Study of a Novel Therapeutic Vaccine Against Hepatitis C Using Ad6NSmut and MVA-NSmut in Chronically Infected Patients (HCV004)
The purpose of this study is to determine whether administration of recombinant IMPs Ad6NSmut and MVA-NSmut (experimental vaccines for hepatitis C) in HCV chronically infected patients in combination with the standard Interferon/ribavirin therapy is safe and induces an immunological response.
|Study Design:||Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Phase Ib Study to Assess the Safety and Immunogenicity of a Novel HCV Vaccine, Based on the Sequential Injection of Ad6NSmut and MVA-NSmut, Given in Combination With PEG-Interferon Alfa Plus Ribavirin for Re-treatment of Chronic Hepatitis C|
- Number and severity of adverse events [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]Safety is assessed by the frequency, incidence and nature of adverse events and serious adverse events arising during the study. Abnormal clinical findings from medical history, examination or blood, will be assessed as to their clinical significance. All AEs occurring during the study observed by the investigator or reported by the patient, whether or not attributed to study medication, will be reported in the CRF. All AEs that result in a patient's withdrawal from the study or that are present at the end of the study, will be followed up until a satisfactory resolution occurs, or until a non-study related causality is assigned.
- IFNγ ELISpot. Unit: IFNγ spot forming cells (SFC)/ million splenocytes [ Time Frame: 6 months ] [ Designated as safety issue: No ]The primary assay to monitor vaccine immunogenicity is the IFNγ ELISpot. This is an established immunological assay to measure cell mediated immune response against HCV NS proteins. Immunogenicity data analysis will be based on tabulations of HCV NS-specific responses at times pointed out in the study visit flow chart. Analysis of immunogenicity data collected will be performed at the end of the study.
- HCV-RNA. Unit: viral genomes/ml/ALT [ Time Frame: 6 months ] [ Designated as safety issue: No ]Viral dynamics is determined by measuring over time both HCV-RNA levels, by commercially available quantitative assays, and Serum alanino-aminotransferase (ALT). ALT and HCV-RNA data are then fitted into a bio-mathematical model to evaluate the effects of the antiviral therapy regimens on the viral load and the infected cell decline throughout the whole treatment course.
|Study Start Date:||March 2012|
|Study Completion Date:||February 2013|
|Primary Completion Date:||October 2012 (Final data collection date for primary outcome measure)|
Experimental: Unique Arm
Biological: Ad6NSmut, MVA-NSmut
2 doses Ad6NSmut at week 0 and 4, then 2 doses of MVA-NSmut at weeks 8 and 12. PEG-IFN/RBV therapy starts at week 10 after first vaccination
An effective antiviral T cell response can mediate HCV viral control and induce the spontaneous resolution of HCV during primary infection. This observation strongly supports the case for the development of T cell induction strategies as a potential therapy for HCV. A hallmark of persistent HCV infection, when viral loads are high, is a weak and narrowly focused HCV specific T cell response, whereas in resolved infection with undetectable viral loads robust T cell responses are detected. A very potent immunization strategy might overcome this problem and induce a strong and diversified cell mediated immune response against HCV.
The rationale of using HCV vaccine in combination with PEG-IFN/RBV is supported both, by in vitro models and by mathematical models of HCV dynamics under antiviral therapy. Studies of viral dynamics suggested that HCV RNA kinetics result from the sum of two major actions or phases: inhibition of viral production and reduction of infected cells number. The mathematical model, relying on both HCV-RNA and alanine aminotransferase (ALT) measures after PEG-IFN/RBV therapy, suggests that the elimination of infected cells by the immune system could play a major role in sustaining viral reduction. This view is in accordance with the results of a recent study showing that IFN-γ, one of the cytokines secreted by CTLs (Cytotoxic T Lymphocyte) and NK (Natural Killer) cells, is able to inhibit HCV genomic and subgenomic replication in an "in vitro" model. In the mathematical description the parameter that represents the putative "non lytic" control of HCV replication during antiviral therapy is φ, resulting from the difference π-δ0, where π and δ0 are the time constant of the second phase decay of viraemia and of the infected cells, respectively. Interestingly, the median value of parameter φ, which is inversely related to the half-life of HCV-RNA molecules in the infected cells after phase 1, was significantly higher in sustained responders than in transient responders and non responders (NR). In addition, whereas the baseline HCV-RNA production was comparable in all patients regardless of their outcome, the median value of the residual HCV-RNA production during therapy was significantly higher in NR than in responders. This data support the hypothesis that to reach a sustained response and an efficacious control of the infection, the elimination of the infected cells is more relevant than a strong inhibition of viral production. All the above considerations support the hypothesis that vaccination might be a new therapeutic opportunity to a cohort of consecutive HCV genotype 1a and 1b infected patients who failed to respond to PEG-IFN/RBV therapy. Therefore a potent induction of T cell responses in chronically infected patients might be used in combination with the current antiviral therapy in order to achieve sustained response in previously partial responders or relapsers.
|Azienda Ospedaliera Universitaria Pisana. Ospedale di Santa Chiara|
|Pisa, Italy, 56126|
|Azienda Ospedaliera Universitaria di Pisa. Ospedale di Cisanello|
|Pisa, Italy, 56126|
|Study Chair:||Ferruccio Bonino, Prof.||Azienda Ospedaliera Universitaria. Università di Pisa. Italy|
|Principal Investigator:||Maurizia Brunetto, Dr.||Azienda Ospedaliera Universitaria. Università di Pisa. Italy|