Heterologous Effects of BCG in Healthy UK Adults

Evaluation of the Heterologous Effects of Bacille Calmette-Guérin (BCG) Vaccination in Healthy UK Adults

TB038 is a clinical study to assess the non-specific effects of BCG vaccination and gain a better understanding of how the body's immune system reacts to BCG and in turn potentially prevents infection from other bacteria.

Study Overview

• Status: Completed
• Conditions: Tuberculosis
• Intervention / Treatment: Drug: BCG SSI; Drug: BCG Sii; Other: No vaccination

Detailed Description

Since 1927, it has been observed that BCG-vaccinated neonates have lower all-cause mortality rates. This heterologous or non-specific effect within the first 6-12 months of life has been demonstrated in randomised and observational studies in low income countries with high childhood mortality rates. The most consistent effect is reduced neonatal mortality due to fewer cases of neonatal sepsis, respiratory infection and fever. The main limitation of these studies is the risk of confounding inherent in their cross sectional and observational designs. It is essential that we determine the cogency of this effect, as potential BCG replacement vaccines must be non-inferior to BCG in this regard.

There is a plausible rationale that BCG, a replicating mycobacterium, is capable of inducing non-specific innate immunity, which could induce protection against disease and death from non-mycobacterial infections early in life. For example, intravesical BCG is an effective treatment for bladder cancer, an effect presumed to be non-specific and innate. However, our understanding of the immunological mechanisms involved is incomplete. Data is needed from robust experiments to quantify any causal relationship between infant survival and BCG vaccination. Demonstrating an effect of recent BCG vaccination on the growth of common bacterial pathogens involved in neonatal sepsis, using whole blood in an in-vitro human model, would provide evidence to support a randomised controlled trial in infants in TB high burden countries and would impact on public health vaccination scheduling. In addition it would provide us with an in-vitro model by which to assess future BCG replacement vaccines.

Healthy BCG naïve adults in the UK have been selected for this study because of their low baseline level of anti-mycobacterial immunity and therefore reduced ability to suppress BCG growth. Whilst the target population for the heterologous effects of BCG vaccination is infants, the blood volume required in order to optimise the GIA would not be possible to collect from infants. Therefore by undertaking this work in healthy BCG naïve UK adults we can obtain the blood volumes required for this exploratory work in a population of individuals with a similar background mycobacterial exposure to infants in TB high burden, low income countries.

Volunteers in this study will receive BCG vaccination at the standard dose of 2-8x10^5 cfu. BCG SSI containing Mycobacterium bovis strain Danish 1331 is preferred as it is licensed in the UK for vaccination. However BCG SSI can frequently go into short supply globally with impact on UK supply. In the event of this occurring, BCG vaccine supplied by the Sii (Serum institute of India) will be used instead which contains Mycobacterium bovis BCG strain Moscow 361 I and is on the WHO list of prequalified vaccines. The same strain will be used for all volunteers.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Oxfordshire
    • Oxford, Oxfordshire, United Kingdom, OX3 7LE
      • Centre for Clinical Vaccinology and Tropical Medicine , University of Oxford
    • Oxford, Oxfordshire, United Kingdom, OX3 7LE
      • Oxford University Hospitals- John Warin Ward, University of Oxford
  • West Midlands
    • Birmingham, West Midlands, United Kingdom, B15 2TH
      • NIHR Wellcome Trust Clinical Research Facility, University of Birmingham

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Volunteers must meet all of the following criteria to enter the study:

• Healthy adult aged 18-45 years
• BCG naïve
• Resident in or near Oxford (for CCTVM and John Warin Ward) or Birmingham (for NIHR WTCRF) for the duration of the study period
• No relevant findings in medical history or on physical examination
• Allow the Investigators to discuss the volunteer's medical history with their GP
• Use effective contraception for the duration of the study period (females only)
• Agreement to refrain from blood donation during the duration of the study and for a period of 3 months after their last visit
• Give written informed consent
• Allow the Investigator to register volunteer details with a confidential database to prevent concurrent entry into clinical trials or studies
• Able and willing (in the Investigator's opinion) to comply with all the study requirements

Exclusion Criteria:

Volunteers must meet none of the following criteria to enter the study:

• Laboratory evidence at screening of latent M. tb infection as indicated by a positive IGRA response
• Clinical, radiological, or laboratory evidence of current active TB disease
• Previous vaccination with BCG, or any candidate TB vaccine
• Within the last year had close household contact with an individual with smear positive pulmonary tuberculosis
• Clinically significant history of skin disorder, allergy, immunodeficiency (including HIV), cancer (except BCC or CIS), cardiovascular disease, respiratory disease, gastrointestinal disease, liver disease, renal disease, endocrine disorder, neurological illness, psychiatric disorder, drug or alcohol abuse
• History of serious psychiatric condition
• Concurrent oral or systemic steroid medication or the concurrent use of other immunosuppressive agents
• Concurrent use of long term antibiotic therapy
• History of anaphylaxis to vaccination or any allergy likely to be exacerbated by any component of the BCG vaccine
• Any abnormality of screening blood or urine tests that is deemed to be clinically significant or that may compromise the safety of the volunteer in the study
• Positive HBsAg, HCV or HIV antibodies
• Female confirmed pregnant or intention to become pregnant during study period, or currently lactating
• Current involvement in another study or trial that involves regular blood tests or an investigational medicinal product
• Use of an investigational medicinal product or non-registered drug, live vaccine, or investigational medical device for four weeks prior to dosing with the study vaccine
• Administration of immunoglobulins and/or any blood products within the three months preceding the planned challenge date
• Any other significant disease, disorder, or finding, which, in the opinion of the Investigator, may either put the volunteer at risk, or may influence the result of the study, or may affect the volunteer's ability to participate in the study

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1; 32 BCG-naïve subjects receiving BCG SSI or BCG Sii at standard dose (2-8x10^5 cfu) via Intradermal route.	Drug: BCG SSI; Intradermal injection; Other Names: Bacille Calmette-Guérin Statens Serum Institute (BCG SSI); Drug: BCG Sii; intradermal injection; Other Names: Bacille Calmette-Guérin Serum Institute of India
Experimental: Group 2; 8-16 control volunteers receiving no vaccination.	Other: No vaccination

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Growth inhibition assays	Determine the heterologous effects of BCG vaccination in healthy UK adults using in-vitro Growth Inhibition Assays as a surrogate marker to assess the individuals' capacity to control growth of S. aureus, K. pneumonia, Group B streptococci and E.coli.	Up to Day 84

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Immune response markers	Evaluation of laboratory markers of the immune response that correlate with levels of bacterial growth inhibition identified using the in-vitro GIAs.	Up to Day 84

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Background levels of S. aureus, K. pneumonia, Group B streptococci and E.coli carriage.	Use of bacterial antibody titres, nasal swab culture and faecal culture to determine background levels of S. aureus, K. pneumonia, Group B streptococci and E.coli carriage in subjects in this study.	Up to Day 14
Confounding effects of BCG on bacterial growth.	Use of bacterial antibody titres, nasal swab culture and faecal culture to evaluate confounding effects of BCG on the growth of S. aureus, K. pneumonia, Group B streptococci and E.coli.	Up tp Day 14

Collaborators and Investigators

• Sponsor: University of Oxford

Publications and helpful links

General Publications

• Wilkie M, Tanner R, Wright D, Lopez Ramon R, Beglov J, Riste M, Marshall JL, Harris SA, Bettencourt PJG, Hamidi A, van Diemen PM, Moss P, Satti I, Wyllie D, McShane H. Functional in-vitro evaluation of the non-specific effects of BCG vaccination in a randomised controlled clinical study. Sci Rep. 2022 May 12;12(1):7808. doi: 10.1038/s41598-022-11748-x.

Helpful Links

• Jenner Institute Clinical Trials

Study record dates

Study Major Dates

• Study Start: February 1, 2015
• Primary Completion (Actual): November 1, 2016
• Study Completion (Actual): November 1, 2016

Study Registration Dates

• First Submitted: February 3, 2015
• First Submitted That Met QC Criteria: February 27, 2015
• First Posted (Estimate): March 5, 2015

Study Record Updates

• Last Update Posted (Estimate): November 30, 2016
• Last Update Submitted That Met QC Criteria: November 29, 2016
• Last Verified: October 1, 2016

More Information

Terms related to this study

• Keywords: BCG study
• Additional Relevant MeSH Terms: Infections; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Positive Bacterial Infections; Actinomycetales Infections; Mycobacterium Infections; Tuberculosis
• Other Study ID Numbers: TB038