 weeks apart
Saline (negative control) administered intranasally by an electronic pipette (500µL) Two doses administered 4 weeks apart
90 µg H5N1 IIV administered intramuscularly (1 mL) One booster dose administered 6 months following last immunization
Center for Vaccine Development and Global Health, University of Maryland School of Medicine
Baltimore, Maryland, United States
Safety Outcome: Number of participants reporting local or systemic reactions
Local and systemic reactions will be assessed in the clinic within 1 hour of intranasal BW-1014, positive control, and placebo administration, including visual assessment of nasal passages
Time frame: Up to Day 29
Safety Outcome: Number of participants reporting solicited reactions and general AEs
Solicited reactions and general AEs will be assessed in follow up visit/phone call within 7 days of vaccination with intranasal BW-1014, positive control and placebo
Time frame: Up to Day 36
Safety Objective: Number of participants reporting unsolicited AEs
Unsolicited AEs will be assessed in follow up visits/phone calls within 28 days of primary vaccinations with intranasal BW-1014, positive control and placebo
Time frame: Up to Day 57
Safety Outcome: Number of participants reporting any hematological and biochemical laboratory abnormality (Class 1 of higher)
Hematological and biochemical laboratory abnormality (Class 1 of higher) will be assessed in follow up visits within 7 days of first dose intranasal BW-1014 or within 14 days second dose intranasal BW-1014, positive control, and placebo
Time frame: Up to Day 43
Safety Outcome: Number of participants reporting medically attended AEs (MAAEs)
MAAEs will be assessed in follow up visits/phone calls within 28 days of primary vaccinations with intranasal BW-1014, positive control, and placebo
Time frame: Up to Day 57
Safety Outcome: Number of participants reporting serious adverse events (SAEs)
SAEs will be assessed by study arm. An adverse event is considered "serious" if it results in death, or a life-threatening AE, or in hospitalization, or in a substantial disruption of the ability to conduct normal life functions, or in a congenital anomaly/birth defect.
Time frame: Up to Day 393
Safety Outcome: Number of participants reporting potential immune-mediated medical conditions (PIMMCs)
PIMMCs will be assessed by follow up visits/phone calls following vaccinations with intranasal BW-1014, positive control, and placebo
Time frame: Up to Day 393
Safety Outcome: Number of participants reporting new onset chronic medical conditions (NOCMCs)
NOCMCs will be assessed by follow up visits/phone calls following vaccinations with intranasal BW-1014, positive control, and placebo
Time frame: Up to Day 393
Safety endpoint: Number of participants reporting local or systemic reactions to intramuscular H5N1 IIV vaccine
Local or systemic reactions will be assessed within 1 hour of vaccination with intramuscular H5N1 IIV vaccine
Time frame: Day 197
Safety endpoint: Number of participants reporting solicited reactions and general AEs
Solicited reactions and general AEs will be assessed within 7 days of vaccination with intramuscular H5N1 IIV vaccine
Time frame: Day 204
Safety endpoint: Number of participants reporting unsolicited AEs
Unsolicited AEs will be assessed within 28 days of vaccinations with intramuscular H5N1 IIV vaccine
Time frame: Day 225
Safety endpoint: Number of participants reporting any hematological and biochemical laboratory abnormality (Class 1 of higher)
Hematological and biochemical laboratory abnormality (Class 1 of higher) will be assessed within 7 days of vaccination with intramuscular H5N1 IIV vaccine,
Time frame: Day 204
Safety endpoint: Number of participants reporting medically attended AEs (MAAEs)
MAAEs will be assessed within 28 days of vaccination with intramuscular H5N1 IIV vaccine,
Time frame: Day 225
Primary Humoral Immune Response Outcome: HI Geometrical Mean Titers levels
The primary humoral immune response to homologous H5N1 (clade 2.1) will be measured using hemagglutinin inhibition assays after two doses of intranasal vaccine or placebo
Time frame: Up to Day 57
Primary Humoral Immune Response Outcome: Rates of seroconversion
Rates of seroconversion are defined as the percentage of subjects with either a pre-vaccination HI titer \< 1:10 and a post-vaccination HI titer \> 1:40 or a pre-vaccination HI titer \> 1:10 and a minimum of four-fold rise in post-vaccination HI antibody titer.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: Day 57 compared to Day 1
Primary Humoral Immune Response Outcome: IgA and IgG endpoint titer levels
Strain-specific GMT by ELISA will be measured using ELISA after two doses of intranasal vaccine or placebo
Time frame: Up to Day 57
Primary Mucosal Immunogenicity Outcome: Mucosal vaccine-specific IgA Geometric Mean Titer (GMT)
Mucosal vaccine-specific IgA Geometric Mean Titer (GMT) will be assessed by ELISA
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific activation marker (CD69), cytokines/chemokines
Vaccine-specific activation marker (CD69) will be assessed in cells isolated from the nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific activation marker (CD154), cytokines/chemokines
Vaccine-specific activation marker (CD154) will be assessed in cells isolated from the nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal vaccine-specific IgG Geometric Mean Titer (GMT)
Mucosal vaccine-specific IgG Geometric Mean Titer (GMT) will be assessed by ELISA
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific IFN-gamma
Vaccine-specific cytokine (IFN-gamma) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific TNF-α
Vaccine-specific cytokine (TNF-α) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific IL-4
Vaccine-specific cytokine (IL-4) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific IL-2
Vaccine-specific cytokine (IL-2) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific IL-10
Vaccine-specific cytokine (IL-10) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific IL-21
Vaccine-specific cytokine (IL-21) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific CD107a
Vaccine-specific degranulation marker (CD107a) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific Granzyme B
Vaccine-specific degranulation marker (Granzyme B) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific T-cell memory subset (effector memory cell)
Vaccine-specific T-cell memory subset (effector memory cell) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific T-cell memory subset (central memory cell)
Vaccine-specific T-cell memory subset (central memory cell) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197
Primary Mucosal Immunogenicity Outcome: Mucosal Vaccine-specific T-cell memory subset (effector memory CD45RA+ cell)
Vaccine-specific T-cell memory subset (effector memory CD45RA+ cell) will be assessed in cells isolated from nasal cavity by Flow Cytometry
Time frame: Up to Day 197