Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany.
CureVac AG, Tübingen, Germany.
Lancet. 2017 Sep 23;390(10101):1511-1520. doi: 10.1016/S0140-6736(17)31665-3. Epub 2017 Jul 25.
BACKGROUND: Vaccines based on mRNA coding for antigens have been shown to be safe and immunogenic in preclinical models. We aimed to report results of the first-in-human proof-of-concept clinical trial in healthy adults of a prophylactic mRNA-based vaccine encoding rabies virus glycoprotein (CV7201). METHODS: We did an open-label, uncontrolled, prospective, phase 1 clinical trial at one centre in Munich, Germany. Healthy male and female volunteers (aged 18-40 years) with no history of rabies vaccination were sequentially enrolled. They received three doses of CV7201 intradermally or intramuscularly by needle-syringe or one of three needle-free devices. Escalating doses were given to subsequent cohorts, and one cohort received a booster dose after 1 year. The primary endpoint was safety and tolerability. The secondary endpoint was to determine the lowest dose of CV7201 to elicit rabies virus neutralising titres equal to or greater than the WHO-specified protective antibody titre of 0·5 IU/mL. The study is continuing for long-term safety and immunogenicity follow-up. This trial is registered with ClinicalTrials.gov, number NCT02241135. FINDINGS: Between Oct 21, 2013, and Jan 11, 2016, we enrolled and vaccinated 101 participants with 306 doses of mRNA (80-640 μg) by needle-syringe (18 intradermally and 24 intramuscularly) or needle-free devices (46 intradermally and 13 intramuscularly). In the 7 days post vaccination, 60 (94%) of 64 intradermally vaccinated participants and 36 (97%) of 37 intramuscularly vaccinated participants reported solicited injection site reactions, and 50 (78%) of 64 intradermally vaccinated participants and 29 (78%) of 37 intramuscularly vaccinated participants reported solicited systemic adverse events, including ten grade 3 events. One unexpected, possibly related, serious adverse reaction that occurred 7 days after a 640 μg intramuscular dose resolved without sequelae. mRNA vaccination by needle-free intradermal or intramuscular device injection induced virus neutralising antibody titres of 0·5 IU/mL or more across dose levels and schedules in 32 (71%) of 45 participants given 80 μg or 160 μg CV7201 doses intradermally and six (46%) of 13 participants given 200 μg or 400 μg CV7201 doses intramuscularly. 1 year later, eight (57%) of 14 participants boosted with an 80 μg needle-free intradermal dose of CV7201 achieved titres of 0·5 IU/mL or more. Conversely, intradermal or intramuscular needle-syringe injection was ineffective, with only one participant (who received 320 μg intradermally) showing a detectable immune response. INTERPRETATION: This first-ever demonstration in human beings shows that a prophylactic mRNA-based candidate vaccine can induce boostable functional antibodies against a viral antigen when administered with a needle-free device, although not when injected by a needle-syringe. The vaccine was generally safe with a reasonable tolerability profile. FUNDING: CureVac AG.
背景:基于编码抗原的 mRNA 的疫苗已在临床前模型中显示出安全且具有免疫原性。我们旨在报告在德国慕尼黑的一个中心对健康成年人进行的首例预防用基于 mRNA 的狂犬病病毒糖蛋白(CV7201)疫苗的首次人体概念验证临床试验的结果。
方法:我们在德国慕尼黑的一个中心进行了一项开放性、非对照、前瞻性、1 期临床试验。没有狂犬病疫苗接种史的健康男性和女性志愿者(年龄 18-40 岁)按顺序入组。他们通过针筒或三种无针装置中的一种皮内或肌内接受三剂 CV7201 接种。随后的队列接受递增剂量,一年后给一组接受加强剂量。主要终点是安全性和耐受性。次要终点是确定引发狂犬病病毒中和抗体滴度等于或大于世界卫生组织规定的 0.5 IU/ml 的保护抗体滴度的最低 CV7201 剂量。该研究正在继续进行长期安全性和免疫原性随访。该试验在 ClinicalTrials.gov 上注册,编号为 NCT02241135。
结果:在 2013 年 10 月 21 日至 2016 年 1 月 11 日期间,我们入组并接种了 101 名参与者,共接种了 306 剂 mRNA(80-640 μg),采用针筒(18 剂皮内和 24 剂肌内)或无针装置(46 剂皮内和 13 剂肌内)。在接种疫苗后的 7 天内,64 名皮内接种者中的 60 名(94%)和 37 名肌内接种者中的 36 名(97%)报告了注射部位的局部反应,64 名皮内接种者中的 50 名(78%)和 37 名肌内接种者中的 29 名(78%)报告了全身性的不良事件,包括 10 例 3 级事件。1 例 640μg 肌内剂量后 7 天发生的 1 例意外、可能相关的严重不良事件,无需进一步治疗即可缓解。通过无针皮内或肌内装置注射 80μg 或 160μg CV7201 剂量的 45 名参与者中的 32 名(71%)和 200μg 或 400μg CV7201 剂量的肌内接种的 13 名参与者中的 6 名(46%),在所有剂量水平和方案中均可诱导产生 0.5 IU/ml 或更高的病毒中和抗体滴度。1 年后,14 名接受 80μg 无针皮内剂量加强接种的参与者中有 8 名(57%)产生了 0.5 IU/ml 或更高的抗体滴度。相反,皮内或肌内针筒注射无效,只有一名参与者(接受 320μg 皮内注射)显示出可检测的免疫反应。
结论:这是首次在人类中进行的演示,表明当使用无针装置给药时,一种预防性的基于 mRNA 的候选疫苗可以诱导针对病毒抗原的可增强的功能性抗体,尽管当通过针筒注射时不行。该疫苗总体上具有良好的安全性和可接受的耐受性。
资金来源:CureVac AG。
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