This randomized, placebo controlled single center study examines the extent to which 600 mg/m2/day of orally administered ISLA101 (fenretinide), given prophylactically or therapeutically, may reduce or eliminate signs and symptoms of dengue virus (DENV) infection over 29 days following subcutaneous challenge of healthy subjects with 'Dengue 1 Live Virus Human Challenge' (DENV-1-LVHC). Humoral and cellular immune responses, both innate and adaptive, circulating virus, and changes in clinical laboratory measures will also be examined.
Pharmacology studies have identified the potential for fenretinide to inhibit the binding of the DENV nonstructural protein 5 (NS5) to host nuclear importins (IMPs) IMP-α and IMP-β1, thereby impairing infection and replication. This Phase 2 study is to evaluate the effectiveness of fenretinide in an encapsulated oral formulation (ISLA101) against challenge with Dengue 1 Live Virus Human Challenge (DENV-1-LVHC) product, both prophylactically and therapeutically. Oral doses will be taken with a high fat meal to improve absorption, as fenretinide is known to have poor gut permeability attributed to its accumulation in lipophilic cell membranes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
15
ISLA101 is an oral gelatin capsule containing 100 mg of fenretinide (N-\[4-Hydroxyphenyl\]retinamide, mw 391.56) dissolved in corn oil and polysorbate 80. ISLA101 capsules will be administered orally as one dose of 300 mg/m2 each 12 hours (q12 +/-1 h).
The DENV-1-LVHC investigational challenge material consists of the dengue-1 virus strain 45AZ5 as a powder, lyophilized for reconstitution. The product is reconstituted with 0.7 mL of water for injection (WFI) and diluted to a concentration of 6.5 x 103 PFU/mL.
Placebo capsules will be administered orally as one dose of 300 mg/m2 each 12 hours (q12 +/-1 h).
SUNY Upstate Medical University
East Syracuse, New York, United States
Characterization of DENV viremia following inoculation
Area under the curve of RNAemia by qRT-PCR for Cohort 1 Time to loss of detection of dengue virus RNAemia for Cohort 2
Time frame: over 29 days from inoculation
To further characterize circulating virus in the two interventional groups versus control
Time to positive RNAemia by qRT-PCR
Time frame: over 29 days from inoculation
To characterize circulating virus in the two interventional groups versus control
Peak level of RNAemia by qRT-PCR
Time frame: over 29 days from inoculation
To characterize circulating virus in the two interventional groups versus control
Duration of RNAemia by qRT-PCR (Cohort 1)
Time frame: Over 29 days from inoculation
To characterize circulating virus in the two interventional groups versus control
Area under the curve of RNAemia by qRT-PCR (Cohort 2)
Time frame: Over 29 days from inoculation
To characterize circulating virus in the two interventional groups versus control
Levels of infectious virus in blood by Plaque Assay
Time frame: Over 29 days from inoculation
To determine the effect of ISLA101 on solicited signs and symptoms of DENV when given prophylactically and through Day 21 post-inoculation, or only as delayed therapy
The calculated score of solicited signs and symptoms associated with dengue virus infection, including any of the listed events below, will consist of summing the CTCAE grades across all days for all events, where the score will be summarized by number of positive subjects: * Fever, nausea, vomiting, fatigue, rash, abdominal pain, eye pain, bone pain, joint pain, muscle pain, headache.
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Time frame: Over 29 days from inoculation
To compare the occurrence of unanticipated signs or symptoms of severe dengue
The proportion of subjects with any of the following: * diffuse abdominal pain or tenderness, * persistent vomiting, * clinical fluid accumulation (ascites, pleural effusion), * mucosal bleeding, * lethargy, * restlessness, * liver enlargement \>2 cm, * increase in hematocrit concurrent with rapid decrease in platelet count. * severe plasma leakage, * severe hemorrhage, * severe organ impairment.
Time frame: Over 29 days from inoculation
To compare the need for hospital care between groups
Proportion of subjects hospitalized for dengue symptoms
Time frame: Over 29 days from inoculation
To compare the need for hospital care between groups
Length of hospitalization stay for dengue symptoms
Time frame: Over 29 days from inoculation
To compare the need for hospital care between groups
Number of days in the intensive care unit for each hospitalization for dengue symptoms
Time frame: Over 29 days from inoculation
To evaluate changes from baseline in platelet among the three groups
Number of participants with abnormal platelet counts, observed over 29 days from inoculation, will be summarized overall, by group, by duration and by toxicity grade for each group compared with control. A summary of subjects with shifts from baseline (relative to normal range) in laboratory test results will be provided.
Time frame: Over 29 days from inoculation
To describe the Cmax of ISLA101 at the tested dose, route, and duration
Concentration-time plots of first and NEXT-TO-LAST dose of ISLA101
Time frame: from first to next to last dose of ISLA101 (Day 24) for Cohort 1
To describe the Tmax of ISLA101 at the tested dose, route, and duration
Concentration-time plots of first and NEXT-TO-LAST dose of ISLA101
Time frame: from first to next to last dose of ISLA101 (Day 24) for Cohort 1
To describe the Cmax of ISLA101 at the tested dose, route, and duration
Concentration-time plots of first and NEXT-TO-LAST dose of ISLA101
Time frame: from first to next to last dose of ISLA101 (Day 21) for Cohort 2
To describe the Tmax of ISLA101 at the tested dose, route, and duration
Concentration-time plots of first and NEXT-TO-LAST dose of ISLA101
Time frame: from first to next to last dose of ISLA101 (Day 21) for Cohort 2