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A Phase 1/2A Study to Evaluate the Safety, Immunogenicity, and Shedding of MEDI-560 in Infants 1 to < 12 Months of Age

28 november 2011 uppdaterad av: MedImmune LLC

An Expanded Phase1/2a Randomized, Double-blind, Placebo-controlled Study to Evaluate the Safety, Tolerability, Immunogenicity, and Viral Shedding of MEDI-560, A Live, Attenuated Recombinant Parainfluenza Virus Type 3 (PIV3) Vaccine, Administered Intranasally to Healthy Infants 1 to <12 Mos. of Age

The primary objective of this study is to describe the safety and tolerability of 3 doses of MEDI-560 at 10^5 TCID50 when administered to children 6 to < 12 months of age who are HPIV3 (human parainfluenza virus type 3) seronegative at baseline and to infants 1 to < 3 months of age regardless of baseline serostatus.

Studieöversikt

Status

Avslutad

Betingelser

Detaljerad beskrivning

This is a randomized, double-blind, placebo-controlled, multidose Phase 1/2a multicenter study designed to evaluate the safety, tolerability, viral shedding, immunogenicity, and genotypic and phenotypic stability of MEDI-560 in infants 1 to < 12 months of age. Three doses of MEDI-560 at a dosage level of 10^5 TCID50 were administered 0, 2, and 4 months after enrollment to a 30-participant cohort of 6 to < 12 month-old HPIV3 seronegative children randomized 2:1 to MEDI-560 vs placebo. A second 160-participant cohort of 1 to < 3 month-old infants not screened for baseline serostatus was planned but was not opened to enrollment for reasons other than safety. Participants were followed for safety through 180 days post last dose. Nasal wash specimens were collected at screening and Days 7, 12, and 28 following each dose and during unscheduled illness visits to assess vaccine virus shedding and genotypic and phenotypic stability of any shed vaccine virus. Blood was collected at screening to determine eligibility and prior to Dose 1 for baseline serostatus. Blood for assessment of antibodies to HPIV3 was collected approximately 7 to 12 days after Dose 1 and Dose 3 and 1 month after each dose for antibodies to PIV3.

Studietyp

Interventionell

Inskrivning (Faktisk)

30

Fas

  • Fas 2
  • Fas 1

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

    • Arkansas
      • Bentonville, Arkansas, Förenta staterna, 72712
        • Children's Investigational Research Program
      • Little Rock, Arkansas, Förenta staterna, 72205
        • Arkansas Pediatric Clinic
    • California
      • Madera, California, Förenta staterna, 93637
        • Madera Family Medical Group
      • Roseville, California, Förenta staterna, 95678
        • Allergy Medical Group of the North Area
    • Florida
      • Miami, Florida, Förenta staterna, 33155
        • Miami Children's Hospital
      • Naranja, Florida, Förenta staterna, 33032
        • Homestead Clinical Research
      • Tampa, Florida, Förenta staterna, 33606
        • University of South Florida College of Medicine Department of Pediatrics
    • Hawaii
      • Honolulu, Hawaii, Förenta staterna, 96826-1032
        • Kapiolani Medical Center for Women and Children
    • Kentucky
      • Lexington, Kentucky, Förenta staterna, 40503
        • Michael W. Simon, M.D.
    • Louisiana
      • New Orleans, Louisiana, Förenta staterna, 70112
        • Tulane University
    • Massachusetts
      • Boston, Massachusetts, Förenta staterna, 02111
        • Tufts-New England Medical Center
    • Nebraska
      • Omaha, Nebraska, Förenta staterna, 68134
        • Meridian Clinical Research LLC
    • Nevada
      • Las Vegas, Nevada, Förenta staterna, 89107
        • Children's Lung Specialists Ltd.
    • New York
      • Syracuse, New York, Förenta staterna, 13210
        • SUNY Upstate Medical University
    • North Carolina
      • Durham, North Carolina, Förenta staterna, 27705
        • Duke Health Center- Pickett Road
    • Ohio
      • Cincinnati, Ohio, Förenta staterna, 45229-3039
        • Cincinnati Children's Hospital Medical Center
      • Cleveland, Ohio, Förenta staterna, 44106
        • University Hospitals Case Medical Center
    • Oklahoma
      • Tulsa, Oklahoma, Förenta staterna, 74127
        • Oklahoma State University Center for Health Sciences
    • Pennsylvania
      • Bethlehem, Pennsylvania, Förenta staterna, 18015
        • St. Luke's Hospital
      • Pittsburgh, Pennsylvania, Förenta staterna, 15202
        • Belleview Pediactric Assoc.
    • Tennessee
      • Kingsport, Tennessee, Förenta staterna, 37660
        • Holston Medical Group
    • Utah
      • St. George, Utah, Förenta staterna, 84790
        • Dixie Pediatrics
    • West Virginia
      • Huntington, West Virginia, Förenta staterna, 25701
        • University Physicians Internal Medicine

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

1 månad till 11 månader (Barn)

Tar emot friska volontärer

Ja

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  1. Male or female whose age on the day of randomization falls within one of the two age cohorts:

    Cohort 1: 6 to < 12 months (≥ 6 months of age and not yet reached their 1st year birthday); Cohort 2: 1 to < 3 months (> 28 days of age and not yet reached their 3rd month birthday)

  2. Cohort 1 only: Participant is seronegative to HPIV3 at screening as determined by ELISA; or the legal representative is willing to provide access to data documenting that the participant was screened for another MedImmune trial after written informed consent was obtained, and that the participant is seronegative to HPIV3 within 21 days prior to randomization into MI-CP150 as determined by ELISA at MedImmune
  3. Participant was the product of a normal full term pregnancy, defined as 36-42 weeks gestation
  4. Participant is in general good health
  5. Participant's legal representative is available by telephone
  6. Written informed consent and Health Insurance Portability and Accountability Act authorization (if applicable) obtained from the participant's legal representative
  7. Participant's legal representative is able to understand and comply with the requirements of the protocol as judged by the investigator
  8. Participant is available to complete the follow-up period of 180 days after the final dose of investigational product as required by the protocol
  9. Participant's legal representative is willing and able to bring the subject to the study site for evaluation of respiratory illness in accordance with the protocol

Exclusion Criteria:

  1. Any fever (≥ 100.4°F [≥ 38.0°C], regardless of route) or lower respiratory illness within 7 days prior to randomization
  2. Moderate or severe nasal congestion that in the investigator's opinion could prevent intranasal delivery of investigational product
  3. Cohort 1 only: weight < the fifth percentile for age on the day of randomization
  4. Cohort 2 only: history of low birth-weight (ie, < 2,500 grams at birth) or weight < fifth percentile for age on the day of randomization
  5. Any drug therapy (chronic or other) within 7 days prior to randomization or expected receipt through the protocol-specified blood collection 28 days after each investigational product dosing, except that infrequent use of over-the-counter medications such as pain relievers are permitted according to the judgment of the investigator
  6. Any current or expected receipt of immunosuppressive agents including steroids (≥ 2 mg/kg per day of prednisone or its equivalent, or ≥ 20 mg/day if the participant weighs >10 kg, given daily or on alternate days for ≥ 14 days); children in this category should not receive investigational product until immunosuppressive agents including corticosteroid therapy have been discontinued for ≥ 30 days; the use of topical steroids is permitted according to the judgment of the investigator
  7. History of receipt of blood transfusion or expected receipt through 30 days after final investigational product dosing
  8. History of receipt of immunoglobulin products or expected receipt through 30 days after final investigational product dosing
  9. Receipt of any investigational drug within 60 days prior to randomization or expected receipt through 30 days after final investigational product dosing
  10. Receipt of any live virus vaccine (excluding rotavirus vaccine) within 28 days prior to randomization or expected receipt within a 28-day window around any dose
  11. Receipt of any inactivated (eg, non-live) vaccine or rotavirus vaccine within 14 days prior to randomization or expected receipt within a 14-day window around any dose
  12. Known or suspected immunodeficiency, including human immunodeficiency virus
  13. Living in the same home or enrolled in the same classroom at day care with infants < 24 months of age within 28 days after each dose (only one child per household may be enrolled into the study)
  14. Contact with pregnant caregiver within 28 days after each dose
  15. Household contact with an immunocompromised person within 28 days after each dose; the participant should also avoid close contact with immunocompromised individuals for at least 28 days after each investigational product dose
  16. Household contact within 28 days after each dose with a healthcare worker who has direct patient care responsibilities or household contact within 28 days after each dose with someone who is a day care provider or preschool teacher for children < 24 months of age
  17. History of allergic reaction to any component of the investigational product
  18. Previous medical history or evidence of an intercurrent or chronic illness that, in the opinion of the investigator, may compromise the safety of the participant
  19. Known or suspected active or chronic hepatitis infection
  20. History of medical diagnosis of asthma, reactive airway disease, wheezing requiring medication, bronchoconstriction or treatment with a β2 agonist (eg, albuterol), cystic fibrosis, chronic lung disease of prematurity (eg, bronchopulmonary dysplasia), chronic pulmonary disease, medically confirmed apnea, hospitalization for respiratory illness or mechanical ventilation
  21. A family member or a household contact who is an employee of the research center or otherwise involved with the conduct of the study
  22. Any condition that, in the opinion of the investigator, might interfere with investigational product evaluation

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Förebyggande
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Fyrdubbla

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: Cohort 1 MEDI-560
MEDI-560 vaccine was a frozen preparation of live, attenuated rHPIV3cp45 virus filled into Becton Dickinson^TM Luer slip tip syringes. Each 0.2 mL dose contained 10^5 TCID50 of MEDI-560 in a sucrose phosphate glutamate buffer.
MEDI-560 vaccine was a frozen preparation of live, attenuated rHPIV3cp45 virus filled into Becton Dickinson^TM luer slip tip syringes. Each 0.2 mL dose contained 10^5 TCID50 of MEDI-560 in a sucrose phosphate glutamate buffer.
Placebo-jämförare: Cohort 1 Placebo
Placebo was a frozen preparation filled into Becton Dickinson^TM Luer slip-tip syringes. Each 0.2 mL dose contained sucrose phosphate buffer.
Placebo was a frozen preparation filled into Becton Dickinson^TM luer slip-tip syringes. Each 0.2 mL dose contained sucrose phosphate buffer.

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Number of Participants With Solicited Adverse Events (SEs) After Dose 1
Tidsram: Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With SEs After Dose 2
Tidsram: Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With SEs After Dose 3
Tidsram: Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Adverse Events (AEs) After Dose 1
Tidsram: Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Unsolicited AEs reported by 1 or more participants in either treatment group through 28 days post Dose 1.
Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With AEs After Dose 2
Tidsram: Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Unsolicited AEs reported by 1 or more participants in either treatment group through 28 days post Dose 2.
Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With AEs After Dose 3
Tidsram: Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Unsolicited AEs reported by 1 or more participants in either treatment group through 28 days post Dose 3.
Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Medically Attended Lower Respiratory Illnesses (MA-LRIs) After Dose 1
Tidsram: Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With MA-LRIs After Dose 2
Tidsram: Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With MA-LRIs After Dose 3
Tidsram: Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Serious Adverse Events (SAEs) After Dose 1
Tidsram: Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Days 0-28 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With SAEs After Dose 2
Tidsram: Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
One participant had event of pneumonia after Dose 2.
Days 0-28 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With SAEs After Dose 3
Tidsram: Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Days 0-28 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Significant New Medical Conditions (SNMCs)
Tidsram: Day 0 through 180 days after final dose
A SNMC is a newly diagnosed medical condition that is of a chronic, ongoing nature and is assessed by the investigator as medically significant.
Day 0 through 180 days after final dose

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Number of Participants Shedding Vaccine-like Virus at Any Time During Study Participation
Tidsram: Days 7, 12, and 28 after each dose and during visits for pre-specified illness symptoms occurring Day 0 through 180 days post final dose.
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 7, 12, and 28 after each dose and during visits for pre-specified illness symptoms occurring Day 0 through 180 days post final dose.
Number of Participants Shedding Vaccine-like Virus at 7 Days After Dose 1
Tidsram: Days 7-10 after Dose 1 (Dose 1 was on Day 0)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 7-10 after Dose 1 (Dose 1 was on Day 0)
Number of Participants Shedding Vaccine-like Virus at 12 Days After Dose 1
Tidsram: Days 12-18 after Dose 1 (Dose 1 was on Day 0)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 12-18 after Dose 1 (Dose 1 was on Day 0)
Number of Participants Shedding Vaccine-like Virus at 28 Days After Dose 1
Tidsram: Days 28-34 after Dose 1 (Dose 1 was on Day 0)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 28-34 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With Shedding of Vaccine-like Virus on Any Day During Days 0-28 After Dose 1
Tidsram: Days 0-34 after Dose 1 (Dose 1 was on Day 0)
Days 0-34 after Dose 1 (Dose 1 was on Day 0)
Number of Participants Shedding Vaccine-like Virus at 7 Days After Dose 2
Tidsram: Days 7-10 after Dose 2 (Dose 2 was on Day 48-64)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 7-10 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants Shedding Vaccine-like Virus at 12 Days After Dose 2
Tidsram: Days 12-18 after Dose 2 (Dose 2 was on Day 48-64)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 12-18 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants Shedding Vaccine-like Virus at 28 Days After Dose 2
Tidsram: Days 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With Shedding of Vaccine-like Virus on Any Day During Days 0-28 After Dose 2
Tidsram: Days 0-34 after Dose 2 (Dose 2 was on Day 48-64)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 0-34 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants Shedding Vaccine-like Virus at 7 Days After Dose 3
Tidsram: Days 7-10 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 7-10 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants Shedding Vaccine-like Virus at 12 Days After Dose 3
Tidsram: Days 12-18 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 12-18 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants Shedding Vaccine-like Virus at 28 Days After Dose 3
Tidsram: Days 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Shedding of Vaccine-like Virus on Any Day During Days 0-28 After Dose 3.
Tidsram: Days 0-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of participants with nasal wash specimens that were culture positive for HPIV3 in which vaccine-like virus was identified.
Days 0-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Participants With Hemagglutination Inhibition (HAI) Seroconversion/Seroresponse to HPIV3 28 Days After Dose 1
Tidsram: Days 28-34 after Dose 1 (Dose 1 was on Day 0)
Hemagglutination inhibition seroconversion/seroresponse is equal to or greater than a 4-fold rise in HAI antibody titer from baseline. Hemagglutination inhibition antibody results obtained on or after detection of wild-type HPIV3 in culture were not considered valid.
Days 28-34 after Dose 1 (Dose 1 was on Day 0)
Number of Participants With HAI Seroconversion/Seroresponse to HPIV3 28 Days After Dose 2
Tidsram: Days 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Hemagglutination inhibition seroconversion/seroresponse is equal to or greater than a 4-fold rise in HAI antibody titer from baseline. Hemagglutination inhibition antibody results obtained on or after detection of wild-type HPIV3 in culture were not considered valid.
Days 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Number of Participants With HAI Seroconversion/Seroresponse to HPIV3 28 Days After Dose 3
Tidsram: Days 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Hemagglutination inhibition seroconversion/seroresponse is equal to or greater than a 4-fold rise in HAI antibody titer from baseline. Hemagglutination inhibition antibody results obtained on or after detection of wild-type HPIV3 in culture were not considered valid.
Days 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Number of Nasal Wash Samples Containing Vaccine-like Virus in the Absence of Admixture With Wild-type HPIV3 in Which the Vaccine-like Virus Was Genotypically Stable
Tidsram: Day 0 after Dose 1 to 180 days after the final dose
A nasal wash specimen was collected at screening and on Days 7 (7-10), 12 (12-18), and 28 (28-34) post each dose and during visits for pre-specified illness symptoms occurring Day 0 through 180 days post final dose to assess vaccine virus replication. Genotypic stability of recovered vaccine-type virus at the 15 mutations of phenotypic importance was assessed.
Day 0 after Dose 1 to 180 days after the final dose
Number of Nasal Wash Samples Containing Vaccine-like Virus in the Absence of Admixture With Wild-type HPIV3 in Which the Vaccine-like Virus Was Phenotypically Stable
Tidsram: Day 0 after Dose 1 to 180 days after the final dose
A nasal wash specimen was collected at screening and on Days 7 (7-10), 12 (12-18), and 28 (28-34) post each dose and during visits for pre-specified illness symptoms occurring Day 0 through 180 days post final dose to assess vaccine virus replication. Determination of the temperature sensitivity of recovered vaccine-type virus.
Day 0 after Dose 1 to 180 days after the final dose
Geometric Mean Titers (GMTs) of Serum HAI Antibodies to HPIV3 at Baseline
Tidsram: Baseline (Day 0 prior to Dose 1)
Pre-dose GMT of HAI antibody to HPIV3
Baseline (Day 0 prior to Dose 1)
Geometric Mean Titers of Serum Antibodies to HPIV3 Day 28 Post Dose 1
Tidsram: Day 28-34 after Dose 1 (Dose 1 was on Day 0)
Post-Dose 1 GMT of HAI antibody to HPIV3
Day 28-34 after Dose 1 (Dose 1 was on Day 0)
Geometric Mean Titers of Serum Antibodies to HPIV3 Day 28 Post Dose 2
Tidsram: Day 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Post-Dose 2 GMT of HAI antibody to HPIV3
Day 28-34 after Dose 2 (Dose 2 was on Day 48-64)
Geometric Mean Titers of Serum Antibodies to HPIV3 Day 28 Post Dose 3
Tidsram: Day 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)
Post-Dose 3 GMT of HAI antibody to HPIV3
Day 28-34 after Dose 3 (Dose 3 was 48-64 days after Dose 2)

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Utredare

  • Studierektor: Judith Falloon, MD, MedImmune LLC

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 oktober 2007

Primärt slutförande (Faktisk)

1 april 2009

Avslutad studie (Faktisk)

1 april 2009

Studieregistreringsdatum

Först inskickad

27 juli 2007

Först inskickad som uppfyllde QC-kriterierna

27 juli 2007

Första postat (Uppskatta)

30 juli 2007

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

30 december 2011

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

28 november 2011

Senast verifierad

1 november 2011

Mer information

Termer relaterade till denna studie

Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .

Kliniska prövningar på Friska

Kliniska prövningar på MEDI-560

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