NMRC-M3V-Ad-PfCA Vaccine - Clinical Trial 1

• Part A Dose-escalation: Assess the safety and tolerability of NMRC-M3V-Ad-PfCA, in a dose-escalation design, in healthy, malaria-naïve adults. [ Time Frame: study duration ] [ Designated as safety issue: Yes ]
  NMRC-M3V-Ad-PfCA
• Part B Regimen-comparison: Assess the safety and tolerability of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined (NMRC-M3V-Ad-PfCA). [ Time Frame: study duration ] [ Designated as safety issue: Yes ]
  NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA
• Part B Regimen Comparison: Assess the protective efficacy against sporozoite challenge (Pf, 3D7 strain) of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined (NMRC-M3V-Ad-PfCA). [ Time Frame: study duration ] [ Designated as safety issue: No ]

• • Assess the safety and tolerability of NMRC-M3V-Ad-PfCA, in a dose-escalation design, in healthy, malaria-naïve adults.
• Assess the safety and tolerability of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined (NMRC-M3V-Ad-PfCA).
• Assess the protective efficacy against sporozoite challenge (Pf, 3D7 strain) of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined (NMRC-M3V-Ad-PfCA).
• Part A Dose-escalation
• Part B Regimen-comparison

• Part A Dose-escalation: Assess the immunogenicity of NMRC-M3V-Ad-PfCA in healthy, malaria- naïve adults. [ Time Frame: study duration ] [ Designated as safety issue: No ]
• Part B Regimen-comparison: Assess immunogenicity of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined. (NMRC-M3V-Ad-PfCA) [ Time Frame: study duration ] [ Designated as safety issue: No ]
• Part B Regimen-comparison: Compare immunogenicity and protective efficacy of one vs. two doses of NMRC-M3V-Ad-PfCA. [ Time Frame: study duration ] [ Designated as safety issue: No ]
• Part B Regimen-comparison: Compare immunogenicity and protective efficacy of two doses of NMRC-M3V-Ad-PfCA administered at short (ten days) vs long (16 weeks) intervals. [ Time Frame: study duration ] [ Designated as safety issue: Yes ]

• Part A Dose-escalation
• • Assess the immunogenicity of NMRC-M3V-Ad-PfCA in healthy, malaria- naïve adults.
• Part B Regimen-comparison
• Assess immunogenicity of the two components individually (NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA) and when combined. (NMRC-M3V-Ad-PfCA)
• Compare immunogenicity and protective efficacy of one vs. two doses of NMRC-M3V-Ad-PfCA.
• Compare immunogenicity and protective efficacy of two doses of NMRC-M3V-Ad-PfCA administered at short (ten days) vs long (16 weeks) intervals.

The purpose of this study is to determine whether a new investigational malaria vaccine is safe, well tolerated and effective against experimental exposure to malaria when given to healthy people with no previous exposure to malaria. The vaccine consists of a modified form of a relatively common virus, adenovirus, that has been rendered incapable of replicating itself and modified to deliver the malaria gene of interest to the body's cells allowing the cell to manufacture the protein encoded by the gene and present it to the body's immune system in a more natural and presumably effective way.

The vaccine, called NMRC-M3V-Ad-PfCA (key: NMRC + Multi-antigen Multi-stage, Malaria Vaccine + Adenovectored + P. falciparum CSP & AMA1 antigens), is a combination of two recombinant adenovirus-derived constructs (adenovectors), one expressing the pre-erythrocytic stage antigen circumsporozoite protein (CSP) and the other expressing the erythrocytic stage antigen Apical Membrane Antigen 1 (AMA1), both from the 3D7 strain of P. falciparum. The vector is an attenuated, replication-deficient adenovirus derived from wildtype serotype 5 adenovirus through the deletion of several genes. The vaccine is formulated in a buffered saline solution (Final Formulation Buffer = FFB).

This is a Phase 1/2a, randomized, open-label, dose-escalating trial of the NMRC-M3V-Ad-PfCA vaccine administered intramuscularly to healthy, malaria-naïve adult volunteers. All volunteers will be seronegative (< 1:500, by a luciferase-based neutralizing antibody assay; VRC, Bethesda) for adenovirus serotype 5. In the first part of the study (dose-escalation phase, Part A), 1 x 1010 particle units (pu) per construct or 2 x 1010 pu total will be administered to six volunteers as a single dose to assess safety, and 4 weeks later, 5 x 1010 pu per construct or 1 x 1011 pu total dose (five-fold dose escalation) will be administered to six additional volunteers. In the second part of the study (regimen-comparison phase, Part B), three regimens for administration will be compared: one dose, two doses administered ten days apart, and two doses administered 16 weeks apart. Separate groups will receive one dose of the individual components of the vaccine (NMRC-MV-Ad-PfC and NMRC-MV-Ad-PfA). Following immunization, volunteers participating in the regimen-comparison phase as well as several non-immunized control volunteers (serving as infectivity controls) will be challenged with P. falciparum sporozoites in order to assess vaccine efficacy against non-immunized controls challenged at the same time. The proposed design of the regimen-comparison phase will provide information to direct selection of an appropriate dosing regimen for subsequent studies, and will also indicate whether the two constituent antigens, when co-formulated, act synergistically, independently, or interfere with each other in the induction of antigen-specific immune responses and protective immunity.

• Biological: NMRC-M3V-Ad-PfCA
  Malaria Vaccine
• Biological: NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA
  Malaria Vaccines

• Experimental: Dose-escalation
  Intervention: Biological: NMRC-M3V-Ad-PfCA
• Experimental: Regimen-comparison
  Intervention: Biological: NMRC-MV-Ad-PfC, NMRC-MV-Ad-PfA

• Li S, Locke E, Bruder J, Clarke D, Doolan DL, Havenga MJ, Hill AV, Liljestrom P, Monath TP, Naim HY, Ockenhouse C, Tang DC, Van Kampen KR, Viret JF, Zavala F, Dubovsky F. Viral vectors for malaria vaccine development. Vaccine. 2006 Aug 1 Ophorst OJ, Radosevic K, Havenga MJ, Pau MG, Holterman L, Berkhout B, Goudsmit J, Tsuji M. Immunogenicity and protection of a recombinant human adenovirus serotype 35-based malaria vaccine against Plasmodium yoelii in mice. Infect Immun. 2006 Jan;74(1):313-20. Bruna-Romero O, Rocha CD, Tsuji M, Gazzinelli RT. Enhanced protective immunity against malaria by vaccination with a recombinant adenovirus encoding the circumsporozoite protein of Plasmodium lacking the GPI-anchoring motif. Vaccine. 2004 Sep 9;22(27-28):3575-84. Gilbert SC, Schneider J, Hannan CM, Hu JT, Plebanski M, Sinden R, Hill AV. Enhanced CD8 T cell immunogenicity and protective efficacy in a mouse malaria model using a recombinant adenoviral vaccine in heterologous prime-boost immunisation regimes. Vaccine. 2002 Jan 15;20(7-8):1039-45. Rodrigues EG, Zavala F, Nussenzweig RS, Wilson JM, Tsuji M. Efficient induction of protective anti-malaria immunity by recombinant adenovirus. Vaccine. 1998 Nov;16(19):1812-7.
• Tamminga C, Sedegah M, Regis D, Chuang I, Epstein JE, Spring M, Mendoza-Silveiras J, McGrath S, Maiolatesi S, Reyes S, Steinbeiss V, Fedders C, Smith K, House B, Ganeshan H, Lejano J, Abot E, Banania GJ, Sayo R, Farooq F, Belmonte M, Murphy J, Komisar J, Williams J, Shi M, Brambilla D, Manohar N, Richie NO, Wood C, Limbach K, Patterson NB, Bruder JT, Doolan DL, King CR, Diggs C, Soisson L, Carucci D, Levine G, Dutta S, Hollingdale MR, Ockenhouse CF, Richie TL. Adenovirus-5-vectored P. falciparum vaccine expressing CSP and AMA1. Part B: safety, immunogenicity and protective efficacy of the CSP component. PLoS One. 2011;6(10):e25868. Epub 2011 Oct 7.
• Sedegah M, Tamminga C, McGrath S, House B, Ganeshan H, Lejano J, Abot E, Banania GJ, Sayo R, Farooq F, Belmonte M, Manohar N, Richie NO, Wood C, Long CA, Regis D, Williams FT, Shi M, Chuang I, Spring M, Epstein JE, Mendoza-Silveiras J, Limbach K, Patterson NB, Bruder JT, Doolan DL, King CR, Soisson L, Diggs C, Carucci D, Dutta S, Hollingdale MR, Ockenhouse CF, Richie TL. Adenovirus 5-vectored P. falciparum vaccine expressing CSP and AMA1. Part A: safety and immunogenicity in seronegative adults. PLoS One. 2011;6(10):e24586. Epub 2011 Oct 7.

INCLUSION CRITERIA:

• Between the ages of 18-50 (inclusive)
• Negative results of HIV ELISA, HbSAg, anti-HCV antibody, and no other clinically significant abnormal laboratory results from screening.
• Adenovirus serotype 5 (Ad5) titer <1:500
• Able to provide written informed consent.
• Complete an Assessment of Understanding and verbalize an understanding of any questions answered incorrectly.
• In good general health without clinically significant medical history or physical exam abnormalities at screening.
• Willing to continue immunogenicity and clinical follow-ups for one year and telephone or mail (electronic/U.S. Postal) contact as long term safety monitoring provision for an additional four years (totaling five years of participation; immunized volunteers only).
• Male and female participants being immunized and female participants being challenged agree to use effective means of birth control (an FDA approved contraceptive, abstinence) between screening and 60 days following last clinical study visit or able to provide evidence of no reproductive capability.

EXCLUSION CRITERIA:

• Have a history of malaria infection, exposure to malaria infection(i.e. you have been to an area that has malaria within the past two years),lived in a country with malaria for more than 5 years or receipt of certain candidate malaria vaccines
• Known immune system disease
• Known blood, heart, liver, kidney disease
• At known significant risk for developing heart disease
• A positive result on HIV testing at screening
• A positive result on Hepatitis B or C testing at screening
• Removal of your spleen
• Taking medication that suppresses the immune system within 30 days of immunization.
• Received or will be receiving another vaccine within 30 days of immunization
• Received blood products (e.g. transfused with blood cells, platelets, plasma or serum) within 120 days of the immunization
• Have had serious adverse reactions to other vaccines including hives, anaphylaxis, respiratory difficulty, tongue/mouth/neck/throat/body swelling or abdominal pain
• Pregnant, breastfeeding, or planning to become pregnant during the next year
• Plan to participate (or have participated in the last 30 days) in any other research study including an investigational drug or device
• Unwilling or unable to participate/complete all study elements
• Evidence of previous infection with adenovirus 5 or prior receipt of an adenovirus containing vaccine.

• United States Agency for International Development (USAID)
• Congressionally Directed Medical Research Program (CDMRP)
• Military Infectious Diseases Research Program (MIDRP)
• Naval Medical Research Center