Safety and Immunogenicity of the Recombinant BCG Vaccine AERAS-422 in Healthy BCG-naïve Adults: A Randomized, Active-controlled, First-in-human Phase 1 Trial
Daniel F Hoft, Azra Blazevic, Asmir Selimovic, Aldin Turan, Jan Tennant, Getahun Abate, John Fulkerson, Daniel E Zak, Robert Walker, Bruce McClain, Jerry Sadoff, Judy Scott, Barbara Shepherd, Jasur Ishmukhamedov, David A Hokey, Veerabadran Dheenadhayalan, Smitha Shankar, Lynn Amon, Garnet Navarro, Rebecca Podyminogin, Alan Aderem, Lew Barker, Michael Brennan, Robert S Wallis, Anne A Gershon, Michael D Gershon, Sharon Steinberg, Daniel F Hoft, Azra Blazevic, Asmir Selimovic, Aldin Turan, Jan Tennant, Getahun Abate, John Fulkerson, Daniel E Zak, Robert Walker, Bruce McClain, Jerry Sadoff, Judy Scott, Barbara Shepherd, Jasur Ishmukhamedov, David A Hokey, Veerabadran Dheenadhayalan, Smitha Shankar, Lynn Amon, Garnet Navarro, Rebecca Podyminogin, Alan Aderem, Lew Barker, Michael Brennan, Robert S Wallis, Anne A Gershon, Michael D Gershon, Sharon Steinberg
Abstract
Background: We report a first-in-human trial evaluating safety and immunogenicity of a recombinant BCG, AERAS-422, over-expressing TB antigens Ag85A, Ag85B, and Rv3407 and expressing mutant perfringolysin.
Methods: This was a randomized, double-blind, dose-escalation trial in HIV-negative, healthy adult, BCG-naïve volunteers, negative for prior exposure to Mtb, at one US clinical site. Volunteers were randomized 2:1 at each dose level to receive a single intradermal dose of AERAS-422 (>10(5)-<10(6)CFU=low dose, ≥10(6)-<10(7)CFU=high dose) or non-recombinant Tice BCG (1-8×10(5)CFU). Randomization used an independently prepared randomly generated sequence of treatment assignments. The primary and secondary outcomes were safety and immunogenicity, respectively, assessed in all participants through 182days post-vaccination. ClinicalTrials.gov registration number: NCT01340820.
Findings: Between Nov 2010 and Aug 2011, 24 volunteers were enrolled (AERAS-422 high dose, n=8; AERAS-422 low dose, n=8; Tice BCG, n=8); all were included in the safety and immunogenicity analyses. All 24 subjects had at least one adverse event, primarily expected local reactions. High dose AERAS-422 vaccination induced Ag85A- and Ag85B-specific lymphoproliferative responses and marked anti-mycobacterial activity in a whole blood bactericidal activity culture assay (WBA), but was associated with varicella zoster virus (VZV) reactivation in two vaccinees. These volunteers displayed high BCG-specific IFN-γ responses pre- and post-vaccination possibly predisposing them to autocrine/paracrine negative regulation of immune control of latent VZV. A systems biology transcriptomal approach identified positive correlations between post-vaccination T cell expression modules and WBA, and negative correlations between post-vaccination monocyte expression modules and WBA. The expression of one key macrophage marker (F4/80) was constitutively elevated in the two volunteers with zoster.
Interpretation: The unexpected development of VZV in two of eight healthy adult vaccine recipients resulted in discontinuation of AERAS-422 vaccine development. Immunological and transcriptomal data identified correlations with the development of TB immunity and VZV that require further investigation.
Funding: Aeras, FDA, Bill and Melinda Gates Foundation.
Keywords: Functional T cell assays; Herpes zoster;; Recombinant BCG;; Transcriptomes;; Tuberculosis;.
Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
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