Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
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Purpose
Malaria is one of the major infectious diseases in the world with a tremendous impact on the quality of life, significantly contributing to the ongoing poverty in endemic countries. It causes 800.000 deaths per year, the majority of which are children under the age of five. The malaria parasite enters the human body through the skin, by the bite of an infected mosquito. Subsequently, it invades the liver and develops and multiplies inside the hepatocytes. After a week, the hepatocytes burst open and the parasites are released in the blood stream, causing the clinical phase of the disease.
As a unique opportunity to study malaria immunology and efficacy of immunisation strategies, a protocol has been developed in the past to conduct controlled human malaria infections (CHMIs). CHMIs generally involve small groups of malaria-naïve volunteers infected via the bites of P. falciparum infected laboratory-reared Anopheline mosquitoes. Although potentially serious or even lethal, P. falciparum malaria can be radically cured at the earliest stages of blood infection when risks of complications are virtually absent.
The investigators have shown previously that healthy human volunteers can be protected from a malaria mosquito (sporozoite) challenge by immunization with sporozoites (by mosquito bites) under chloroquine prophylaxis (CPS immunization). Interestingly, sterile protection in 100% of the human CPS immunized volunteers was achieved by a relatively miniscule dose, i.e. a total of 45 infectious mosquito bites, strikingly 20-fold more potent than the 1000 bites needed in a model using irradiated mosquitoes. One possible explanation for this efficient induction of protective immunity, is the immune modulating effect of chloroquine. The investigators aim to assess this possible immune modulating effect in CPS immunization by comparing immunization with P. falciparum sporozoites under chloroquine with immunization under mefloquine prophylaxis, which has the same antimalarial effect, but not the immune modulating effects known from chloroquine.
| Condition | Intervention |
|---|---|
|
Malaria Plasmodium Falciparum |
Drug: Chloroquine prophylaxis Drug: Mefloquine prophylaxis Biological: Immunization Biological: Controlled Human Malaria Infection Drug: Malarone |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Basic Science |
| Official Title: | Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis |
- Duration of prepatent period after challenge infection as measured by microscopy [ Time Frame: 21 days after challenge (day 239 of the study) ] [ Designated as safety issue: No ]
- Development of parasitemia as measured by PCR [ Time Frame: 21 days after challenge (day 239 of study) ] [ Designated as safety issue: No ]
- Frequency of signs or symptoms in study groups [ Time Frame: Day 0 - day 358 of study ] [ Designated as safety issue: Yes ]
- Cellular immune responses between study groups [ Time Frame: Day 0 -day 358 of study ] [ Designated as safety issue: No ]
- Humoral immune responses between study groups [ Time Frame: Day 0 - 358 ] [ Designated as safety issue: No ]
| Enrollment: | 20 |
| Study Start Date: | January 2012 |
| Study Completion Date: | April 2013 |
| Primary Completion Date: | December 2012 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Chloroquine immunisation
This group will receive chloroquine prophylaxis, and three times infected mosquito-bites.
|
Drug: Chloroquine prophylaxis
Standard prophylactic regime: a loading dose of 300 mg on day 14 and day 17 and then 300 mg once a week, starting on day 21, for a total duration of 13 weeks. On day 0, day 3, day 7 and day 10, this group will receive a placebo.
Biological: Immunization
Group 1 and 2 will receive three immunizations with Plasmodium falciparum infected mosquito-bites. Group 3 will receive an equal number of uninfected mosquito-bites.
Biological: Controlled Human Malaria Infection
Exposure to the bites of 5 Plasmodium falciparum infected mosquitoes.
Drug: Malarone
When thick smear positive, of ar day 21 after challenge, all volunteers will be treated with malarone.
Other Name: atovaquon/proguanil
|
|
Experimental: Mefloquine immunisation
This group will receive mefloquine prophylaxis and infected mosquito-bites.
|
Drug: Mefloquine prophylaxis
Mefloquine prophylaxis, starting with a loading regime of split doses during the first three weeks: 125 mg on day 0, day 3, day 7, day 10, day 14 and day 17 and 250 mg once a week from day 21 onwards for a total duration of 13 weeks.
Biological: Immunization
Group 1 and 2 will receive three immunizations with Plasmodium falciparum infected mosquito-bites. Group 3 will receive an equal number of uninfected mosquito-bites.
Biological: Controlled Human Malaria Infection
Exposure to the bites of 5 Plasmodium falciparum infected mosquitoes.
Drug: Malarone
When thick smear positive, of ar day 21 after challenge, all volunteers will be treated with malarone.
Other Name: atovaquon/proguanil
|
|
Placebo Comparator: Mefloquine control
This group will receive mefloquine prophylaxis, and uninfected mosquito-bites.
|
Drug: Mefloquine prophylaxis
Mefloquine prophylaxis, starting with a loading regime of split doses during the first three weeks: 125 mg on day 0, day 3, day 7, day 10, day 14 and day 17 and 250 mg once a week from day 21 onwards for a total duration of 13 weeks.
Biological: Immunization
Group 1 and 2 will receive three immunizations with Plasmodium falciparum infected mosquito-bites. Group 3 will receive an equal number of uninfected mosquito-bites.
Biological: Controlled Human Malaria Infection
Exposure to the bites of 5 Plasmodium falciparum infected mosquitoes.
Drug: Malarone
When thick smear positive, of ar day 21 after challenge, all volunteers will be treated with malarone.
Other Name: atovaquon/proguanil
|
Eligibility| Ages Eligible for Study: | 18 Years to 35 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Age > 18 and < 35 years healthy volunteers (males or females)
- Good health based on history and clinical examination
- Negative pregnancy test
- Use of adequate contraception for females
- Signing of the informed consent form, thereby demonstrating understanding of the meaning and procedures of the study
- Agreement to inform the general practitioner and to sign a request to release medical information concerning contra-indications for participation in the study
- Willingness to undergo a Pf controlled infection through mosquito bites
- Agreement to stay in a hotel room close to the trial center during a part of the study (Day 5 after challenge till treatment is finished)
- Reachable (24/7) by mobile phone during the whole study period
- Available to attend all study visits
- Agreement to refrain from blood donation to Sanquin or for other purposes, during the whole study period
- Willingness to undergo HIV, hepatitis B and hepatitis C tests
- Negative urine toxicology screening test at screening visit and the day before challenge
- Willingness to take a prophylactic regime of chloroquine or mefloquine and curative regimen of Malarone®
Exclusion Criteria:
- History of malaria
- Plans to travel to malaria endemic areas during the study period
- Plans to travel outside of the Netherlands during the challenge period
- Previous participation in any malaria vaccine study and/or positive serology for Pf
- Symptoms, physical signs and laboratory values suggestive of systemic disorders including renal, hepatic, cardiovascular, pulmonary, skin, immunodeficiency, psychiatric, and other conditions which could interfere with the interpretation of the study results or compromise the health of the volunteers
- History of diabetes mellitus or cancer (except basal cell carcinoma of the skin)
- History of arrhythmias or prolonged QT-interval
- Positive family history in 1st and 2nd degree relatives for cardiac events < 50 years old
- An estimated, ten year risk of fatal cardiovascular disease of ≥5%, as estimated by the Systematic Coronary Risk Evaluation (SCORE) system
- Clinically significant abnormalities in electrocardiogram (ECG) at screening
- Body Mass Index (BMI) below 20 or above 30 kg/m2
- Any clinically significant deviation from the normal range in biochemistry or hematology blood tests or in urine analysis
- Positive HIV, HBV or HCV tests
- Participation in any other clinical study within 30 days prior to the onset of the study
- Enrollment in any other clinical study during the study period
- For women: pregnancy or lactation
- Volunteers unable to give written informed consent
- Volunteers unable to be closely followed for social, geographic or psychological reasons
- History of drug or alcohol abuse interfering with normal social function
- A history of treatment for psychiatric disease or moderate or severe psychological episode in volunteer
- A history of convulsions in volunteer
- Severe depression, anxiety disorder of psychosis in first or second degree family
- Contra-indications to Malarone®, chloroquine or mefloquine including hypersensitivity or treatment taken by the volunteer that interferes with Malarone®, chloroquine or mefloquine
- The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids and oral anti-histaminic are allowed) and during the study period
- Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia
- Co-workers or trainees of the departments of Medical Microbiology, Parasitology, or Internal Medicine of the Leiden University medical Centre
- A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency
Contacts and Locations| Netherlands | |
| Leiden University Medical Centre | |
| Leiden, Netherlands, 2333 ZA | |
| Principal Investigator: | Leo G Visser, MD, PhD | Leiden University Medical Centre |
More Information
Additional Information:
No publications provided
| Responsible Party: | Radboud University |
| ClinicalTrials.gov Identifier: | NCT01422954 History of Changes |
| Other Study ID Numbers: | ZonMw2 |
| Study First Received: | August 23, 2011 |
| Last Updated: | April 26, 2013 |
| Health Authority: | Netherlands: The Central Committee on Research Involving Human Subjects (CCMO) |
Additional relevant MeSH terms:
|
Malaria Protozoan Infections Parasitic Diseases Chloroquine Chloroquine diphosphate Mefloquine Malarone Amebicides Antiprotozoal Agents Antiparasitic Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
Antimalarials Antirheumatic Agents Anti-Inflammatory Agents, Non-Steroidal Analgesics, Non-Narcotic Analgesics Sensory System Agents Peripheral Nervous System Agents Physiological Effects of Drugs Anti-Inflammatory Agents Filaricides Antinematodal Agents Anthelmintics Central Nervous System Agents |
ClinicalTrials.gov processed this record on June 13, 2013