- Authors
- Spring, Michele D; Cummings, James F; Ockenhouse, Christian F; Dutta, Sheetij; Reidler, Randall; Angov, Evelina; Bergmann-Leitner, Elke; Stewart, V Ann; Bittner, Stacey; Juompan, Laure; Kortepeter, Mark G; Nielsen, Robin; Krzych, Urszula; Tierney, Ev; Ware, Lisa A; Dowler, Megan; Hermsen, Cornelus C; Sauerwein, Robert W; de Vlas, Sake J; Ofori-Anyinam, Opokua; Lanar, David E; Williams, Jack L; Kester, Kent E; Tucker, Kathryn; Shi, Meng; Malkin, Elissa; Long, Carole; Diggs, Carter L; Soisson, Lorraine; Dubois, Marie-Claude; Ballou, W Ripley; Cohen, Joe; Heppner, Jr, D Gray
- Part of
- PLoS ONE, 2009-04, Vol.4 (4), p.e5254--e5254
- Abstract
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- This Phase 1/2a study evaluated the safety, immunogenicity, and efficacy of an experimental malaria vaccine comprised of the recombinant Plasmodium falciparum protein apical membrane antigen-1 (AMA-1) representing the 3D7 allele formulated with either the AS01B or AS02A Adjuvant Systems.
After a preliminary safety evaluation of low dose AMA-1/AS01B (10 microg/0.5 mL) in 5 adults, 30 malaria-naïve adults were randomly allocated to receive full dose (50 microg/0.5 mL) of AMA-1/AS01B (n = 15) or AMA-1/AS02A (n = 15), followed by a malaria challenge. All vaccinations were administered intramuscularly on a 0-, 1-, 2-month schedule. All volunteers experienced transient injection site erythema, swelling and pain. Two weeks post-third vaccination, anti-AMA-1 Geometric Mean Antibody Concentrations (GMCs) with 95% Confidence Intervals (CIs) were high: low dose AMA-1/AS01B 196 microg/mL (103-371 microg/mL), full dose AMA-1/AS01B 279 microg/mL (210-369 microg/mL) and full dose AMA-1/AS02A 216 microg/mL (169-276 microg/mL) with no significant difference among the 3 groups. The three vaccine formulations elicited equivalent functional antibody responses, as measured by growth inhibition assay (GIA), against homologous but not against heterologous (FVO) parasites as well as demonstrable interferon-gamma (IFN-gamma) responses. To assess efficacy, volunteers were challenged with P. falciparum-infected mosquitoes, and all became parasitemic, with no significant difference in the prepatent period by either light microscopy or quantitative polymerase chain reaction (qPCR). However, a small but significant reduction of parasitemia in the AMA-1/AS02A group was seen with a statistical model employing qPCR measurements.
All three vaccine formulations were found to be safe and highly immunogenic. These immune responses did not translate into significant vaccine efficacy in malaria-naïve adults employing a primary sporozoite challenge model, but encouragingly, estimation of parasite growth rates from qPCR data may suggest a partial biological effect of the vaccine. Further evaluation of the immunogenicity and efficacy of the AMA-1/AS02A formulation is ongoing in a malaria-experienced pediatric population in Mali.
www.clinicaltrials.gov NCT00385047.
- Subjects
- Adjuvants, Immunologic - administration & dosage; Adjuvants, Immunologic - pharmacology; Adolescent; Adult; Adults; Alleles; Analysis; Animals; Antigens; Antigens, Protozoan - administration & dosage; Antigens, Protozoan - genetics; Antigens, Protozoan - immunology; Appropriate technology; Aquatic insects; Biological effects; Biological response modifiers; Confidence intervals; Double-Blind Method; Drug Combinations; Effectiveness; Enzyme-Linked Immunosorbent Assay; Enzymes; Erythema; Evaluation; Formulations; Goats; Growth rate; Health care; Homology; Humans; Immune response; Immunogenicity; Immunology; Infectious Diseases; Interferon; Light microscopy; Lipid A - administration & dosage; Lipid A - analogs & derivatives; Lipid A - pharmacology; Lymphocytes; Malaria; Malaria vaccine; Malaria Vaccines - administration & dosage; Malaria Vaccines - adverse effects; Malaria Vaccines - immunology; Malaria, Falciparum - prevention & control; Mathematical models; Medical research; Medical societies; Medicine, Experimental; Membrane proteins; Membrane Proteins - administration & dosage; Membrane Proteins - genetics; Membrane Proteins - immunology; Microbiology; Middle Aged; Mosquitoes; Multidisciplinary; Pain; Parasitemia; Parasites; Peptides; Plasmodium falciparum; Plasmodium falciparum - immunology; Plasmodium falciparum - metabolism; Polymerase chain reaction; Population (statistical); Proteins; Protozoan Proteins - administration & dosage; Protozoan Proteins - genetics; Protozoan Proteins - immunology; Safety; Saponins - administration & dosage; Saponins - pharmacology; Statistical analysis; Studies; Vaccination; Vaccine efficacy; Vaccines; Vector-borne diseases; γ-Interferon